January 25, 2017 "A Message to Supporters of Hawaii Universal Healthcare: First, we who have been working on this issue for the past month want to THANK ALL OF YOU for your PATIENCE and UNDERSTANDING as you wait for word from us on what’s been happening. Now that the Legislature has opened, we have a lot of news for you. ​We have two bills, one in the Senate, SB 1269, courtesy of Sen. Russell Ruderman, and one in the House, HB129, courtesy of Vice Speaker John Mizuno. These bills would revitalize the Hawaii Health Authority, give it an appropriation, and direct it to prepare a comprehensive plan for universal State-based health care for Hawaii. The HHA would report to the Legislature with a plan in December. However, the actual adoption of such a plan by the Legislature in 2018 or later, and the administrative implementation of the plan – including coordination with federal medical care plans such as Medicare, Medicaid, CHIP, and others, can take a very long time. ​The Hawaii Health Authority was established 7 years ago under the Department of Budget and Finance to be a semi-independent agency that would give advice on healthcare policy free of influences. ​We wrote to the Governor, asking for his support for our bills. We like to think our letter got to him after his staff sent to the Legislature two bills, HB 1111 and SB 977, that would just kill HHA, and supposedly transfer health planning duties to two existing agencies under the Department of Health, the State Health Planning and Development Agency (SHPDA) and the Health Care Innovation Office" (HCIO), which is located in the Governor's office. But neither of these agencies is designed to perform the comprehensive healthcare planning that HHA was designed to do and that is now urgently needed. SHPDA is responsible for certifying when and where new facilities such as hospitals, MRI facilities, dialysis centers, etc. are needed according to public health needs. The HCIO was originally funded by the health insurance companies and was focused on implementing the Affordable Care Act (ACA), which is now being dismantled by the Trump administration. Regrettably, the ACA, combined with the Medicare Access and CHIP Reauthorization Act (MACRA), are the primary source of the very onerous documentation, reporting, and prior approval requirements that are having destructive and costly effects on healthcare delivery in Hawaii today. The HCIO has been entirely focused on implementing these very policies. As a result, doctors’ overhead costs have increased by over $40,000 per doctor per year, and they must now spend twice as much time paying attention to their computers as to their patients. We are 20% short of doctors and losing more every year; a majority of our doctors are “burned out” and want to leave practice; and already 47% of primary care doctors in Hawaii are refusing new Medicare patients, with even more refusing new Medicaid. This is a CRISIS! These payment structures, policies, and procedures are what desperately need to be reformed, with the goals of improving quality of care and population health, and reducing cost. However, the policies that have come out of the HCIO are having the opposite effects of these intended goals. We emphatically need the HHA and a new model for healthcare reform focused on administrative simplification, reduced healthcare overhead, and lowering healthcare prices, not misguided attempts to incentivize reduced utilization of health services via imposing more and more administrative burdens – which is what is happening now. The bottom line is that the "federal policy changes, new business models, and new technologies,” which the administration bills refer to, are having increasingly destructive effects on doctors, hospitals, and patient access to care and are driving costs up, not down, perhaps more so in Hawaii due to the relative cost-effectiveness of our previous model compared to the rest of the country. These current policies and business models urgently need to be reassessed. Failure to do so will leave the administration and legislature with an escalating crisis due to the unraveling of our health care delivery system. Proper planning will take time, and we need to get in front of these problems to minimize avoidable damage. Otherwise we will be attempting to repair a broken system in the absence of any effective solutions. So, right now, we are asking for a meeting with the Governor, or high-level staff, to get him to see things our way – and YOUR WAY! We have reminded him that we are a core group representing literally thousands of very politically active and aware Hawaii residents, mostly active Democrats, who are very anxiously expecting major progress in health care legislation this year. Our proposal to revitalize the HHA has been endorsed by the leadership of the Democratic Party of Hawaii as a priority for this year’s session of the State Legislature, and this initiative enjoys the strong support of the Democratic Party’s Kupuna Caucus and other progressive organizations in Hawaii. ​You should also be aware of at least one other bill on the horizon, a Single Payer bill, SB 1199, sponsored by Senators Glenn Wakai, Stanley Chang, Will Espero, Gil Keith-Agaran, Karl Rhoads, Donovan Dela Cruz, Brickwood Galuteria, Les Ihara, Lorraine Inouye, and Michelle Kidani. ​WHAT CAN YOU DO NOW? Please stand by for a little while longer. Sometime very soon, we will be asking you to contact your Legislators to get the bills heard to revitalize the HHA, or to take similar action. As you can see, things can go either way right now. Let’s all continue to stand by for just a little while longer so that, when we do speak up, we speak in a strong, unified voice! ​We thank you all again very, very much for your patience. We’re doing as well as can be expected at this point. With you, we expect to have a very favorable outcome. We’ll all stay in touch. Please send messages to us via the Healthcare for All Hawaii Facebook page, or to one of us via email." ​​​​​Best wishes, Alan B. Burdick (Primary author) Stephen Kemble, MD ​Leslie Hartley Gise, MD​​ Bart Dame ​Dennis B. Miller​​​ Erynn Fernandez ​Daria Fand​​​​ Karen Cobeen