Some Kauaians denied health insurance

The good news is that Hawai’i has a lower percentage of residents without health insurance than most other states.

The bad news is that there are around 117,000 uninsured people in the state, a figure twice the population of Kaua’i.

Worse news is that Kaua’i, with an estimated uninsured population of around 6,500 people, is at or near the top of the list of counties with the highest incidence of people without health insurance.

Estimates indicate 11 percent of the county’s residents are uninsured, while statewide uninsured populations range from 7.5 percent to 11 percent, according to Pi’ilani Pang, project manager for The Hawaii Uninsured Project.

Since The Garden Island ran a story earlier this month about the island’s uninsured population and statewide and local efforts to get more residents covered with health insurance, the newspaper received numerous calls from residents with stories of coverage being denied.

Carol Smith of Lihu’e said her son has just moved home after finishing college and working for a few years in Colorado, and she was told by representatives of both HMSA (Hawaii Medical Service Association) and Kaiser Permanente that there would be a six-month wait before he could get coverage.

“I was just appalled over it. Here he is without insurance, and he has to, of course, get a job, McDonald’s or where ever, that has medical coverage,” she said.

“And I don’t think that’s right. I thought doors was open to have medical insurance, but I guess not,” said Smith.

A successful small business man on the North Shore who wanted to be identified only as Richard said he was turned down for health insurance by HMSA because he has hepatitis C.

He makes too much money to qualify for the state’s low-income health-insurance program, QUEST (also called Med-QUEST), and is dismayed that HMSA would deny him insurance.

“It’s like they only want people who aren’t sick,” he said.

Cliff Cisco, HMSA senior vice president, said these people are the few who are caught between making too much money to qualify for QUEST, and not falling under an employer group-coverage plan.

Most individual plans have waiting periods and require mandatory disclosure of pre-existing medical conditions on application forms, Cisco continued.

The waiting period for those seeking individual or sole-proprietor coverage can be as long as 12 months, and the lengthy application process, called “medical underwriting,” screens for, among other things, possible pre-existing medical conditions (like hepatitis C).

The North Shore resident with the pre-existing condition would not be denied coverage were he to join a business that offers group coverage, as the state mandates HMSA and other insurance carriers cover all employees under all group coverage policies, regardless of potential or real pre-existing medical conditions among the employees, he said.

In the case of the returning Kauaian, Cisco said if the man got a full-time job, the employer would offer him health benefits through a group health plan, as per state law.

The rules are different for individual and group plans, he said.

Underwriting the risk of just one individual, as opposed to an entire group of people where the costs are spread across the whole group, requires HMSA and other insurers to carefully scrutinize individual applications, he said.

The long wait time is to ensure the insurer that there are no long-term medical conditions that will cost the carrier lots of money down the road, he said.

Experts in providing medical care to low-income families, under-served individuals and Native Hawaiians, recently met on O’ahu to discuss ways to get even more federal and state money to help provide coverage for low-income and fixed-income people in the state.

Of the state’s uninsured population, the largest ethnic group is Native Hawaiian, and the largest age segment is those between 20 and 29.

“QUEST emerged as Hawai’i’s solution to the state’s exploding health care cost for providing medical services to low-income families,” said John McComas, chief executive officer of AlohaCare.

AlohaCare is the state’s only QUEST-exclusive health insurance plan. Since the state began privatization efforts to reach low-income residents with health insurance coverage in the mid-1990s, the private sector has proven itself more effective and efficient than the state in both delivering the coverage and cutting costs associated with delivering it, McComas added.

“QUEST is a success story, but we need to do more” in terms of getting even more lower-income residents covered by health insurance, he added.

“We’re working with the University of Hawaii and (state) Department of Health to get a better picture of who is uninsured and what’s keeping Hawai’i residents from obtaining health insurance,” said Pang of The Hawaii Uninsured Project.

Those delivering medical services to low-income folks across the state say part of the problem might be QUEST’s detailed application process and attending required paperwork documentation.

Staff Writer Paul C. Curtis can be reached at mailto:mailto:pcurtis@pulitzer.net or 245-3681 (ext. 224).

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