Hawaii Health Connector

» see hawaiihealthconnector.com as it lived, on the wayback machine

~ the obit ~

Health insurance in Turkey is a state scheme you are enrolled into rather than a product you shop for, so the American arrangement where you visit a website and compare plans has always struck me as a strange errand to put on citizens. Hawaii built one of those websites. It cost $205 million in federal money and lasted two years.

The Affordable Care Act let states run their own insurance marketplaces instead of using the federal one, and Hawaii took the option. CGI Group got the build contract, worth about $53 million, which is the same firm whose work on healthcare.gov became a national story that autumn. Enrollment opened on 15 October 2013. By 28 December the Connector had signed up 2,192 people, fewer than any other state in the country.

It never recovered from that start. The board accepted the state's closure proposal on 5 June 2015, small-business enrollment stopped on 15 June and individual enrollment on 30 September, and the migration of existing customers to healthcare.gov finished on 15 October. Governor David Ige announced on 20 November that the remaining operation would be wound up early. The Connector worked its last day on Friday 4 December 2015.

~ the rap sheet ~

~ the math that never worked ~

The law that created these exchanges also required them to be financially self-sustaining by 2015, funding themselves out of fees charged on the policies sold through them. That works if you sell enough policies. Hawaii was not going to, and the state legislature declined to put up roughly $28 million to keep the thing breathing while it tried. Federal grant money could pay to build an exchange but was not allowed to pay to run one, so the day the grants ran out was always going to be the deadline.

~ the island problem ~

Hawaii was the worst possible state for this, and had been since 1974. The Prepaid Health Care Act passed that year requires employers to provide a health plan to anyone working twenty hours a week or more, and it has been in force ever since. Before it passed, about 30 percent of the state was uninsured. By 2013 Hawaii had the lowest uninsured rate in the country, somewhere near 4 percent.

So the Connector was built to serve the people a forty-year-old state law had already covered. Nearly every small employer that might have used the business marketplace was buying insurance for its staff anyway, because it was legally required to. Around 38,000 people enrolled over the exchange's life and only 8,200 of them ever paid a premium. A state exchange funded by a cut of its own sales needs customers, and Hawaii had spent four decades making sure there were almost none.

~ what was left ~

Three executive directors ran it in two years. Coral Andrews resigned in December 2013 and Tom Matsuda held the job on an interim basis after her. Jeff Kissel arrived in 2015 to manage the shutdown. Kissel's line on the way out was "We saved a bunch of lives," which given the enrollment figures is both defensible and a long way from what $205 million was meant to buy. All 33 staff positions were gone by 1 May 2016.

The domain is still registered. Visiting hawaiihealthconnector.com today returns 114 bytes of JavaScript whose only job is to bounce you to a parking page.

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