Date: 1994-08-19
Speaker: PATSY MINK (democrat)
Chamber: H

who serves the Second District. as you know. Mr. Speaker. I serve urban Honolulu. the Honolulu that maybe many people are familiar with. with the outline of Diamond Head against a beautiful blue sky and Waikiki and Its beautiful beaches. and all of which I am privileged to represent and invite everybody to and hope you will come out and help improve our economy so we can keep our health care Insurance premiums low. We would be delighted to have you come out. We will take care of you. by the way. if you get sick while you are out there. You are familiar with that. The friendly skies will take you there to Hawaii. Mrs. MINK has the rest of Oahu. on which Honolulu is located. and all the other islands. In other -words. when her plane lands from the friendly skies in Honolulu. at Honolulu International Airport. she has to get on a plane again and fly to Kaui. Molokai. Niihau. the big island of Hawaii. fly to both sides of the island of Hawaii. to the Kona or Hilo side. When she is there. she has to drive 1. 2. or 3. hours to Hana on Maui. We invite you there. too. It is a small quiet community if you want to get away from It all. We have universal health care coverage in Hana. It will take 2 to 3 hours to drive there. So naturally we have some difficulties in actually putting the providers. the physical capacity to provide the health care that we have on paper. that is to say -what the law requires in terms of coverage. every one has that. But actually physically providing it is difficult. It is costly. And yet with all of these cost factors which drive our figures up. we still are below the costs associated with the rest of the United States. Mr. Speaker. I have enjoyed this discussion with you and those who are observingand listening today so much. I know my good friend Mr. DORNAN has some things he wants to share with us. I am going to let him know that I will not be taking the full 25 minutes I am anxious to hear what he has to say. In fact. I cannot cover all the material in this particular segment. but I will come back. I am sure that people want to know. now that the issue has been raised. that we do. in fact. have universal health care coverage in Hawaii. We are not saying and never have said. by the way. Mr. Speaker. as you well know. that we seek merely to duplicate the Hawaii system in the rest of the country. Mrs. MINK and myself have never said that. We have never indicated that. I think that our law. as I said was 20 years old. it has been very effective. I would think it forms a good foundation. We think that it offers an opportunity for objective people. for people of good will and good faith to take a look at what we do and how we do it and how we have modified. how we have modified it and what we would like to see changed. Certainly. we see that. But we do believe that there has to be more than a coincidence Involved. When our little State in the middle of the Pacific. just two Representatives here in this vast body. 435 people. suddenly is zeroed in on as somehow misrepresenting what it is that takes place in our State or somehow trying to foist off on the rest of the Nation that which we do. on the contrary. What we have said. and in fact I note that there are some Members in the Senate now. am I allowed to mention the Senate. by the way. during special orders or do I have to say the other body. I do not mean any disrespect. I understand there is some concern in the Senate that has been expressed at least by newspaper reports. although I wish some of these folks would actually get in touch with us and speak to us personally about it. about Hawaii possibly having a waiver in whatever results in health care. Well. it is of no concern to me. Mr. Speaker. at all. If Members of the House of Representatives in the U.S. Senate want to pass a health care bill that provides for health care less than that which is already In effect in the State of Hawaii. I would presume that no one would object if Mrs. MINK and myself and our good Senators across the way. Mr. INOUYE and Mr. AKAKA would like to have the people of Hawaii not have health care coverage taken away from them. It only makes sense. I am not worried about waivers or changes. We have one of those already. We have a waiver that we have been given. Of course. the reason was we are the only one that has the national health care plan. The waiver we have is from the Employment Retirement Income Security Act of 1974. commonly known as ERISA. If I use that acronym. what it means is the Employee Retirement Income Security Act. That is a Federal law. And we have limited exemption from it. Why? The ERISA. the Employee Retirement Security Act. preempts State authority in terms of regulating self insured employer health plans. It preempts our State authority. Inasmuch as we already passed a universal health care bill before the enactment of the ERISA. we wanted to make certain that our act. our ability to take care of our people was not impaired. So we have a limited exemption. In fact. our exemption is so limited it is virtually impossible for us to amend our act. Believe me. Mr. Speaker. we would be delighted in the State of Hawaii to amend the prepaid health care plan that was written 20 years ago in some administrative ways that we think would advance the case. the kinds of things that are xnow being proposed in the national health care bill in 1994. but we are disenabled from doing that because of the restrictions about preemption on the Federal level. So we find ourselves. then. in a situation where we are able to provide health. care insurance at a lower rate than anybody else in the rest of the Nation. despite disquisitions here on the floor of the House and pronouncements on the floor of the House to the contrary. I do not know where all these statistics come from. I can tell you what the statistics actually are. I have the Hawaii Medical Service Associations statistics here. I have the Kaiser Permanente Health Maintenance Organization plans here. prices here that we pay in Hawaii. I have all of it. I want .to. indicate oneother thing that comes up with respectto the. I -will not say false but misleading. the misleading. statement that . our employerbased mandate for. insurance somehow. is supposed to provide total coverage. For those who are lowincome residents. the gap group that were not covered by our insurance plan -were not otherwise eligible for Medicaid. we had what was called the State health insurance plan. which we put into effect. Enrollment is voluntary. you cannot force everybody into it. So I. think that for my purposes today. Mr. Speaker. I would like to wind down my remarks and allow Mr. DORNAN to launch into his remarks for the. day by repeating. then. an obvious point to us that. and this is highlighted in the General Accounting Office report. Hawaii has the highest rate of coverage but not universal care. I will repeat what is in the report: Hawaii has the highest rate of coverage of any State. does not have universal coverage. This widespread coverage is the result of States employer mandate. the Medicaid Program. and SHIP. the State health insurance plan coverage for the gap group. Estimates of Hawaiis uninsured rate range from 3.75 percent in 1991. survey to a 7percent determined by data from the current population survey. In other words. that is done strictly by statistics. So you can come up. anybody can come up with something that says. it is 3 percent. somebody else says it is 7 percent. but with our -new program. which we have put into effect called the Healthquest Program. We came up to the Congress. We came up to the new administration and we said. look. we are quite aware of the fact that because we have not been able to amend our law the way we want to as a result of Federal preemption. that we do not cover 100 percent of our people the way we want to. We want to make more certain of that. So this year we were able to get another small waiver enabling us to put together what is called health quest. and improvement on the State health insurance plan known as SHIP. We have the Health Quest Program. That is going to be fully in place. as I said. by September 9 of this year. The Health Quest Program. Mr. Speaker. I Want to indicate to you. is again not a governmentprogram in the sense that it has been portrayed here on the floor of the House. It is again selfadministering. It was competed for. We have five different groups. I have heard down here on the floor our Hawaiian Medical Services Association. and I suppose even Kaiser. I do not know if lambasting is exactly the Word. but let me put it this way: The implication of the discussion on the floor was that somehow the choice of our people was limited: as a -result of these two providers having the major share ofemployees and others in the State of Hawaii. Mr. Speaker. they have competed for 20 years. They have a major share because they have provided good service. I am astounded by people who tout the private ca~re system. the privatesector system. who then complain when it works. Mr. Speaker. are those* of us who are satisfiedI have been a member of the Kaiser system. the Kaiser Health Maintenance Organization. for 35 years. 35 years. The reason that I have been associated with them for 35 years is that I am satisfied with the service that I get. Does it sound strange. then. that I would continue to be a member? I have good friends who are members of the Hawaii Medical Services Association. the HMSA. and they have been there for 35 years. Why? Because they are satisfied with it. I happened to start with Kaiser. I suppose I could have picked the HMSA at the time. I was a student at the University of Hawaii at* the time. That is the way we got started. I could have changed. There are other plans out there now. .There are three or four other plans that are available to us in Hawaii. all competitive with one another. I am not compelled to stay with any one system. I can change. Every year. I want to point out. every year those who are not satisfied with- their health plan can change the plan that is provided. We are not stuck. We have nobody there that makes us stay there. As a matter of fact. Mr. Speaker. I have indicated that our plan is selfadministering. The other gentlewoman from Hawaii has told me she believes there are two clerks in the Department of Labor and Industrial Relations that monitor the health care plan system in Hawaii. I am not certain and she is not certain. She believes there are two clerks. -Two clerks for 20 years is not bad. We are not sure where they actually are. but if we find them I will bring them in. their names and where their desks are in the State. I am not sure where they are. I will have to look real hard. That is the sum total of the bureaucracy associated With our health plan. It is all selfadministered. After all. does anybody think that the health providers are going to let a member disappear and not pay? Of course they are not. It is in their interest to do it. That is why it is selfadministered. Mr. Speaker. I want to conclude by saying that we have taken care not only of those who are employed. but we have taken care of the gap group. we have taken care of those on Medicaid. we have taken care of everybody to provide what for all intents and purposes is 100 percent coverage. I will go into the costs of that coverage in inother special order. I will be happy to discuss Hawaiis health care system with any of the opposition to national health care reform. I willfbe happy to share with them what bur experiences have been. and hopefully convince them that if they keep an open .mind. if they are willing to discuss it In good faith and with a modicum of good will. that perhaps we can arrive at a proposal and a plan that will allow all of us here. regardless of our party affiliations. to act on a nonideological basis on behalf of the interests of all the people of the United States.