Please click the link above to sign the petition for Universal Single Payer Healthcare in Hawaii.


Let’s get serious and fix the biggest drain on our economy and our lives:

Health Insurance.

Here in Hawaii we have an ideal Healthcare law to support, HRS322H The Hawaii Health Authority. 

It is a Universal Single Payer Healthcare law passed in 2009, which has languished due to a lack of support from Governors Abercrombie and Governor Ige.

This August we have an opportunity to vote for candidates who  pledge to support Universal Healthcare, not unlimited insurance cost increases.  Ask your candidates if they support the Hawaii Health Authority.

What is wrong with our healthcare?

Well, last November 2017 Insurance Commissioner Ito announced that, “Health Insurance premiums will increase 6.5% annually resulting in a cost of $42,000 per year for a family of four in Hawaii by 2026, and there is nothing we can do about it, except to decrease utilization.”

Yes we can do something about it, we can allow the existing law, the Hawaii Health Authority, to design a Universal Single Payer Healthcare system. 

Talking about health insurance policy can be a little complex.

Fixing healthcare is simple.

Step one:  Throw out all current health insurance rules, regulations, and laws, and start over with one good benefit package for everyone, which is provided via one simple administrative system. 

At the federal level, Single Payer is ideal.

 At the state level, All Payer is much more practical. 

All Payer leaves all current insurance companies in place, but, the state gives them all the same ‘unified’ business model to follow.

 The benefit of a unified billing system is that the providers will not need to maintain separate software and billing know-how for each insurer.  They won’t have to understand what is and isn’t available from each various benefit package offered by Medicaid, various private health insurers, Medicare Advantage, and Medicare.  Currently, all providers must maintain the ability to process the uniquely complex approval and billing procedures for each insurance provider.  If the state were to create one Unified benefit package offering the same approval and billing rules, administrative costs would significantly drop.

Most obstacles to receiving care will vanish.  Currently, many private practice physicians cannot afford to accept Medicare and Medicaid patients, due to administrative complexities and lower reimbursement.  In the Hawaii Health Authorities unified system, the benefit package will be the same for everyone.  Doctors will know what is available.  Billing will be the same for each insurance provider.  Doctors and hospitals can significantly reduce their medical billing staff.  Insurance companies will significantly reduce their approval and billing staff.

 Less paper work, lower costs!  That is how we can afford to cover everyone regardless of ability to pay.  This will also reduce the cost of business.  Fixing healthcare will be a major economic stimulant.


System requirements:

1. Healthcare with less than 3% of total spending being spent on non-medical administration.  This includes billing procedures, payroll for medical billers on the both the provider side and the payee side, rent, and CEO salaries of insurance companies.  (Currently, nationally, we spend approximately 1/3 of total health care dollars on non-medical administrative overhead.  In Hawaii, since 2009, HMSA inflicted a new system called Managed Care on us.  This new system caused providers to double the amount of time they spend on patient reporting.  Coincidentally, our health insurance premiums in Hawaii started increasing in 2009, due to these HMSA driven changes.  Because of Managed Care, by 2026, a family of four will cost $42,000 per year just for health insurance premiums.

2.  Provide one high quality benefit package to everyone.   

If everyone has the same benefit package, and if the billing procedures are the same regardless of insurance provider, and if compensation to providers is the same regardless of source: Medicaid, Private, and Medicare Advantage will reimburse the same amount.   Then, private practice physicians and hospitals will have a vastly easier time taking care of people, and a vastly easier time billing insurance companies.

3. Negotiate Prescription Drug Prices.  A federal bill offers the best path for controlling costs, however, states have options.  30 states have, since 2004, participated in a multi-state discount group for Medicaid.  Hawaii used to be member, until 2009, when, due to Managed Care’s changes, Hawaii’s Med Quest program voluntarily quit membership in a discount program.  If Hawaii’s Medicaid program rejoins a discount program for Medicaid, and if the Hawaii Health Authority is allowed to design a unified All Payer healthcare system for Hawaii, then everyone in Hawaii can receive a discount on prescription drugs.


Those three steps are just about all we need to do avoid our current massive increase in health insurance premiums, and to provide healthcare for everyone in Hawaii.

Happily, the Hawaii Democratic Party, at the recent state convention, just passed an ideal new Hawaii Democratic Party Healthcare platform as of June 2018: 




We believe that healthcare is a right, not a privilege, and our healthcare system must put people before profits. The high costs of insurance and insufficient coverage mean that many people do not have access to the care they need, which creates devastating social costs that are also a significant economic burden to the state.

Therefore, we support robust funding of the Hawaii Health Authority, or other agency, to design a statewide, unified, cost-effective healthcare system that includes comprehensive healthcare services for all, and then submit that design to the legislature for evaluation.

Such a universal, comprehensive healthcare system would: (1) Unify the delivery of healthcare in Hawaii by establishing a single network, benefit structure, reimbursement system, drug formulary, and prior authorization policies. All state-regulated payers would be required to pay into this unified system, including Medicaid, Medicare Advantage, and health insurance provided by the state and counties, and commercial health insurance plans funded by employers and individuals.(2) provide parity of mental and physical health coverage; (3) provide cost- effective regulation of comprehensive health care delivery systems with an administrative overhead of less than 3%; (4) include and protect all women’s healthcare needs including reproductive rights and the healthcare needs of the LGBTQIA community; (5) provide preventative health programs; (6) provide long-term care, dental, and vision care; and (7) provide for COFA citizens and other non-citizens lawfully residing in Hawaii on an equal basis with US citizens and permanent residents.


We urge Hawaii’s Medicaid Program to join an existing multi-state prescription drug discount purchasing group as Medicaid, and then, via the HHA’s ability to create a unified statewide system, enable delivery of that discount to all state residents.


On the federal level, we support a universal single-payer healthcare system similar to or better than HR 676, Expanded and Improved Medicare For All, wherein all individuals residing in the United States and U.S. territories are provided with comprehensive healthcare services.

Caveat:  the line about “… or other agency,” was a compromise line.  There is not any other agency in Hawaii which has the statutory authority to enact the regulatory health policy reform we need, however, due to an abundance of caution on the part of some, we added that line to satisfy their request. 

Additional considerations:

Due to issues with employers declining to provide health insurance to part time workers, we should separate healthcare from employment.  This could entail replacing the Pre-Paid Health Care Act. However, given that the new system would result in all employees receiving healthcare, it satisfies and exceeds the minimum requirements of Pre-Paid, so we could just leave Pre-Paid on the books, and move forward with a better system which satisfies all of the requirements of Pre-Paid, and which also fixes the deficiencies.   In the event of the new system failing, Pre-Paid would remain in effect. 

Employers could still choose an insurance provider, and then pay an amount set by the Hawaii Health Authority for each employee, regardless of who they are, regardless of their age or medical history.  The employer contribution would solely be based on the number of employees, regardless of who they are, or how many hours they work. This will incentivize employers to hire full time workers over part time.

In this way, everyone has health insurance regardless of employer, and regardless of being unemployed or self-employed.  Self-employed sole proprietors would be assessed the same contribution rate as an employer pays for each employee.  We can literally throw away all of the qualifications, applications, screening, etc., because everyone not on VA or DoD will retain virtually the same coverage.  If a person ceases to be employed, our Medicaid Program automatically covers them, without any need for a screening.  Lose job, get covered by Medicaid, automatically, anytime.  No ‘windows’ of application.  No barriers to applying for free healthcare when unemployed.

It is much less expensive, for the tax payer, to pay for medical bills up front than to let people suffer from untreated injuries or illnesses.  Untreated medical conditions cause homelessness.  Homelessness exacerbates medical conditions, which is part of why Hawaii spends $1.6 billion dollars per year, out of $2 billion in total for all our Medicaid recipients, on 16% of Medicaid recipients.  A significant number of that 16% are chronically homeless.

  If we also champion Senator Jeff Green’s proposal to classify homelessness as a medical condition under Medicaid, then we can use Medicaid dollars to pay rent for the chronically homeless.  This will decrease their very significant medical bills, not to mention, help them to rejoin society.  Not to mention, remove the need for the controversial ‘sit lie’ laws.

It is cheaper to pay market rent for the homeless than to pay their medical bills, so why don’t we help prevent their medical conditions in advance by paying their rent?  The fact that this will reduce a significant amount of Hawaii’s homeless population should make this an immediate priority.

Employers would see at least a two thirds reduction in their workers compensation cost, due to everyone being covered regardless of employer or employment.  Employers would be relieved of needing to contract with a worker’s compensation provider, relieving of annual audits, relieved of costly compliance paperwork, but, would still be assessed a smaller amount, to be applied to disability pay.

Medicare Advantage will be folded into this Unified All Payer System, with a benefit package that exceeds Medicare, and is equally as portable as private insurance.  Due to massive systemic issues afflicting Medicare because of the 2015 MACRA laws, many physicians avoid accepting new Medicare patients.  For a state to receive Medicare revenue and rewrite the administrative rules, a state needs to apply for a federal 914 waiver.  Given our current political climate, this appears unlikely.  We could still apply for it, and if we received it, then we could set up an ideal Single Payer system.

 In the meantime, we can press on with an All Payer system, and simply make Medicare Advantage equal with Medicaid and private health insurance.  Patients will have the choice to remain in traditional Medicare, or opt in to Medicare Advantage, at no additional cost.

Via the Hawaii Health Authority, we can provide long term care to kupuna, via Medicare Advantage.  Given a benefit package which exceeds Medicare and given that all providers will beg their Medicare patients to opt in the administratively simpler system, most seniors will opt in to Medicare Advantage, resulting in federal Medicare revenue being directed to the state, without needing to apply for a waiver.

 Currently, many physicians try to avoid accepting either Medicaid or Medicare, due to increasing charting complexity and low reimbursement.

After we unify Medicaid, private insurance, and Medicare Advantage, then, since reimbursement and administrative procedures will be the same regardless of insurance provider, all physicians will see all patients as equal.  Physicians will be incentivized to set up private practice in rural areas, where office rent is lower.

We are facing a silver tsunami of early retiring physicians.  They don’t want to deal with all these new administrative complexities.  By simplifying things and standardizing reimbursement, physician burnout will end, our shortage of physicians will end, and access to healthcare will improve.

So, why hasn’t Hawaii’s Governor supported the Hawaii Health Authority?

Please ask him!  Please Senator Baker, Chair of the Senate Health Committee, as well.  As a matter of fact, please contact candidates you are considering voting for in the upcoming state primary, and ask them: “do you support the mission of the Hawaii Health Authority?”  If their answer is no, then that candidate is in favor of catastrophic health insurance premium increases.  If they would like more information, please contact Healthcare For All Hawaii at and a meeting will be arranged.

In my POV, bundled donations from HMSA and other pharmaceutical companies appear to have a correlation with members of our government choosing to maintain a costly health insurance system, and choosing to decline to receive discounts on prescription drugs.

As with all progressive proposals, the obstacle is the lobbying power of those industries whose interests conflict with public interest.

We need publicly financed campaigns, a ban on dark Super Pac money, and a ban on bundled donations if we want to see a legislature and a governor who represent people, not the donor class.

 Additional links:

What is the Hawaii Health Authority?

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