HI Legislature Page 1 of 1

Hawaii State Legislature

Bill Status
HB1598
Generated on 8/27/2007 8:41:51 AM
Measure Title: RELATING TO HEALTHCARE.
Report Title: Healthcare; Universal
Description: Establishes agency to operate a single-payer universal healthcare
insurance system.
Package: None
Companion:
Introducer(s): MIZUNO, BERTRAM, CARROLL, GREEN, WATERS, Brower,
Magaoay, Manahan, Souki
Current HLT, CPC, FIN
Referral:
Date Status Text
1/23/2007 H Pending introduction.
1/24/2007 H Introduced and Pass First Reading.
1/26/2007 H Referred to HLT, CPC, FIN, referral sheet 5
Click on the measure number for history of the measure.
$ = Appropriation measure
ConAm = Constitutional Amendment
Please read our Disclaimer Statement.
Some of the above items require Adobe Acrobat Reader. Please visit Adobe's download page
for detailed instructions.

http://www.capitol.hawaii.gov/sitel/docs/getstatus2.asp?billno=HB1598 8/27/2007
HB1598 Page 2 of 16

HOUSE OF REPRESENTATIVES 11 D K I 1598

TWENTY-FOURTH LEGISLATURE, 2007 |"1 D I M .

STATE OF HAWAII • •

A BILL FOR AN ACT

RELATING TO HEALTHCARE.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

SECTION 1.The legislature f i n d s t h a t i t is in t h e best

i n t e r e s t of the State of H a w a i i for e a c h and e v e r y p e r m a n e n t resident

to have high quality and a f f o r d a b l e h e a l t h c a r e insurance coverage.

Healthcare is m o r e t h a n j u s t m e d i c a l i n s u r a n c e p a y o u t s . It includes

c o s t - s a v i n g and early i n t e r v e n t i o n m e a s u r e s to p r e v e n t medical

conditions from b e c o m i n g c h r o n i c , p e r m a n e n t l y d i s a b l i n g , or fatal.

Hawaii1s current healthcare i n s u r a n c e c o m p l e x is a disjointed,

costly, inefficient, and unnecessarily complicated multi-payer

p r i v a t e m e d i c a l i n s u r a n c e m o d e l t h a t is m o s t l y profit-driven,

adversarial,beset with constant cost-shifting and reluctant

healthcare delivery, onerously bureaucratic, and generally

economically irrational. Additionally, healthcare rates are

s k y r o c k e t i n g at or n e a r d o u b l e - d i g i t annual rates and are creating an

affordability and accessibility crisis for H a w a i i ' s residents.

T h e t h r e e b i g g e s t c o s t — d r i v e r s of h e a l t h c a r e in t h e United

States and Hawaii today are associated with the following:

( 1 ) A profit-driven c o m p l e x of p a y m e n t - r e l u c t a n t multi-payer

health insurance bureaucracies competing to insure only the

healthy and the w e a l t h y , while leaving those who need

http://www.capitol.hawaii.gov/sessioncurrent/Bills/HB 1598 .htm 8/27/2007

HB1598 Page 3 of 16

h e a l t h c a r e the m o s t , to the taxpayers;

(2) The lack of a central e l e c t r o n i c h e a l t h c a r e d a t a b a s e ; and

(3) I n o r d i n a t e l y high—cost p r e s c r i p t i o n drugs.

For m o r e t h a n a q u a r t e r of a c e n t u r y , H a w a i i w a s far a h e a d of

most other states and often called itself "the health state" because

o f t h e 1974 P r e p a i d H e a l t h c a r e A c t (PHCA)• In 1994 H a w a i i h a d a l o w

u n i n s u r e d p o p u l a t i o n of b e t w e e n t w o a n d f i v e p e r c e n t . But, the

c r i s i s in h e a l t h c a r e on t h e U n i t e d S t a t e s c o n t i n e n t b e g a n c o m i n g to

Hawaii•

Today, more than one hundred thousand Hawaii residents are

without any healthcare insurance coverage. More than twelve thousand

of t h e u n i n s u r e d a r e c h i l d r e n . Many other Hawaii residents are

u n d e r i n s u r e d , u n a b l e t o u s e t h e i r i n s u r a n c e p r o p e r l y or e v e n a t all,

b e c a u s e of i n c r e a s i n g l y e x p e n s i v e d e d u c t i b l e s a n d o u t - o f - p o c k e t co-

p a y m e n t s for o u t p a t i e n t v i s i t s , d i a g n o s t i c t e s t s , a n d prescription

drugs, among other factors.

T h e a n n u a l h i g h i n c r e a s e in p r e m i u m c o s t s t r a n s l a t e s into

increased employer costs. Under PHCA, private-sector employers are

r e q u i r e d to p a y h e a l t h i n s u r a n c e p r e m i u m s e q u a l t o t h e a m o u n t of t h e

p r e m i u m t h a t e x c e e d s t h e c a p on e m p l o y e e c o n t r i b u t i o n s of o n e and

h a l f p e r c e n t of a f u l l - t i m e e m p l o y e e ' s p a y . Public employers

g e n e r a l l y p a y e v e n m o r e b e c a u s e of t h e i r e x e m p t i o n f r o m P H C A a n d m u s t

n e g o t i a t e w i t h t h e i r e m p l o y e e s for e m p l o y e r - p r o v i d e d family

healthcare insurance.

P H C A d o e s n o t r e q u i r e e m p l o y e r s to p r o v i d e h e a l t h insurance

c o v e r a g e for e m p l o y e e s w o r k i n g l e s s t h a n t w e n t y h o u r s p e r week.

I n c r e a s i n g h e a l t h i n s u r a n c e c o s t s p r o m p t e d s o m e e m p l o y e r s to h i r e

i n d i v i d u a l s to w o r k o n l y part—time, or l e s s t h a n t w e n t y h o u r s per

http://www.capitol.hawaii.gov/sessioncurrent/Bills/HB 1598 .htm 8/27/2007

HB1598 Page 4 of 16

w e e k , to avoid h a v i n g to pay for e m p l o y e e h e a l t h c a r e b e n e f i t s under

PHCA.

Even well-insured individuals are experiencing problems with

their health maintenance organizations and insurance companies

d e n y i n g , or v e r y r e l u c t a n t l y d i s p e n s i n g , e x p e n s i v e m e d i c i n e s and

treatments. A 2005 national study by Harvard University found that

a b o u t half of a l l b a n k r u p t c y filings are partly due medical expenses,

and m o s t p e o p l e w h o file for b a n k r u p t c y p r o t e c t i o n b e c a u s e of medical

problems have health insurance.

The legislature further finds that Canada has for m a n y years had

a tried, tested, and true universal publicly administered healthcare-

for-all healthcare insurance model with one payout agency for

caregivers and providers. A v a r i a t i o n of this v e r y s u c c e s s f u l system

a d a p t e d to m e e t the unique conditions in H a w a i i w o u l d be very

beneficial for t h e f o l l o w i n g reasons:

(1)For u n i o n m e m b e r s a n d t h e i r e m p l o y e r s , it m e a n s taking

healthcare off the negotiating table;

(2) For p a t i e n t s , as t a x p a y e r s a n d i n s u r a n c e p r e m i u m - p a y e r s , it

means significant reductions in o v e r a l l c o s t s , i n c r e a s e s in

b e n e f i t s , and the s l o w i n g of a n n u a l i n f l a t i o n cost

increases. It a l s o m e a n s a t r a n s i t i o n from increasingly

uncaring profit—driven h e a l t h c a r e to the restoration of

human-need driven mutually respectful and caring patient—

doctor-nurse-and other caregiver relationships, which in

earlier times were f u n d a m e n t a l to m e a n i n g f u l healthcare;

(3) For b u s i n e s s e s , large and s m a l l , it r e d u c e s significant

overhead expenses；

(4) For the local economyA it m e a n s keeping almost all

http://www.capitol.hawaii.gov/sessioncurrent/Bills/HB 1598 .htm 8/27/2007

HB1598 Page 5 of 16

h e a l t h c a r e d o l l a r s in t h e state;

(5) For g o v e r n m e n t , it m e a n s h a v i n g o n e i n t e g r a t e d electronic

h e a l t h i n f o r m a t i o n d a t a b a s e for u n p r e c e d e n t e d p l a n n i n g and

cost-containment capabilities. It a l s o m e a n s r e l i e f from

t h e p e r c e i v e d e m e r g i n g p r o b l e m of " u n f u n d e d liabilities"

a s s o c i a t e d w i t h l o n g - t e r m f u n d i n g of g o v e r n m e n t retiree

lifetime healthcare benefits;

(6) For p h y s i c i a n s , n u r s e s , a n d o t h e r c a r e g i v e r s , it m e a n s less

paperwork, much less work stress, and much more time with

patients;

(7) For h o s p i t a l s , c o m m u n i t y h e a l t h c l i n i c s , home-care

p r o v i d e r s , a n d l o n g - t e r m c a r e f a c i l i t i e s , it m e a n s

sufficient and dependable annual financing through global

budgets; and

(8) For t h e g e n e r a l p u b l i c , it m e a n s a c c e s s i b l e a n d affordable

h e a l t h c a r e for e v e r y p e r s o n , a n d r e l i e f f r o m t h e increasing

s t r e s s e s of c o n s t a n t w o r r y o v e r t h e i n s t a b i l i t y of

healthcare coverage.

The l e g i s l a t u r e declares that single—payer, uniformly—delivered

high—quality healthcare—for—all is a b a s i c h u m a n r i g h t for Hawaii's

citizens.

T h e p u r p o s e of t h i s A c t is t o c r e a t e a u n i f i e d , single-payer,

universal healthcare system covering all Hawaii residents, similar to

t h a t of Canada's.

SECTION 2. T h e H a w a i i R e v i s e d S t a t u t e s is a m e n d e d b y a d d i n g a

n e w c h a p t e r t o b e a p p r o p r i a t e l y d e s i g n a t e d a n d to r e a d as follows:

"CHAPTER

SINGLE-PAYER UNIVERSAL HEALTHCARE SYSTEM

http://www.capitol.hawaii.gov/sessioncurrent/Bills/HB 1598 .htm 8/27/2007

HB1598 Page 6 of 16

§ 一 l Definitions. Unless otherwise clear from the context,

as used in this chapter:

"Authority" means the authority.

"Central unified electronic health information system database,"

means a primary, computerized electronic health information system to

store and access medical records f o r t h e state—wide single—payer

universal healthcare insurance system.

"County healthcare review boards" means the county bodies tasked

with continuously monitoring healthcare conditions, to assist the

authority to m a x i m i z e the e f f i c i e n c y and cost—effectiveness of a

single-payer universal healthcare system.

"Global b u d g e t " m e a n s the a n n u a l or m o n t h l y lump sum that the

authority pays each hospital, community health clinic, home-care

agency and l o n g - t e r m care facility to cover all o p e r a t i n g expenses.

"Healthcare registration cards" means a personalized medical

identification card showing that a permanent resident is c o v e r e d by

the single-payer universal healthcare system.

"Medically necessary" means procedures, treatments, and other

services that are needed and performed primarily by the physicians

and other q u a l i f i e d healthcare p r a c t i t i o n e r s according to medical

b e s t p r a c t i c e s a n d w h i c h a r e r e c o g n i z e d as s u c h b y t h e authority.

"Pay-as-we-go" means monthly healthcare funding and insurance

claims paid-out immediately for those needing "medically necessary"

healthcare.

"Prepaid" means Hawaii's state-funded single-payer healthcare

for all i n s u r a n c e s y s t e m p r o v i d i n g m e d i c a l l y - n e c e s s a r y healthcare

services without fees, c o - p a y m e n t s , or deductibles at the time

h e a l t h c a r e is needed.

http://www.capitol.hawaii.gov/sessioncurrent/Bills/HB 1598 .htm 8/27/2007

HB1598 Page 7 of 16

"State healthcare insurance planning and financing authority"

means the administrator o f t h e u n i v e r s a l s i n g l e - p a y e r healthcare

insurance s y s t e m for the state of Hawaii.

"Single-payer universal healthcare insurance system" means

c o v e r i n g all p e r m a n e n t r e s i d e n t s of the State of Hawaii.

"Universal" means healthcare f o r a l l of H a w a i i ' s permanent

residents.

"Universal healthcare provision fund" means the fund used by the

a u t h o r i t y to c o l l e c t funds and p a y out c l a i m s , and to a d m i n i s t e r an

emergencies and demographic changes contingencies reserve fund; and a

retraining fund for h e a l t h field employees affected by the transition

t o —the s i n g l e — p a y e r u n i v e r s a l h e a l t h c a r e insurance system.

§ -2 Single-payer universal healthcare insurance system;

established. (a) T h e r e is e s t a b l i s h e d t h e sing丄e—payer universal

healthcare insurance system to p r o v i d e the same u n i f o r m l y high-

q u a l i t y l e v e l of " m e d i c a l l y n e c e s s a r y " h e a l t h c a r e to a l l Hawaii1s

permanent residents. Private healthcare insurers are prohibited from

d u p l i c a t i n g the c o v e r a g e s p r o v i d e d by the single—payer universal

healthcare insurance system.

§ 一 3 Twenty functional concepts； established. Hawaii state-

funded single-payer universal healthcare insurance s y s t e m is based

upon twenty functional concepts as follows:

(1)、、Universal〃 the S t a t e of H a w a i i single—payer universal

healthcare insurance system finances 、、healthcare — for—all"

which means quality healthcare is " u n i v e r s a l l y available"

o n a 、、prepaid〃 b a s i s t o p e r m a n e n t residents;

(2) 、、Prepaid" - H a w a i i ' s state-funded single-payer healthcare-

for—all i n s u r a n c e s y s t e m t h a t p r o v i d e s medically-necessary

http://www.capitol.hawaii.gov/sessioncurrent/Bills/HB 1598 .htm 8/27/2007

HB1598 Page 8 of 16

healthcare services without fees, c o - p a y m e n t s , or d e d u c t i b l e s at

the time of h e a l t h c a r e need. The s y s t e m o p e r a t e s on a

ヽ、pay一as —we一go" b a s i s . Income and other taxes are collected

by the system on an ongoing basis through payroll deduction

and/or at r e t a i l c h e c k o u t c o u n t e r s , or t h r o u g h other

appropriate revenue raising methods, including existing

funding from federal and state; including but not limited

to m e d i c a r e / m e d i c a i d , and prepaid healthcare act funds,

employee union trust fund funds, until full transition is

c o m p l e t e d , as t h e funds for p r e - p a y i n g for healthcare

services when they are needed. Persons with healthcare

needs may present their healthcare registration cards to

receive medically necessary healthcare services without

ever seeing a b i l l for them. This represents great savings

over previous billing processes;

(3) "Comprehensive" 一 the S t a t e of H a w a i i single-payer

universal healthcare insurance s y s t e m is " c o m p r e h e n s i v e " in

t h a t it c o v e r s a l l m e d i c a l l y n e c e s s a r y h o s p i t a l , physician,

d e n t i s t , home一care, and long-term care services for every

Hawaii permanent resident；

(4) "Medically necessary" 一 medically necessary procedures,

treatments, and other services that are primarily the

responsibility of p h y s i c i a n s and other qualified healthcare

practitioners according to w e l l - e s t a b l i s h e d best practices

which are recognized by the authority. In a d d i t i o n , the

county healthcare review boards shall assess which

prescription drugs, appliances, services, and delivery

modes are:

http://www.capitol.hawaii.gov/sessioncurrent/Bills/HB 1598 .htm 8/27/2007

HB1598 Page 9 of 16

(A) Medically necessary; or

(B) Effective; or

(C) Both,

a n d a c c o r d i n g l y m a k e t h e i r r e c o m m e n d a t i o n s to the

authority;

(5) "Accessible" 一 t h e r e is a c c e s s i b i l i t y to o n e high—quality

l e v e l of h e a l t h c a r e - f o r - a l l w i t h o u t i n c o m e or o t h e r

barriers；

(6) "High—quality" - u n i f o r m l y h i g h q u a l i t y of systemwide

h e a l t h c a r e p r o v i s i o n is t h e s t a n d a r d of t h e single-payer

universal healthcare system;

(7) " C h o i c e " 一 p a t i e n t s h a v e t h e i r c h o i c e of p h y s i c i a n ,

d e n t i s t , a n d o t h e r single—paver u n i v e r s a l h e a l t h c a r e system

caregivers；

(8) "Portable" - single-payer universal healthcare system

c o v e r a g e is p o r t a b l e f o r p e r m a n e n t r e s i d e n t s w i t h i n and

o u t s i d e t h e S t a t e of H a w a i i .

Portability applies primarily between islands and

counties. A l s o , portability within the state means that

w h e n e m p l o y e e s c h a n g e e m p l o y e r s t h e r e is no p r o b l e m w i t h

h a v i n g to c h a n g e h e a l t h c a r e p l a n s . This Act also entitles

H a w a i i p e r m a n e n t r e s i d e n t s to " r e c e i v e m e d i c a l l y necessary

s e r v i c e s in r e l a t i o n t o an e m e r g e n c y w h e n a b s e n c e f r o m t h e

S t a t e is t e m p o r a r y , s u c h as on b u s i n e s s or vacation’’/

(9) “Publicly a d m i n i s t e r e d " 一 t h e S t a t e of H a w a i i single—payer

u n i v e r s a l h e a l t h c a r e i n s u r a n c e s y s t e m s h a l l be m a i n t a i n e d

a n d a d m i n i s t e r e d b y an e l e c t e d authority.

(10) " P u b l i c l y f u n d e d " 一 h e a l t h c a r e i n s u r a n c e p r e m i u m s are

http://www.capitol.hawaii.gov/sessioncurrent/Bills/HB 1598 .htm 8/27/2007

HB1598 Page 10 of 16

directly and indirectly collected through:

(A) T a x e s ；or

(B) O t h e r a u t h o r i t y revenue— ]:aising m e a s u r e s ; or

(C) Both; and

deposited immediately into the State's universal healthcare

provision fund. It is u s e d b y t h e a u t h o r i t y t o c o l l e c t and

pay out healthcare insurance claims and global budget funds

t o i n s t i t u t i o n a l p r o v i d e r s o n a pay—as—we—go b a s i s or

allocated as needed into the u n i v e r s a l h e a l t h c a r e provision

f u n d h e a l t h c a r e p a y - o u t s r e s e r v e or b o t h . There shall be a

fiscal firewall between the universal healthcare provision

fund and the state budget;

( 1 1 ) " S i n g l e - p a y e r “ 一 f i n a n c i n g of H a w a i i ' s healthcare-for-a11

system shall be publicly funded and healthcare insurance

c l a i m s s h a l l b e p a i d o u t to d o c t o r s , d e n t i s t s , hospitals,

and other eligible caregivers and providers by the single

p a y - o u t g o v e r n m e n t a g e n c y , or t h e a u t h o r i t y , o n a 、、pay—as —

we-g〇〃 b a s i s ;

(12) 、、Pay一as一we一g〇〃一 h e a l t h c a r e f u n d i n g is r a i s e d e a c h ongoing

m o n t h a n d i n s u r a n c e c l a i m s a r e paid—out as s o o n as

p r a c t i c a b l e , for t h o s e n e e d i n g m e d i c a l l y necessary

healthcare;

(13) " U n i v e r s a l h e a l t h c a r e p r o v i s i o n f u n d " - t h e universal

h e a l t h c a r e p r o v i s i o n f u n d is f u n d a m e n t a l t o t h e single—

p a y e r u n i v e r s a l h e a l t h c a r e s y s t e m a n d is u s e d b y t h e

a u t h o r i t y to collect and pay out h e a l t h c a r e insurance

claims and global budget funds to institutional providers

on a p a y - a s - w e - g o b a s i s or t o b e a l l o c a t e d a s n e e d e d into

http://www.capitol.hawaii.gov/sessioncurrent/Bills/HB 1598 .htm 8/27/2007

HB1598 Page 11 of 16

the universal healthcare provision fund healthcare pay-outs

reserve. P a r t of t h e p u r p o s e o f t h e r e s e r v e f u n d is t o

provide retraining grants. T h e o t h e r p a r t is for

healthcare related contingencies to b u i l d capital

improvement support funding;

(14) " F i s c a l f i r e w a l l " - m e d i c a l l y n e c e s s a r y is t h e operative

term throughout Hawaii's single-payer universal healthcare

s y s t e m ; b u t , n o w h e r e m o r e so t h a n in r e g a r d t o t h e funding

of the s y s t e m . The autonomous authority oversees and

maintains the universal healthcare provision fund, which is

completely i n d e p e n d e n t of the state budget;

(15) " C e n t r a l u n i f i e d e l e c t r o n i c h e a l t h i n f o r m a t i o n system

database" The State of H a w a i i single-payer universal

healthcare insurance system collects and maintains i n real—

t i m e a n up—to—the—minute s i n g l e c e n t r a l d a t a b a s e for

comprehensive, complete, and accurate electronic healthcare

information. T h i s is a v e r y s i g n i f i c a n t m a j o r s o u r c e of

savings and cost—containment which makes the low—cost

f i n a n c i n g of c o m p r e h e n s i v e single-payer universal

healthcare possible. T h i s u n i f i e d high—tech health

information system, for instance, enables:

(A) Accurate future projections/

(B) Unprecedented planning and cost—containment

capabilities;

(C) E a r l y d e t e c t i o n of m e d i c a l m i s t a k e s , m a l p r a c t i c e and

fraud; and

(D) Early system-wide s h a r i n g of e m e r g i n g "best

practices";

http://www.capitol.hawaii.gov/sessioncurrent/Bills/HB 1598 .htm 8/27/2007

HB1598 Page 12 of 16

(16) " C o u n t y h e a l t h c a r e r e v i e w b o a r d s " 一 c o u n t y h e a l t h c a r e review

boards are elected, independent bodies established by each

c o u n t y g o v e r n m e n t — a l o n g t h e l i n e s of O a h u ' s elected

n e i g h b o r h o o d b o a r d s y s t e m — to c o n t i n u o u s l y monitor

h e a l t h c a r e c o n d i t i o n s in t h e i r r e s p e c t i v e c o u n t i e s to

a s s i s t t h e a u t h o r i t y in m a k i n g t h e S t a t e of Hawaii's

s i n g l e - p a y e r u n i v e r s a l h e a l t h c a r e i n s u r a n c e s y s t e m rit t h e

s p e c i f i c h e a l t h c a r e n e e d s of e a c h island;

(17) " R e t r a i n i n g f u n d " — a r e t r a i n i n g f u n d is c o l l e c t e d as p a r t

of t h e u n i v e r s a l h e a l t h c a r e p r o v i s i o n f u n d . The purpose is

t o p r o v i d e c o s t — e f f e c t i v e f u n d i n g for h e a l t h r l e l d workers

d i s p l a c e d b y t h e t r a n s i t i o n t o t h e single—payer universal

healthcare system;

(18) " G l o b a l b u d g e t s " 一 t h e a u t h o r i t y p a y s e a c h hospital,

community health clinic, home-care agency, and long-term

c a r e f a c i l i t y an a n n u a l or m o n t h l y g l o b a l l u m p s u m t o cover

all operating expenses 一 that is, a global budget.

Hospitals,long-term care facilities, and home-care

a g e n c i e s , a n d t h e a u t h o r i t y n e g o t i a t e t h e a m o u n t of these

p a y m e n t s a n n u a l l y , b a s e d on p a s t e x p e n d i t u r e s , previous

financial and clinical performance, projected changes in

l e v e l s of s e r v i c e s , w a g e s a n d i n p u t c o s t s , a n d p r o p o s e d new

and innovative programs. Hospitals, long-term care

f a c i l i t i e s , and h o m e - c a r e agencies m a y not b i l l for non-

operating expenses. Hospitals, long-term care facilities,

a n d h o m e - c a r e a g e n c i e s m a y n o t u s e a n y of t h e i r operating

b u d g e t for e x p a n s i o n , p r o f i t , e x c e s s i v e executives'

i n c o m e s , m a r k e t i n g , o r m a j o r c a p i t a l p u r c h a s e s or leases.

http://www.capitol.hawaii.gov/sessioncurrent/Bills/HB 1598 .htm 8/27/2007

HB1598 Page 13 of 16

Major capital expenditures come from the universal healthcare

provision fund, but w i l l be appropriated separately based

upon community needs.エnvestor—owned hospitals will be

c o n v e r t e d t o not—for—profit s t a t u s , a n d t h e i r owners

c o m p e n s a t e d for past i n v e s t m e n t . Global budgets for

institutional providers eliminate billing, while providing

a predictable and stable financial support;

(19) " L i f e t i m e i n d i v i d u a l i d e n t i f i c a t i o n n u m b e r " 一 the authority

systematically registers each and every Hawaii permanent

r e s i d e n t with an a s s i g n e d lifetime identification number so

that they are c o v e r e d b y the system and issues to them a

single-payer universal healthcare system healthcare user

card. A l s o , t h i s is t h e f i r s t s t e p in b r i n g i n g a l l of

Hawaii's healthcare information into one secure, constantly

updated, central unified electronic, computerized health

information system database; and

(20) " H e a l t h c a r e r e g i s t r a t i o n cards" 一 eligible healthcare users

of t h e S t a t e o f H a w a i i s i n g l e — p a y e r u n i v e r s a l healthcare

insurance system shall register with the system and be

issued a lifetime individual identification number and a

healthcare registration card to be able to access system

healthcare. N e w b o r n c i t i z e n s w i l l be r e g i s t e r e d at birth,

in m o s t c a s e s b y t h e f a c i l i t y w h e r e t h e b i r t h occurs.

§ 一 4 State healthcare insurance planning and financing

authority. (a) T h e r e is e s t a b l i s h e d w i t h i n t h e d e p a r t m e n t of

t a x a t i o n , for a d m i n i s t r a t i v e support purposes, the elected autonomous

a u t h o r i t y , t o d e t e r m i n e t h e c o s t s of t h e s y s t e m , a n d t o g a t h e r the

needed rinancing methods and transition mechanisms, including the

http://www.capitol.hawaii.gov/sessioncurrent/Bills/HB 1598 .htm 8/27/2007

HB1598 Page 14 of 16

r e t r a i n i n g of a f f e c t e d personnel.

(b) The State of H a w a i i o f f i c e of e l e c t i o n s shall prepare and

execute all the necessary p r o c e d u r e s f o r t h e e l e c t i o n of a authority

members in t h e 2 0 0 8 e l e c t i o n s in a c c o r d a n c e w i t h this Act.

(c) Trustee-members of the a u t h o r i t y s h a l l be chosen through

statewide election. T h e a u t h o r i t y shall be c o m p o s e d of seven voting

t r u s t e e - m e m b e r s , and meet the same age and state residency

r e q u i r e m e n t s as c a n d i d a t e s for the state senate. There shall be one

trustee-chairperson member elected with no county residency

requirement. All trustee-members shall be elected by voters

statewide for terms of six y e a r s each; e x c e p t that the terms of the

six non-chairperson t r u s t e e m e m b e r s in t h e f i r s t e l e c t i o n s h a l l be:

(1)Two each for t w o , four, and six y e a r s , r e s p e c t i v e l y , with

each s e a t 1 s i n i t i a l t e r m of t w o , f o u r , o r s i x y e a r s being

d e t e r m i n e d b y l o t t e r y c o n d u c t e d b y t h e o f f i c e of elections；

(2) T h r e e of t h e n o n - c h a i r p e r s o n trustees shall be residents of

the city and c o u n t y of Honolulu; and

(3) Three, one each, shall be a permanent r e s i d e n t of Hawaii

county, Kauai county and Maui county, respectively.

(d) Effective Wednesday, November 5, 2 0 0 8 , the a u t h o r i t y , as

soon as p o s s i b l e upon t a k i n g o f f i c e shall m o v e to o r g a n i z e according

t o t h e p r o v i s i o n s o f t h i s A c t a n d in t h a t p r o c e s s t o a s s u m e the

f u n c t i o n s of the state h e a l t h p l a n n i n g and d e v e l o p m e n t a g e n c y , which

are h e r e b y t r a n s f e r r e d to the a u t h o r i t y , as w e l l as the

responsibilities a s s o c i a t e d w i t h b e i n g t h e n e w S t a t e of Hawaii

liaison with the centers for medicare and medicaid services and other

federal healthcare a g e n c i e s , and to assume p r e p a i d health care act

functions and the Hawaii employer union health benefits trust fund.

http://www.capitol.hawaii.gov/sessioncurrent/Bills/HB 1598 .htm 8/27/2007

HB1598 Page 15 of 16

The latter two functions shall be maintained intact and stable until

the full i n t e g r a t i o n of each into the s y s t e m can be c o m p l e t e d b y the

authority.

(e) The authority in t h e s p i r i t of a n d w i t h i n t h e p a r a m e t e r s of

the twenty functional-concepts listed herein for Hawaii's single-

payer universal healthcare system, shall:

(1)Start-up a n d m a i n t a i n a t r u s t f u n d c o m p r i s e d of a p a y - a s -

we—go t r a n s f e r p a y m e n t s s y s t e m a n d c o n t i n g e n c i e s and

restraining reserve fund;

(2) Negotiate and receive all federal, state, and other

appropriate healthcare revenue;

(3) Assess temporary progressive income and general excise

surtaxes f o r s t a r t - u p a n d o n - g o i n g m a i n t e n a n c e of the

system, based on the m e d i c a l l y n e c e s s a r y requirements of

healthcare for all H a w a i i residents; and for emergency

costs as n e c e s s a r y , for i n s t a n c e , d u r i n g e p i d e m i c or other

medical catastrophe;

(4) Be the single-payer of u n i v e r s a l h e a l t h c a r e financing (the

one payout agency) f o r Hawaii,-

(5) Hire a chief executive orricer who will be accountable to

the authority trustees for the d e v e l o p m e n t and s u c c e s s of

the single-payer universal healthcare system; and

(6) C o n d u c t a c o n t i n u o u s a n d o n g o i n g p r o g r a m of enrollment.

(f) The c o n c u r r e n c e of a m a j o r i t y of a l l m e m b e r s shall be

n e c e s s a r y to m a k e a n y a c t i o n of the a u t h o r i t y valid.

(g) The s a l a r y of the e x e c u t i v e d i r e c t o r shall be $ a

year and the s a l a r i e s of the a u t h o r i t y c h a i r p e r s o n shall be $

a year, and the other member-directors shall be $ a year."

http://www.capitol.hawaii.gov/sessioncurrent/Bills/HB 1598 .htm 8/27/2007