Aloha! Please testify asap on HB100, and ask for a 'line item to be inserted into the state budget to fund HRS322, The Hawaii Health Authority. On line testimony can be submitted via www.capitol.hawaii.gov There are simple instructions, such as, you must include the bill number, committee name, room number, and date in your testimony, as well as your own name. It is advisable to include your general district in the body of the testimony. The hearing for HB100, the budget bill, is scheduled for March 29 at 9:30 am, in the Ways and Means Committee, conference room 211. Showing in person to testify is ideal, but, for this bill, hundreds of people will be there, and only a small portion will fit in the room, so, show up early and aim for those front row seats! COMMUNITY COALITION FOR HAWAII UNIVERSAL HEALTHCARE THROUGH COMPREHENSIVE PLANNING March 10, 2017 To: All Members of the Hawaii State Legislature Re: HB 100 – State Budget Please add $250,000 line item to Department of Budget & Finance For the Hawaii Health Authority, an attached agency Hawaii is facing a healthcare crisis. It is internally generated and it’s going to get far worse when the Congress amends or repeals the ACA. What will Hawaii do when, not if but when, Congress wipes out Medicaid, which currently insures 360,000 Hawaii residents? That’s one out of every four people in Hawaii. Right now, the Hawaii Health Authority (HHA) is the ONLY HAWAII STATE AGENCY that has statutory responsibility to plan for Hawaii’s healthcare needs in this rapidly-changing political environment. But it needs the tools to do its job. That’s why we strongly urge you to add to the Governor’s budget a line item for $250,000 for the Hawaii Health Authority (HHA), to help it fulfill its critical mandate to develop a comprehensive State-based plan for a healthcare system for Hawaii. The HHA was established in 2009. This Legislature wisely attached the HHA to the Department of Budget & Finance precisely to protect it from bureaucratic pressures from the Department of Health. The HHA is a small, independent policy-planning board to be composed of 9 volunteer members with diverse expertise in medicine and related fields. This authorization would allow the HHA to hire a full-time Executive Director at up to $80,000, and to spend additional funds on research, consulting, and other costs to prepare the comprehensive health plan mandated by HRS 322H-2(b), that includes: (1) Establishment of eligibility for inclusion in a health plan for all individuals; (2) Determination of all reimbursable services to be paid by the authority; (3) Determination of all approved providers of services in a health plan for all individuals; (4) Evaluation of health care and cost effectiveness of all aspects of a health plan for all individuals; and (5) Establishment of a budget for a health plan for all individuals in the State. This is a huge task, and $250,000 would be a bargain amount to get this done. The HHA’s oversight task is ESSENTIAL to repair our unsustainable status quo where we have needless expense, waste, and compromised care. The purpose of the HHA is to research and plan comprehensive universal healthcare as a strategic alternative to the current system. We can’t lose the only State agency that is specifically designed to propose innovative solutions to already imminent and likely intractable problems. Currently, Hawaii’s healthcare system already has major problems from multiple directions. These include, but are hardly limited to, the following: • Under federal ACA and MACRA laws, doctors are being pressured to restrict and deny necessary care, and from assuming responsibility to care for sicker, more complex, and socially disadvantaged patients; • The system is creating equally perverse counter-incentives of “pay-for-performance” and risk-adjustment that burden doctors with excessive documentation and data-management demands; • The system is increasing costs for both providers and payers (Medicare, Medicaid, and private insurance) where physicians and office staff must: o Spend more than 15 hours per week on “quality” measures and reporting; o Spend more than $40,000 per MD per year on “quality” measures and reporting; o Spend twice as much time paying attention to computers as to patients; o Respond to measures, most of which have little to do with actual quality of care; • There are pressures to replace fee-for-service systems with “value-based” payment, shifting insurance risk onto doctors and hospitals, so they have a financial incentive to restrict care; and • Insurers are tightening pharmaceutical formulary restrictions and prior authorizations for drugs and imaging, adding more barriers to care. These problems have resulted in the following, in Hawaii, in rapidly increasing effects in just the past couple of years. Your constituents will confirm this to you: • Rapid loss of physicians from private practice, especially in Hawaii where 2/3 were in individual and small-group practices prior to the ACA, leading to: o Premature retirement o Leaving the state o Taking administrative jobs and jobs with hospitals and big health systems, to avoid insurer micromanagement of patient care • Patients losing access to doctors in out-patient settings, an accelerating problem: o October 2016: 31% of Oahu primary care practices closed to all new patients, double the rate of the previous year; o 47% closed to new Medicare patients, with even more refusing new Medicaid; • More care pushed to ERs and hospitals for those who can’t get care elsewhere; • Epidemic of physician burnout – at 55% in December 2015 and rising annually; • Rising cost (premiums, deductibles, co-pays), less access, and health system collapse! For all these reasons, Hawaii must follow through with the well-planned procedures set out in HRS Chapter 322H to develop a system that will stop the cost-explosion, and begin cost-containment. The HHA is the ONLY AGENCY that can streamline health planning and policy management through careful planning and analysis. And, frankly, bills to make Obamacare part of Hawaii’s state law – SB 403 and HB 552 – won’t solve these problems. Please add $250,000 to the budget of the Department of Budget and Finance for the Hawaii Health Authority, so that it may proceed to plan for a comprehensive universal healthcare system. Thank you for your kind attention to this serious and pressing issue, and for your foresight in considering our plea. Stephen Kemble, MD Alan B. Burdick Marion F. Poirier, RN Daria Fand Dennis Boyd Miller Erynn Fernandez Contact: burdick808@gmail.com Thank you! Dennis B Miller FB Healthcare For All Email singlepayerhawaii@gmail.com www.healthcareforall-hawaii.com