Report Title:

Uninsured Health Care; Federally Qualified Health Centers; Appropriation



Appropriates funds for the provision of direct health care to the uninsured.



H.B. NO.













relating to health.





SECTION 1.  The legislature finds that approximately ten per cent of the adult population of the State of Hawaii has no public or private health insurance.  In the current economic climate of the State, this number is likely to increase as the result of work layoffs and business closures.  According to the Kaiser Commission on Medicaid and the Uninsured:

     (1)  Over four out of five uninsured people are in working families;

     (2)  Uninsured people are more likely than those with insurance to be hospitalized for conditions that could have been avoided;

     (3)  Because the uninsured are less likely to seek regular and preventive care, those with various forms of cancer or with chronic conditions are more likely to be diagnosed in later stages of their diseases resulting in higher rates of death and disability; and

     (4)  Nearly forty per cent of uninsured adults skipped a recommended medical test or treatment, and twenty per cent say they needed but did not get care for a serious problem in the past year.

The significant numbers of uninsured residents have a considerable economic impact on the State's hospitals, community health centers, and other health care providers, threatening their ability to effectively serve the whole community.

The legislature finds that it is in the best interests of the State to ensure access to primary and preventive health care for its residents.  In addition to facilitating a healthier population, improving access to health care reduces state expenditures attributable to hospital and emergency room services for preventable injuries or illnesses.

The legislature further finds that the most effective means to encourage access to primary health care for residents without health insurance is through Hawaii's system of federally qualified health centers.  These centers:

     (1)  Are nonprofit, community-based organizations whose purpose and expertise lie in serving people who otherwise have limited or no access to health care;

     (2)  Provide culturally and linguistically appropriate health care and a broad range of primary care and preventive services, and are located in medically-underserved areas where people have limited access to other health care providers because of geographic and socio-economic barriers;

     (3)  Contribute greatly to the economies and livability of the communities they serve; and

     (4)  Are cost-effective providers whose care results in healthier patients and decreased use of emergency, specialty, and in-patient services.  A recent study shows that community health centers saved Hawaii an estimated $29,000,000 in 2007 in their services to the uninsured.

Unfortunately, while federally qualified health centers represent one of the most effective and responsive systems of community-based primary care for uninsured people, financial support for these providers is inadequate to meet needs for medical, behavioral health, and dental services.

The purpose of this Act is to provide cost-effective health care for Hawaii residents who are uninsured while at the same time ensuring that the community health center system remains financially viable and stable in the face of a growing population of uninsured persons.

     SECTION 2.  There is appropriated out of the general revenues of the State of Hawaii the sum of $           or so much thereof as may be necessary for fiscal year 2009-2010 to pay for the provision of direct health care for the uninsured, which may include primary medical, dental, and behavioral health care; provided that distribution of funds may be on a "per visit" basis, taking into consideration need on all islands.

     The sum appropriated shall be expended by the department of health to provide resources to nonprofit, community based health care providers for the provision of health care for uninsured persons.

     SECTION 3.  This Act shall take effect on July 1, 2009.