Hawaii’s chronic shortage of health care professionals has plagued our state for decades. On the neighbor islands, we need nearly twice as many doctors as we currently have to provide adequate access to care, according to a University of Hawaii study. This shortage is worsened by the burdensome practice of Prior Authorization, where insurance companies require approval before care is provided.
PA creates a significant barrier for physicians, forcing them to spend countless hours filling out forms and fighting for approval to provide care that they believe is necessary for their patients. This practice not only delays or denies critical care, but it also places unnecessary strain on our health care professionals, further exacerbating our shortage of providers.
In Hawaii, physicians and their staff currently waste an average of 20 hours per week on PA requests and appeals, according to the Hawaii Pacific Basin Area Health Education Center. This is time that could be spent caring for underserved patients who need attention. As 42% of doctors report serious adverse events in their patients due to the PA process, it is clear that this practice is not just inefficient but harmful.
Prior Authorization is an administrative process wherein health insurance companies withhold approval for necessary treatments, despite being recommended by qualified health care professionals. Research on this practice, especially here in Hawaii, suggests it contributes to a cycle of inefficiency, hurting both patients and providers. Studies show no compelling evidence that PA improves patient outcomes or reduces overall health care costs. In fact, Medicare Advantage programs, which heavily rely on PA, cost the government significantly more than traditional Medicare, which does NOT require or use PA.
However, there is hope. Currently, legislation is being considered in Hawaii to address these systemic issues. SB1449-SD1-HD2 and HB250-HD2-SD2 are under debate, with provisions requiring insurers to report their PA programs to the State Health Planning and Development Agency and create a workgroup to develop fairer, more efficient alternatives. These bills represent a critical first step in reducing the administrative burden on health care providers and improving access to care for patients.
Dr. David Rosenbloom, professor emeritus at Boston University’s School of Public Health, has long questioned the efficacy of PA. Rosenbloom, who helped create the early prior authorization programs, now points out that over 40 years of research show no evidence that PA improves care or reduces health care spending. Instead, PA often results in increased overall costs and adds to provider burnout.
“Prior authorization might save insurers money in the short term,” Rosenbloom explains, “but it leads to higher long-term costs and contributes to a broken system.”
Given Hawaii’s severe health care workforce shortages, especially on Maui, the Big Island and Kauai, Rosenbloom has proposed a temporary suspension of prior authorization on the neighbor islands. By suspending PA and studying its effects on patient care, provider access, and insurance company practices, we could potentially improve provider availability, reduce delays in care, and re-establish Hawaii as a leader in progressive health care reform.
Rep. Terez Amato (South Maui), a ranking member of the House Health Committee, expressed support for such reforms, stating, “health care is a human right. We must work closely with medical providers to reduce unnecessary burdens and ensure patients get the care they need without costly or dangerous delays. Our goal should be data-driven decisions that minimize costs, improve patient outcomes, and address critical health care shortages.”
In addition, the Hawaii Island Chamber of Commerce has voiced its support for reducing prior authorization’s impact on the health care system. “Prior authorization, in its current form, creates unnecessary delays and administrative burdens that negatively affect physicians, patients, and employers,” said Executive Officer Carla Kuo. “A more balanced, transparent, and collaborative system will streamline care delivery, reduce workforce burnout, and ultimately lower long-term costs.”
While the bills currently under consideration represent an important first step, it is crucial that we act urgently. Rosenbloom’s proposal to suspend prior authorization on the neighbor islands is an innovative, immediate action that could provide valuable insights into the direct impacts of PA on health care access and quality. This approach would allow us to collect the necessary data to inform permanent reforms and potentially lead the nation in demonstrating how reducing unnecessary administrative hurdles can improve health care delivery.
Hawaii has always been a leader in health care innovation, from the passage of the Prepaid Health Care Act in 1974, to our proactive approach to addressing the needs of underserved communities. By making bold decisions now, we can once again position Hawaii as a trailblazer in providing high-quality, accessible health care to all of our residents.
Lisa Rantz is executive director of the Hilo Benioff Medical Center Foundation.
Terez Amato is a state representative for South Maui.
