Aloha! This our group testimony opposing Senate Bill 977 which Abolishes the Hawaii Health Authority. Please go on www.capitol.hawaii.gov and submit your own testimony in opposition to SB977, so that we can keep the possibility of Universal Health Care alive. The deadline to submit testimony is tomorrow morning by 8:30 am. COMMUNITY COALITION FOR HAWAII UNIVERSAL HEALTHCARE THROUGH COMPREHENSIVE PLANNING February 7, 2017 To: The Honorable Rosalyn H. Baker, Chair The Honorable Clarence K. Nishihara, Vice Chair, and Members of the Committee on Commerce, Consumer Protection, and Health The Honorable Gilbert S.C. Keith-Agaran, Chair The Honorable Karl Rhoads, Vice Chair, and Members of the Committee on Judiciary and Labor Re: SB 977 – Abolition of the Hawaii Health Authority Position: Strong Opposition Hearing: Friday, February 8, 2017, 8:30 a.m. Conference Room 016 Dear Chair Baker, Chair Keith-Agaran, and Members of the Committees: Hawaii’s Healthcare is in Crisis – Threatened from Two Major Directions Hawaii’s healthcare is threatened both by the way the ACA has evolved, and by what the Trump administration and the Republican Congress are threatening to do to it. BOTH of these factors pose existential threats to Hawaii’s healthcare systems. The Hawaii Health Authority (HHA) is an extremely important bulwark in responding to this crisis. To abolish the HHA at this juncture is exactly the wrong response to this crisis. The First Part of America’s healthcare crisis already exists because of the way the Affordable Care Act (ACA) has evolved. Hawaii is ALREADY facing a healthcare CRISIS for everyone – consumers, doctors, and employers: ● Right now, a recent Hawaii survey shows that 47% of doctors in private practice in HAWAII are already turning away new Medicare and new Medicaid patients, because of unreasonably burdensome reporting requirements and preauthorization requirements, and because of low rates of compensation. See https://crowncarehi.wordpress.com/2016/10/ 23/finding-a-primary-care-doctor-on-oahu/. ● 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. 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. See http://annals.org/aim/article/2546704/allocation-physician-time-ambulatory-practice-time-motion-study-4-specialties. ● Businesses are struggling to afford health insurance premiums. Many people are forced into medical bankruptcy due to high out-of-pocket expenses for serious illnesses. Healthcare is one of those industries where competition does NOT promote efficiencies and financial savings. The opposite is true: Physicians, hospitals, and other medical providers must deal with the different coding systems, pharmaceutical formularies, pre-authorization requirements, and other differing documentation and authorization demands of different insurers. It’s almost like needing to have multilingual translators on staff to deal with the myriad requirements of the different insurers. As noted, doctors are leaving the practice in frustration at the huge added costs and demands on their time that add nothing meaningful for their patients. The Second Part of America’s healthcare crisis is still on the horizon. We don’t yet know what it really will be: We don’t yet know when this tsunami will hit Hawaii and what precise form it will take. It is the constellation of threats emanating from the Trump administration and the Republican-controlled Congress. These threats are not yet clearly in focus, but the outlines are not pretty. They appear to include the following This new crisis includes (1) the threat to abolish ACA-Obamacare, at least in part. At a date that may be imminent, and may be sometime later. Unless Hawaii can enact timely effective defensive legislation, this threat would reinstate such seemingly bygone life-threatening issues as denials of insurance coverage because of pre-existing conditions. It is (2) the vague threat to curtail Medicare benefits in as yet unclarified ways. This would severely affect Hawaii’s seniors, both those who are State Government retirees and those who are not. It is (3) the rather less vague threat to severely curtail, if not completely abolish Medicaid benefits. Some 350,000 Hawaii residents currently rely on Medicaid for healthcare. They will definitely be in actual, immediate crisis if Medicare is severely curtailed, and that is the current threat, when Congress and the Trump administration speak of “block grants” – which is code for radical cuts in funding. Who We Are We are an unpaid group of Hawaii residents who recognize the crisis in healthcare in Hawaii and how that crisis is being made much worse by what's happening in Washington. We represent literally thousands of very politically active Hawaii residents, mostly active Democrats, who are anxiously expecting major progress in healthcare legislation this year. Why Abolishing the HHA at This Time is Exactly the WRONG THING TO DO. SB 977 is an Administration bill to abolish the Hawaii Health Authority (HHA). The administration contends that all necessary healthcare planning can be accomplished by two other existing State agencies, the State Health Planning and Development Agency (SHPDA), located at the Department of Health, and the Health Care Innovation Office (HCIO), in the Governor's office. However, neither of these agencies is designed to perform the comprehensive healthcare planning that HHA was designed to do and that is now urgently needed. The Administration bill would not even mandate planning at all! SHPDA is an inappropriate agency for overall healthcare planning: It is responsible for certifying when and where new physical facilities such as hospitals, MRI facilities, dialysis centers, etc., to prevent the proliferation of unneeded facilities. SHPDA has a skeleton staff and lacks both the expertise and staff to plan for a system of healthcare delivery Similarly, HCIO is inappropriate. HCIO is a carry-over from former Governor Abercrombie’s “Health Transformation Initiative," later renamed "The Hawaii Health Project." It was originally funded by the health insurance companies and was focused on implementing the Affordable Care Act (ACA). HCIO has been focused on implementing the very policies of ACA and MACRA that are causing physician dissatisfaction and burnout. HCIO has neither the staffing, nor the independence to develop the plans that we need to establish universal care. Indeed, HCIO’s payment structures, policies, and procedures are a very big part of the current crisis that is driving Hawaii’s medical professionals out of business! We are reminded of the first precept of the Hippocratic Oath, the oath that legend tells us has been taken by new physicians since the times of the Ancient Greeks: first, do no harm. When we are facing urgent crises both at the present time because of private insurer competition that is driving insurance rates 30% over where they should be and simultaneously causing physicians to refuse Medicare and Medicaid patients, plus the unknown threats from Washington, to abolish the Hawaii Health Authority in the face of these crises is – frankly – the height of folly. We emphatically need the HHA to design 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 HHA was designed by the Legislature to create exactly the type of plan that would end those problems. Lowering the cost of healthcare will save money for everyone. Simplifying and guaranteeing access to healthcare for all Hawaii residents will increase the quality of our lives. And nothing prevents the Legislature from tasking the HHA with broader requests to study alternatives. It’s been something of a “lifetime” since 2009 – pre-Obamacare to now, the Era of Donald Trump. We must not close the collective eyes and cover the ears of the people of Hawaii to what has been happening. We need healthcare planning in the public interest, by an agency whose sole role is planning and policy-making, and does not have conflicts of interest. That agency is the Hawaii Health Authority . For these many reasons, we urge your Committees to kill SB 977, which would abolish the Hawaii Health Authority. Hawaii must move toward a universal healthcare system. Preferably, we urge the Committees to amend SB 977 to incorporate the provisions of SB 1269, which would revitalize HHA, give it some modest funding, and task it with the duty to develop the essential healthcare planning that Hawaii desperately needs during this crisis. Thus, despite our respect for the Governor and the Department of Health, we believe that HHA is the only agency to fill this critical role. We will be very happy to meet with any and all Legislators who wish to discuss this very serious and urgent matter. We are available to provide whatever additional relevant information we can. Thank you very much again for your kind attention to this situation. Very truly yours, Alan B. Burdick Stephen Kemble, MD Leslie Hartley Gise, MD Bart Dame Dennis B. Miller Erynn Fernandez Daria Fand Karen Cobeen Please reply c/o Alan B. Burdick, burdick808@gmail.com, 486-1018 Facebook: Healthcare For All Hawaii