Change in the air

KAILUA-KONA — With uncertainty over the nation’s health care system, the president and chief operating officer of the state’s largest insurer said he’s keeping an eye on how policy changes could affect coverage in Hawaii.

President-elect Donald Trump made a full repeal of the Affordable Care Act a day one priority for his new administration and the U.S. Senate has already taken preliminary steps to gut the law.

Trump, who takes office today, also said a replacement should come very soon after the initial repeal, rebutting an earlier proposition to “repeal and delay.”

But the real consequences and effects of any hypothetical replacement can’t be known until a plan is put forth with the support it would need to pass.

“If they replace … it depends what they replace it with,” said Michael Stollar of HMSA in a conversation with the West Hawaii Today editorial board. “So probably the single biggest thing we’re concerned about and we’re very anxious about is what they replace the ACA with.”

The effects of some proposals can be more easily mapped than others.

“Anything that cuts back funding to the system is a challenge,” Stollar said.

House Speaker Paul Ryan and Tom Price, Trump’s pick to lead the Department of Health and Human Services, have both backed a plan to convert Medicaid to block grants.

As of now, states and the federal government share the Medicaid costs through an assistance percentage, regardless of the total costs.

The Associated Press reported that supporters of block grants say the change would reduce spending.

But, Stollar said, the assumption is that Medicaid block grants would “be smaller block grants.”

And if cutbacks lead to thousands losing coverage, “that’s terrible for the system at several levels,” he said, and not just terrible for those who lose coverage.

They’ll still have health care needs that hospitals would still need to treat without reimbursement. Then, hospitals will need to make up for that cost on commercial plans, affecting employers who provide insurance to workers.

“It just strains the whole system,” he said. “It’s not good at all.”

Stollar also addressed another proposal, the idea of letting insurance companies sell across state lines.

Selling across state lines is something that Trump pitched during the second presidential debate against then-Democratic nominee Hillary Clinton.

“We have to get rid of the lines around the state artificial lines, where we stop insurance companies from coming in and competing,” Trump said at the time.

Stollar said selling insurance across states is not a problem for HMSA, but it could pose some problems.

The issue would be determining how interstate sales will accommodate for different state regulations for insurance sales.

One possibility is that a company’s “home state” regulations would trump those of the state it’s selling in, which could have drastic ramifications for the insurance marketplace.

“It would be a problem because there is a scenario where people could then come into a state and start selling cut-rate insurance with limited coverage,” he said.

For example, a company based in another state with very low regulatory standards could come into Hawaii and offer extremely cheap insurance at the cost of sky-high deductibles or minimal lifetime limits.

That could have the effect of overall reducing the quality of health care while still taxing the system in Hawaii.

Stollar also added that any national plan that affects the state’s Prepaid Health Care Act, which requires businesses to offer health insurance to employees who work more than 20 hours per week for four or more consecutive weeks, could also have severe impacts to the state’s health systems.

“Prepaid Health Care isn’t perfect,” he said, “but it has a history of ensuring broad and very deep coverage.”

In a 2016 report, the U.S. Census Bureau put the rate of uninsured Hawaii residents at 4 percent, among the lowest in the country, for the preceding year.

Meanwhile Stollar said, the company is looking at ways to build partnerships and improve Hawaii’s health and wellness as a community with actions that only take a buy-in from community leaders.

“We have a vision that we have for the entire system,” said Stollar.

That vision is “Mahie 2020.”

“In order to really create sustainability in health care, we need to improve the health of the population,” he said.

“Just paying for medical services when people are sick doesn’t impact health, and health really is driven by things much further upstream.”

It’s a different role for an insurance company, Stollar said, that moves beyond paying claims into being a key player in improving health and wellness for everyone.

It’s also an approach that requires a put-in from all of a community’s stakeholders: policymakers, employers, schools and others.

Last week, the company announced that West Hawaii would join North and East Hawaii as “Blue Zone” sites, where community leaders come together to pursue goals related to health and wellness.

The insurance company, meanwhile, can make an impact through its ordinary business of payment, Stollar said.

By incentivizing physicians to look at the health of his or her whole community, Stollar said they can encourage doctors to consider what their roles are in preventive care and health.

Changing that approach could push doctors to be more proactive about bringing patients in for preventive care-related tests and screenings.

Email Cameron Miculka at cmiculka@westhawaiitoday.com.