Hawaii has reined in its Quest basic health insurance program because of high enrollments, but it isn't backing away from its goal of universal coverage, officials say.
An article published in American Medical News said the number of uninsured in Hawaii is growing and claimed the state is retreating from a promise to extend some form of health insurance to all residents.
But a spokeswoman for the Quest program, Barbara Bianchi Kai, said universal coverage is "still a goal. We're trying to make it affordable."
Since 1974, the state has aimed at universal coverage by requiring employers to offer health insurance to employees who work more than 20 hours a week. The Quest program, approved under a Medicaid waiver from HCFA in July 1993, was designed to cover the rest of the population-Medicaid and other state-subsidized insurance recipients-through capitated managed care.
About 32,000 elderly, blind and disabled recipients remain in fee-for-service Medicaid in the state. Half will be phased into Quest next year, Kai said.
While officials expected an enrollment of 115,000 in Quest, the program reached a high of 163,000 members in March. That prompted the state to impose restrictions, she said.
In February, the state said it will not accept new Quest applicants-unless they are children or pregnant women with incomes up to 185% of the poverty level-until enrollment drops to 125,000.
Adult dental benefits were reduced to include only emergency coverage. Beginning in April, those with incomes above 100% of the poverty level have to pay the full monthly Quest premium rather than paying according to a sliding scale. The premium, which varies by island, is $167 on Oahu, Kai said.
In addition, a new asset test requirement, imposed not to contain costs but as a result of a legal challenge to the program, indirectly "caused some people to fall out of Quest," Kai said.
To provide a safety net for those who don't qualify for Quest, the state developed Quest Net, a program that admits those with greater assets but provides a smaller benefit level for a smaller monthly premium, she said. There is a cap of 40,000 enrollees on the Quest Net program, "but we haven't come close to that," Kai said.
So far, Quest Net has enrolled 10,000 and Quest enrollment has dropped to 147,000.
Proposals have been made to reduce the benefit package in order to cover more people. The state doesn't keep statistics on those who can't afford health insurance or who choose not to pay the premiums, Kai said.
Effective July 1, the state began paying the five plans in the Quest program at the lowest capitated rate, which was set by Queens Hawaii Care, an HMO. The Quest capitation rate for all plans ranges from $139.07 to $156.56 per enrollee per month, depending on the island.
The other plans are AlohaCare, Kaiser Permanente, StraubCare Quantum and Hawaii Medical Service Association, a Blues plan.
That's "one of the more significant changes" to the Quest program, said Doug Murata, a Honolulu consultant. "Functioning at the lowest level of reimbursement, Queens made some money. So it's clear to me that their risk model is working successfully."
To succeed in Quest, the other plans-especially Hawaii Medical Service Association, which still pays providers mostly through discounted fee-for-service-will "really have to be serious about managed care," Murata said.