Expanding MedQuest could save $20M


Allowing Hawaii residents who earn up to 200 percent of the federal poverty level to return to the state’s Medicaid program could save more than $20 million in health care costs, health care providers told state senators Monday.

The Senate’s Health and Commerce and Consumer Protection committees held an informational hearing Monday afternoon on the impact the Affordable Care Act — the federal mandate for health insurance — may have on Hawaii residents who earn too much to qualify for Medicaid, but who would have qualified for the state health insurance program until income limits were changed last year.

Previously, residents earning up to 200 percent of the federal poverty level, $26,000 for an individual, could get Medicaid coverage. Last year, the limit dropped to 133 percent of federal poverty level.

Robert Hirokawa, CEO of the Hawaii Primary Care Association, said the state’s community health centers bear the brunt of picking up costs for uninsured people in that income gap. A state-commissioned study on the cost of a basic health plan — something the Affordable Care Act said states may begin offering in 2015 — would be about $75 a month for a single person who just misses the Medicaid cutoff with an annual income of $18,000. That $75 a month would be 5 percent of that person’s income, Hirokawa said.

The percentage increases for someone making 200 percent of the federal poverty level to just more than 8 percent of their income to cover basic health plan premiums.

“Those with incomes just above the Medicaid level … may have difficulty affording premium, even with subsidies available to them,” Hirokawa said, citing the study, which the Department of Commerce and Consumer Affairs’ Insurance Division posted online.

Bay Clinic Board Chairwoman Tanya Aynessazian said her own family cannot afford health insurance, with an income at about 225 percent of the poverty level, after her husband lost his job last year.

“Many of us are going to choose whether we see value in paying out of pocket or not,” Aynessazian told the senators.

Federal officials have said people who opt not to purchase health insurance will be penalized.

Hirokawa, Aynessazian and other community health center officials asked senators to consider reinstating the 200 percent limit.

Waikiki Health Center CEO Sheila Beckham estimated putting the 21,000 people whose incomes fall between 133 and 200 percent of the federal poverty level limits on Medicaid could save about $1,200 per person, by getting patients preventative care, instead of emergency room care. That’s nearly $26 million a year that the state could save, other officials noted.

Even Kauila Clark, chairman of the National Association of Community Health Centers and vice chair of a Waianae health center board, has experienced what it’s like to make too much for Medicaid, but not enough to cover his health care costs. He encouraged the senators to take action.

“It would be very, very helpful if the state could relieve that and increase the percentage (limit to qualify for Medicaid),” he said. “Community health centers are prepared to take on the additional patients. We need the assistance of the state. In Hawaii, if we do have aloha, we do take care of our own.”

Sen. Josh Green, D-Kona, Kohala, chairman of the Senate Health Committee, said senators would be considering several resolutions on the matter in the next week.