Hawaii: Transitioning and moving beyond ACA

In 2009, the Hawaii Legislature enacted a law to create the Hawaii Health Authority, a board charged with overall health planning for the state and with developing a comprehensive health system covering everyone in Hawaii. The HHA submitted a report to the Governor and Legislature in December 2011 that includes a summary of Hawaii's Medicaid managed care problems, eight “Principles for Cost-Effective, Sustainable Health Care Reform,” a strategic plan to steer Hawaii from the present situation to a universal single-payer system, including transitional use of features of the Affordable Care Act such as a Health Insurance Exchange and use of Hawaii's Medicaid waiver, and a summary of the cost implications of a fully implemented universal system. The next task for the HHA is to develop specific legislation for implementation of this plan. Hawaii's Governor also established a “Health Transformation Initiative” to bring various stakeholders together, and the HHA report is being used as a guiding vision for this process. I will be discussing the obstacles being confronted as this process unfolds and the advantages of starting with a high-level administrative structure with a guiding vision and principles before development of specific legislative language.