President Donald Trump signed his megabill that includes deep cuts to Medicaid. It will impact the roughly third of Hawaiʻi residents who rely on Medicaid for health coverage.
"Hawaiʻi has worked really hard to be the health state of the future, and so this bill essentially, really erodes a lot of that progress,” said AlohaCare CEO Francoise Culley-Trotman. AlohaCare is the second-largest Medicaid program in the state.
One of the most significant changes will be the work requirements for Medicaid enrollees.
Culley-Trotman pointed to significant costs incurred by states like Arkansas that have tried to institute work requirements for medicaid patients.
"When we think of Hawaiʻi, where we have a high percentage of people that already work, and the efforts and costs it will take to deploy this program, we're really struggling to see how effective this would be,” she said.
Another change would increase the eligibility determination period from once to at least twice a year. She says it will have significant impacts because many low-income families struggle with the cost of housing and move frequently — making it difficult to stay in contact and turn in paperwork.
Because of these changes and other adjustments to Obamacare in the megabill, State Health Planning and Development Agency Administrator Dr. Jack Lewin says the number of uninsured people in Hawaiʻi will increase.
"We could easily go from 3% uninsured people statewide to 10% uninsured, a huge burden on hospitals, on emergency departments, and on patients and families,” he said.
Lewin explained that the state could be on the hook for $300 million to support the people who have lost coverage, the uncompensated care that hospitals and clinics will need to provide, and the administrative burden of implementing the new policies.
“It's all of those things together. First of all, we'd be having to make up the deficit in Medicaid or cut benefits or cut beneficiaries,” he said.
"Secondly, there'll be administrative work costs because we have to go through this whole paperwork thing of documenting that Medicaid beneficiaries are working if they're able bodied and then we have all the additional costs that will confer back to the state indirectly for people that need services for which there's no compensation.”
Gov. Josh Green told reporters that he is putting together a team to address the impacts of the megabill.
“We'll be putting together a tiger team of our teams, experts in Medicaid, in health care, health care associations, support from the other congressional leaders in their teams to make sure we go piece by piece through this bill to see what we can do to mitigate any damage that this bill does,” he said.
"We'll be fighting off any changes that knock people off the Medicaid rules. We will be making sure that we do all that we can to preserve SNAP benefits, food security for our people.”
Culley-Trotman explained the system will adapt, but it will come at a cost.
" We rank higher among the states for health care access, but that takes an incredible amount of energy and the required funding,” she said. “So I think the bigger issue is that we will have to divert resources to these type of changes instead of continuing to focus on the things we've been focused on to date, which is expanding access for people.”
In the meantime, AlohaCare encourages people on Medicaid to make sure their contact information is up to date and share their stories about how Medicaid has impacted them at alohacare.org.
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