1. This research is funded in part through a U.S. Health Resources and Services Administration, State Planning Grant to the Hawaii State Department of Health, Prime Contract No. 1 P09 OA 00046-01. Sub-Contract Research Corporation of the University of Hawaii, Project No. 659075. Research conducted by the University of Hawaii, Social Science Research Institute in collaboration with the Hawaii State Department of Health, Hawaii Institute for Public Affairs/Hawaii Uninsured Project and the Hawaii Health Information Corporation. Insuring Workers Not Covered by PHCA Carol Murry D. William Wood Heather Young Leslie With: J.D. Baker, Jill McGrath Jones, Jin Young Choi, and Evern Williams University of Hawai'i at Mānoa Hawai'i Coverage for All Technical Workshop IV September 26, 2003

2. September 26, 2003 Preliminary Results – Not for Quotation, Citation or Further Dissemination Insuring Workers Not Covered by PHCA The Importance of the Workplace as a Source of Health Insurance In general, 90.7 percent of the residents of Hawai'i are insured for health care compared to 85.4 percent of Americans Of those who are covered for private health insurance (non- government) in Hawai'i 93.2 percent were covered through employment based plans in 1999. Of those who are employed in Hawai'i, 79 percent are insured through their employer compared to 72.2 percent nationally

3. Workers Uncovered by PHCA Workers earning less than 86.67 time minimum wage/month or $542/month Part-time workers - less than 20 hours/week for one employer Government employees, self employed, commission-only, seasonal Employees covered under collective bargaining September 26, 2003 Preliminary Results – Not for Quotation, Citation or Further Dissemination Insuring Workers Not Covered by PHCA

4. September 26, 2003 Preliminary Results – Not for Quotation, Citation or Further Dissemination Impact of PHCA Compared to the U.S. as a whole, Hawai'i has: Higher percentage part-time workers Lower unemployment rate Lower percentage uninsured

5. Uncovered Workers Part-time Self-employed Other ineligible Insuring Workers Not Covered by PHCA September 26, 2003 Preliminary Results – Not for Quotation, Citation or Further Dissemination

6. Interviews of Self-Employed Total number interviewed = 40 Business owners - 16 Contractors/sub-contractors - 10 Workers by the job - 14 Insuring Workers Not Covered by PHCA September 26, 2003 Preliminary Results – Not for Quotation, Citation or Further Dissemination

7. Characteristics of Sample Equal number males and females Age distribution 0 – 19 1 20 – 34 4 35 – 44 10 45 – 54 15 55 – 64 10 65 + 0 September 26, 2003 Preliminary Results – Not for Quotation, Citation or Further Dissemination Insuring Workers Not Covered by PHCA

8. Socioeconomic Groupings Highest15 Mid11 Lowest14 Insuring Workers Not Covered by PHCA September 26, 2003 Preliminary Results – Not for Quotation, Citation or Further Dissemination

9. What They Told Us Worry more about coverage as they are aging Don’t want to overuse services or take charity Self-treatment is common Insuring Workers Not Covered by PHCA September 26, 2003 Preliminary Results – Not for Quotation, Citation or Further Dissemination

10. What They Say They Can Afford Highest$150 - $380 MidUnder $100 LowestNothing Insuring Workers Not Covered by PHCA September 26, 2003 Preliminary Results – Not for Quotation, Citation or Further Dissemination

11. Impact of Lack of Coverage Health Untreated/self-treated injuries and illnesses Suffering No prevention, screening Access No medication, or under-dosage Avoid use of services Costs Medevac, ER, kidney transplant Debt Insuring Workers Not Covered by PHCA September 26, 2003 Preliminary Results – Not for Quotation, Citation or Further Dissemination

12. Recommendations from Self Employed Reasonable premiums Focus on prevention and health education Provide choice in coverage and services Monitor quality Consider Canada and NZ models Develop program for small businesses Other concerns – Native Hawaiians, aged, pre-existing condition, immigrant, shifting employment, incentives for healthy We would add to maintain safety net and avoid “charity”. Insuring Workers Not Covered by PHCA September 26, 2003 Preliminary Results – Not for Quotation, Citation or Further Dissemination