Connecting The Health Care Dots

Coral Andrews, Hawaii Health Connector executive director. Photo by Nathalie Walker

Coral Andrews, Hawaii Health Connector executive director. Photo by Nathalie Walker

Controversial but needed, the Affordable Care Act is open for business. Here’s everything you need to know to get started

To the uninsured of Hawaii: Come out, come out wherever you are. There’s no need to be afraid of Obamacare – the law’s on your side. The government has made it easy for you to get health coverage and possibly qualify for lower premiums. Or, if you have been denied insurance in the past because of a pre-existing condition, this is your opportunity to re-apply for health coverage.

So, by all intent, the Affordable Care Act (ACA) legislative is meant to improve lives.

To the 100,000 uninsured in Hawaii who are targeted: Hawaii Health Connector wants you. Federal grants of $205 million have been invested in a tool to facilitate your access to insurance plans and subsidies.

The high cost of insurance is the main reason people go without coverage. Many do not have access to coverage through a job, and gaps in eligibility for public coverage leave many without an affordable option.

The new law is not meant to micromanage a segment of our population, although it might seem like it. It is transforming our society into one that cares for the well-being of citizens in a way that fairly shares the cost of medical services.

Like the establishment of Social Security and Medicare, the startup process is ponderous and even irksome at first. Hopefully, years from now we can look back at this time in health care reform and say it was all worth it.

Uninsured and Invincible

Frankly, we all know people in our families or social circles who do not have health insurance. Many uninsured are self-employed or work for small firms where health benefits are not offered. Others are young, invincible types who don’t think anything catastrophic will happen to them: “That’s for older folks.”

The rest of us who have health insurance – 92 percent of Hawaii’s residents – are carefully scrutinizing information to learn how health care reform affects us. Because it does.

We also are analyzing new data as it rolls out to determine if our present health care coverage is the best it can be. As 95 plans are loaded to the state’s online health insurance exchange known as Hawaii Health Connector, for the first time there is more transparency for consumers to compare rates and benefits.

Defying Stereotypes

“The face of the uninsured defies stereotypes in Hawaii,” says Coral Andrews, executive director of Hawaii Health Connector. “In many instances it is not the vagrant and homeless.”

There are uninsured people at every social, educational, geographic and economic level.

“Most of my adult life I’ve had no health insurance,” says Grammy award-winning musician John Cruz. “You know the immediate needs like food always seem to be the priority before health insurance.

“Health insurance is very intimidating no matter how you look at it,” laments local writer Jo Archibald. “Whether you’re a parent or business owner, it’s hard to know what is right for you. You want to know that there is going to be someone there to guide you through choosing important things like health insurance.

“While I like to think of health care as what’s in it for me and my family, I know that in the bigger picture it really relates to what’s in it for my community.”

Individual health coverage indeed impacts overall health care quality and costs. It is the reason the federal government passed the Affordable Care Act (ACA, aka Obamacare) three years ago to bring millions of uninsured citizens into the system.

Hawaii was the first state to declare its intent to have a locally operated exchange and is meeting federal milestones, launching its Internet site Oct. 1 at

Like the national roll-out of ACA, online state exchanges, including Hawaii, are works in progress that have experienced startup glitches.

Frankly, it was not unexpected.

“Constructing a national health care marketplace is more complicated than orchestrating voter turnout through public media,” says John McDonough, professor at Harvard School of Public Health. In a Washington Post interview, he describes the development of an online insurance marketplace as “an enormously complex task. The number of systems that have to work together – federal, state, insurance companies, the Internal Revenue Service – the number of systems that have to align here is pretty daunting.”

Then there is the sheer volume of Internet traffic. The national health reform site ( got 8.6 million unique visitors in the first three days, with 250,000 concurrent users at one point.

Hawaii’s Connector logged 19,457 unique visits to its site, got 1,181 applications and received 1,257 calls at the contact center on the first day. By the third week, the Connector logged more than 77,000 unique visits to the website, by which more than 2,250 applications were created.

Clearly there is a need and great interest.

Focus and Function

“We continue to work collaboratively with our state partners and health insurers to make certain that consumers have access to accurate plan and rate information in a secure online marketplace,” Andrews says.

The Connector is designed to help individuals and small businesses shop for health care coverage online. Consumers are accustomed to researching purchases and products on the Internet. The virtual marketplace accommodates today’s 24-hour access, instant-gratification generation of consumers.

Applicants also can go directly to private insurers, but those seeking subsidies or tax credits must use the Connector. It’s the pathway to discounts.

Hawaii Medical Service Association (HMSA) and Kaiser Permanente Hawaii, the state’s two largest insurers, have signed on to the exchange. Three other insurers that do not offer individual plans and specialize in group insurance are taking a wait-and-see stance.

According to the Census Bureau, about 48 million Americans have no health insurance and another 38 million have inadequate health insurance. This means that nearly one-third of Americans face each day without the security of having medical care available to them and their families. People who postpone necessary care and forgo preventive care such as immunizations and routine checkups are more likely to be hospitalized or seek services at emergency rooms. When an uninsured person is in crisis and cannot pay, that burden falls upon the insured population, hospitals, doctors and government. These billions of dollars of “uncompensated care” drive up health insurance premiums for everyone, according to Kaiser Family Foundation.

Hawaii’s response to ACA establishes a state-based insurance marketplace or exchange that is regarded “transformative” by state leaders and stakeholders.

Health care insurance for our people? We’ve got an app for that.

Of Hawaii, For Hawaii

As Connector executive director Andrews puts it, “Many hands and impassioned souls are involved in this project. I would describe the process as iterative, necessitating always looking forward but at the same time driving activity on a day-to-day basis to meet aggressive timelines.

“If we did not go with a state-based exchange, Hawaii would have to adapt to a federally run marketplace that has no integration with our prepaid health care coverage through employers. It also would not have the look and feel of Hawaii,” says Andrews, 51, a former Navy officer and clinician with extensive experience in health policy, international engagement and humanitarian assistance.

Andrews cites the Hii Ola (“of wellness”) aspect of the exchange that does community outreach through assisters or navigators trained in the use and purpose of the Connector.

These marketplace assisters are contracted with more than 30 grassroots organizations.

“In our community, we receive information more readily if we’re getting it from a trusted source,” Andrews explains. Many of the nonprofit organizations serve communities where demographic representations of uninsured are found.

One such entity is Kokua Kalihi Valley on Oahu, where Dr. David Derauf, executive director, notes that 40 percent of the people served at his practice last year were uninsured.

The Connector’s contact center receives inquiries from multiple communication channels. Operating from 8 a.m. to 8 p.m. seven days a week, the center helps customers with questions and appointments for open enrollment. Language support is available.

So that, in a nutshell, is the back story of Hawaii Health Connector and a message to the uninsured population of our state.

We can think of Hawaii Health Connector as a surf-board. We are paddling in a sea of change in the way health care is administered in America. Hawaii is riding the crest of that wave with a hybrid model of public-private partnership hoping to reach universal health care.

It will be a smooth ride if we maintain balance and momentum.

How does Hawaii Health Connector help me?

* You find and buy health plans.
* You can determine if you qualify for low-cost or no-cost health plans.
* You can determine if you qualify for financial help to lower your cost of health care.

Who can use the Connector to buy insurance?

* Legal Hawaii residents. You must have a Hawaii home address and consider Hawaii your permanent home.
* If you receive health coverage through your job, but your family isn’t covered, you can use the Connector to search for and buy coverage that suits their needs.

What kind of help is available to lower the cost of health coverage?

Tax subsidies are available to those who meet certain income requirements and do not have health insurance from an employer or a government program (such as Medicare or Medicaid). Through the Connector, these subsidies can be applied immediately to your insurance premium, reducing the amount you pay each month.

Cost sharing subsidies are available to reduce the amount of out-of-pocket health care expenses an individual or family has to pay. These expenses might include co-payments for health care services or other costs.

How do I enroll?

1) Go online to, call the customer center, talk to your insurance agent or broker, or make an appointment to see a Connector Kokua.

2) Share basic information about you or your household.

3) Choose a plan that fits your specific needs and budget.

4) Apply for financial assistance to lower your plan costs.

5) Complete an enrollment application.

When does coverage begin?

Open enrollment period is October 2013 through March 2014. Health coverage purchased through Dec. 15, 2013, may begin as early as January 2014.

How do small businesses use the Connector?

Through the Small Business Health Options Program (SHOP), you can:

* Get accurate information about health insurance plans.
* Compare prices, benefits and coverage options for employees.
* Manage coverage through easy-to-use online business tools.
* Learn if your company is eligible for tax credits.
* Make payments from one monthly bill, no matter how many plans from different companies you select.

Sole proprietors without employees may buy a health plan through the individual marketplace. As an individual consumer on the Connector, you might be eligible for financial help to lower the cost of coverage.

How do I get connected?

Call: 877-628-5076
Hours: 8 a.m. to 8 p.m. daily.
TTY/TDD: 855-585-8604
Fax: 808-585-8206
Mail: P.O. Box 1170, Honolulu HI 96807-1170