 Aloha welcome to think tech Hawaii's movers shakers and reformers. This is the politics in Hawaii series. I'm your host Carl Kampanya We had originally scheduled to have representative Angus McKelvie here today to talk about legislative Committees how they work how they're organized and so forth due to An unfortunate communication error. He were gonna have to get him scheduled for another time. So Instead I actually am thrilled to say that we have a Mr. DeFi Dale here And we're gonna talk about a few different things. We're gonna actually I'm gonna try to have this conversation be about Healthcare healthcare has been a topic that's been coming up and it's The subject of a few bills and a few resolutions that are being put out I'm trying to help where I can with some of that, but it's a big picture I know we're worried many of us not really maybe but we're worried about what's gonna happen with the affordable care act Perhaps being dismantled one piece at a time or our wholesale. We don't know Biggest questions we have is well, what are those impacts? What are those impacts gonna be for the state of Hawaii? What happened? Where were we? How did we get involved and engaged and all that stuff? So let's just have a conversation about what you're aware of and we'll sort of discuss How all of this kind of fits together some of the bits and pieces that I've been able to pull together the last several days You know, you said you were worried and I'm worried too And a lot of people are worried, but not everybody is worried about the repeal of Obamacare I just came from a meeting in which a small business man told me that his Insurance since Obamacare went into effect his health insurance for his people went up 62% 62% that's here in Hawaii small business since when since Obama care went into so since 2010 Yeah, it's gone up 62%. Yeah. Wow. Okay, and he's really furious about it Yeah, I mean mind you this particular fellow is on the on the Trump side of the polarization Okay, and I think there's a lot of polarization about Obamacare, too Yes, so it's it's not, you know, a unilateral concern or rather, you know one sided one one side only type concerned There are people concerned on both sides There are people who want to see Obamacare repeal as soon as possible a lot of them happen to be in the Republican Congress Right, but there are other people, you know, obviously like you and me that are very concerned about it because we see an Irresponsible move happening here a move that will leave a huge vacuum a vacuum that will affect people's lives and And there will be there will be serious medical problems Unresolved, you know with insurance for a lot of people and they will die. Yes This is a serious problem for the country, you know, not only in domestic, you know Context but in the world looking at us. Yes We're pledging, you know from one side to the other here. We can't seem to make up our minds I think a lot of people in Europe and Asia look at us and say, you know, we can't we can't we get we eat the Cliff every year we get people fighting in Congress locking up with filibuster What have you and now we have this huge engine of health care that we're gonna repeal after only a few years Terrible polarization when we're not even you know of all of the I guess What you consider the high level of civilization way of first tier first class civilizations or countries out there First world we're one of the only that doesn't actually have a universal health care system and The the Obamacare which will make it very clear Obamacare and the Affordable Care Act are the same thing Not everyone actually knows that That's as close as we've gotten nationally and Okay, we've been able to get or through that 20 million more people actually have health care There are a number of things that are that could be better with it But there are there are some important factors number one more people are actually covered Which means we're saving money at the emergency room Because fewer people have to go to the emergency room because they otherwise didn't have a choice And so that's a good thing. Well beyond that there's the whole spectrum of Inclusions and requirements that that the insurance companies are not allowed to just cut you or not pay for this or not pay for that or not address a Pre-existing condition and those things are important and there have been a number of studies done national studies that have been done That have indicated anywhere from 69 to 85 percent of America of the people in America not Democrats not Republicans of the people Want to keep most if not all of the provisions that are within the Affordable Care Act So how do they cherry-pick the things that people want to keep? Get rid of the things that some people don't like and still have it function and have it not collapse Well, you know Congress where they make sausage and all that It's hard to believe that anybody is really figuring this out in a rational systematic way I mean it's being negotiated like sausage. Obamacare itself is 2,000 pages of statute You know that you have to understand it before you start picking the wings off And I think they're not doing that. They're moving so quickly And they don't have a replacement and even at the press conference, you know, Trump could not offer has not offered What might happen as a replacement? So I think the reality is they want to push this repeal through and they don't have a plan to replace it Did you see the and yeah, we're talking more national than local but we'll get to the local Well, there's local too because local is directly affected by what happens. Absolutely. It's absolutely is in fact We've already been impacted by that not necessarily positively actually but the Actual let's just ship. Let's go to that what we have here. We have our prepaid system is what we've had here for Since the 70s, right? There's a few tweaks of modifications that were made, but it's what we had and It was in 2010 that the Affordable Care Act passed and then it was up to each state to implement or not and It was Governor Abbacrom. You said yes, we're gonna implement it So therefore it superseded the system that we can't that we had and we were one of the states that already had the System we had a very good it was best in the country exactly exactly Capita per capita. We had more people covered per capita than in the other state and and that was with that old prepaid system Well, we had to forego that we had to let that go in order to accommodate and it was you know Some of that was you know how politics works you take care of your friends to a certain extent Which I don't I don't think that that's always the best option But let me let me give you a scenario Carl and just see what you say Suppose Congress in its infinite unwisdom You know just repeals of all care. It doesn't exist the whole thing goes away the whole statute the thousand two thousand pages goes away Why can't the Hawaii legislature? I mean I wish Bob toy of hooker were here. He would help us He was here yesterday. You know we were discussing this So it's repealed to the federal level. Why can't Hawaii simply reinstate? Go back to the prepaid care system and put that statute if it's not if it's no longer on the books Then put it on the books if it is on the books and was superseded then start following it again Yes, apparently there's a series of waivers that are going to be needed in order to accommodate that and that includes antitrust waivers that includes a Medicare waivers social security waivers. I mean there's and that's part of the problem. These are federal requirements that in order for us to Let go of it and go back to what we wanted. We need a series of waivers that people are going to fight over So we're and that's one of the challenges that we have next week Marcia Rose joiner is going to have mr. Steven Campbell on who was at one time the head of Hawaii Health Association I'm and she's going to talk to him about her her piece of what she's doing Perhaps the following week or somewhere thereafter I'm going to have them out and I'm going to talk with them specifically about the politics of this Where it is what the recommendations have been from HHA going back a number of years ago And just give a real good analysis of where we are What that pathway can and should be and what legislature can do about it and should do about it now now one of the things is in Jumping we're jumping around a little bit here, but one of the things is HHA is currently not funded They were it that should tell them what HHA okay HHA is the Hawaii Health Association in 2009 the bill passed Legislature got put in front of Governor Lingle. She vetoed it Legislature came back overrode her veto. We have a Hawaii Health Association she didn't fund it and Didn't appoint anybody for it. There's up to nine positions to be appointed And this is a group whose intention is to assess our medical system make it better and Create the pathway Ultimately towards a universal Medicare for all type of system. Well, they were able to get some of that done Later, but that's because the following year before Affordable Care Act came into place ever come he came into office and he appointed eight people of the nine Those eight people started to work on it and they came up with a pathway then the Affordable Care Act came in and they got cut again and There are three remaining volunteer members that are there that we still are trying to ring the bell and it's not funded and But it's already an HRS. It's already approved. It's there We just need to have a line item in the budget and we really only need a couple hundred thousand dollars when you look at it 13.5 billion dollar budget a couple hundred thousand dollars Isn't that much relatively one of the problems is if this repealed by the way the repeal is not guaranteed because you can see fractures already within a Republican Party and you know, there's some of the Republican senators are getting Telephone calls at the rate of ten thousand a day Opposing repeal, right? So, you know, the country is up in arms about this and that polarization is playing out You know, you know in both ways it is the top five states and this is important to know, you know President-elect Trump, soon to be President Trump Won a lot of states the top five states or I should say the top five Affordable Care Act usage States are all red states that Trump won So if they just repeal it wholesale every one of those states are gonna everybody that is In currently enjoying or whatever who is currently engaged and enrolled. It's just gonna be taken away I don't know if they realize that I mean, it's a big it's a big point of self-interest for them. Absolutely absolutely So anyway, so we're not sure it's gonna be repealed, but let's assume for this discussion is repealed You know what what I get and what everybody should get is this going to be very disruptive Yes, not only in those red states, but everywhere. Yes, because then you have to act quickly If there's no replacement plan no transitional period, which I suspect will be the case If they win the repeal Places like Hawaii are gonna have a terrible time and they're gonna have to act very quickly or there will be gaps in coverage Absolutely, and this is the point of contention within the GOP at the moment on that as well So we just take a quick break and then we're gonna come back and then we're gonna jump in on that a little bit So thank you again for joining us. This is think tech Hawaii's movers shakers and reformers politics in Hawaii series I'm here with my guest today J. Findell. We'll see you in a minute. Thanks Aloha, my name is Josh Green. I serve a senator from the Big Island on the Kona side And I'm also an emergency room physician. My program here on think tech is called health care in Hawaii I'll have guests that should be interesting to you twice a month We'll talk about issues that range from mental health care to drug addiction to our health care system and any challenges that we face here in Hawaii, we hope you'll join us again. Thanks for supporting think tech Hi, this is Jane Sugimura I'm the co-host for condo insider and we're on think tech Hawaii every Thursday at 3 o'clock and we're here to talk about condominium living and Issues that affect condominium residents and owners, and I hope you'll join us every week on Thursday. Aloha Hi, I'm Chris Ethan with think tech Hawaii, and I'd like to ask you to come watch my show the economy in you each Wednesday at 3 p.m Let's see reliability. Aloha. Welcome back to think tech Hawaii's movers shakers and reformers politics in Hawaii series I'm your host Carl Kampania. Welcome again J. Findell. We're talking health care here. So, okay Talking about what they're trying to do and how they're trying to do it one big thing that the that the Republicans have been railing on and Democrats also should be worried or any concern about this is our national debt and our deficit our deficit currently sits at 19 trillion dollars Well, what we've got at the moment is what what a bill that was just posed and I believe passed on party lines Last week in the house. No Senate was A bill called the Obamacare repeal act It passed at least on at least some level And I've read through this bill and it very clearly states Very almost nothing about Obamacare. What it says is This is what the budget will look like after we repeal Obamacare And when you get to page five and page six It explicitly lays out how the budget And the deficit is going to increase by 10 trillion dollars To 29 trillion dollars within 10 years with the repeal thanks to the repeal of Obamacare That's self-defeating. Who's going to buy into that? Why would anyone buy into that? But you know what they get to do if they get to pass any legislation that says Obamacare repeal bill They get to tell everybody we kept our promise If they even pass a bill that says yes, we've repealed it But we're going to postpone it for two three four years until we have that exact correct replacement They still get to say we kept our promise That's crazy. Let's remember that's how politics works as well It's really sad. It is sad And he claims it's a mandate Who claims it's a mandate? Trump claims that the people told him The people told him to repeal it. He told me he was going to do it They voted for him and therefore it's a mandate Yeah, well and therefore that again you want to you want to make it happen You create a bill that says we're repealing it wholesale And we're going to replace it in the future in which case we get to say we did that Well, he said repeal and replace repeal and replace until he kind of had to amend that a little bit Disruptive Disruptive exactly it's totally damaging to the not that you want to talk about the rural people and the working class people And everyone who is struggling paycheck to paycheck week to week You attack this you take this down And that's we're not even getting to medicare medicaid and social security You attack just the affordable care act and everybody loses what they currently already have It'll make some people happy, but who is it really going to make happy insurance companies It's going to make insurance companies happy And and that's the whole other thing that we can jump into a little bit as well Um You'll learn a little bit when we get him here, but Stephen Kemble says So hawaii health association coming back locally He said that the single largest other than pharmaceuticals the single largest increase in medical costs in the past 20 years is a result of switching From fee for service To managed care Which means the insurance companies Manage your care, which means they are in charge and they dictate what you get and what you don't get how and when The doctors just administer on their side But the doctors have to spend all of their time filling out paperwork They call it charting in order to get paid and they can't do a lot of things They want to do because the insurance companies won't approve it exactly so therefore the administrative costs of Managed care from the mid 90s has been other than pharmaceuticals the single largest impact On health care costs nationally so That's an area to address That's an area to look at to say well, we need to yeah, let's go back to Globalized billing. Let's go back to Uh, uh fee for service We'll eliminate all of this extra layers of stuff But who's against that the insurance companies because the insurance companies are making billions of dollars as a result of this It's really big business. It's enormous business huge You know, I remember uh, I'm going to tell you uh, it was uh sicko Michael Moore's movie Oh, yeah, yeah, yeah, yeah that and it was really interesting because he revealed A lot of a lot of the legislators. I mean in congress who were working on health care issues They would the terms would expire or they would leave congress at some point and guess where they went to work They went to work in the health care insurance companies. Yeah, you know with this is sort of a payoff thing It's an issue there and a corruption issue if you will And he revealed and exposed that if we didn't know it before But I mean who's to say that that stopped happening. Well, it didn't stop happening. First of all and second of all the problem with that is um When you go back into the world of politics anytime any one of us attacks Politics or attacks anybody who is a politician You get discredited You have there's a campaign against you Then to discredit you and then for no matter what you think no one's going to listen to you anymore And that's exactly where we live right now with the general media and the discrediting of anything Anyone related to media or investigative reporting. We're not to trust them at all So what are we so what where are we supposed to go? How are we supposed to better understand this? How are we supposed to make decisions if we can't get information because most of us don't have the time I think the average person And uh, I might be an average person Yes, absolutely depressed about this. You make a statement that that I believe is credible But then the other guy says no, that's fake. Yeah, and so the You know the claim of fake news is met with a claim of fake news Right, so each side of it tries to neutralize the other side. This all happened recently Absolutely, this is in the the trump campaign happening every day So you actually don't know what to believe anymore So you you have to make new ground rules for yourself on how you find out things and what you believe And how you test on the messages that are given to you and you I mean more and more we live in a world where there are Lies, pardon me all around us. Yes, and what do we do? It's very confusing Exactly, exactly huge. So okay back. That's a big picture. Sorry healthcare. No, but I'm right there with you I agree with you. It's a problem. So healthcare. Well, let's go back locally again and say, okay a couple weeks ago a few weeks ago uh, governor egay Issued a waiver for small businesses as far as the Affordable Care Act is concerned Um In on initial levels. It's like, okay. Well, maybe that could be a good thing small businesses really should be treated differently Uh, there are other ways that we should address them small businesses need our help They don't need to be hurt. So how can we better address that? That's my position on it Uh, personally, so I was like, okay. Well, let's see what that is And then I started to get some business owners small business owners that are coming to me saying Well, wait a minute. Do you understand that what that means is we just lost our tax credits That the Affordable Care Act was providing us and this is for small for-profits as well as small non-profits just lost the tax credits Which means and they received and he sent me a letter said look this letter I received telling me that my rates as a result of this are about to go up 43 percent As a result of losing these tax credits that the Affordable Care Act was giving me So what is supposed to happen here? Is the governor is supposed to find the replacement For the for that for those tax credits to accommodate that. Well, that's what we're waiting for That's really complex Carl. That has been that's been waived and now we're waiting for the governor to repeat You know tax credits are like radioactive in this state You know, you got to approach them very carefully because people are suspicious of tax credits Any kind of tax credit and so, you know, it's not that we can launch into this On a what do you call it a a bill that has no content? Then what do you call that kind of bill? Oh, what are they? Container bill a shelf. Yeah. Yeah, uh, a short short bill. All right a short bill short bill Yeah, there's nothing in it. There's nothing in it and then in the middle of the ledge You know, you're supposed to file a bill, you know in december In the middle of the ledge we take off one of these shelf bills and fill it up with something And you know, that's really what's got to happen here because if obama care is repealed Then we have to make all kinds of quick changes in order to preserve, you know Continuous coverage for our own state citizens. Yeah. Yeah. Well the result could be really disastrous. It could be what we're looking at is is Yes, we have our state unfunded liability I won't go into all of that at the moment, but yes, we have that but that's impacted by this And we're talking about state employees governmental employees retired governmental employees who had been promised something And here we are not knowing what's about to happen and all of these bits and pieces of what this is Well medicare covers this portion of this medicaid can come in and handle this portion of this Uh, portable care act adjusted it this way Okay, well now what and who's paying attention to what that is And that's what we really need. We can't just sit there and assume as a state We can't just say well if they repeal it when they repeal it whatever they repeal it'll be fine We don't know what those impacts are going to be because no one is really looking at every one of those line items to see what that means And I think you know a repeal if it happens Could happen right in the middle of the session. Yeah You know those be fighting in filibuster and all this could happen right in the middle of the session and then we have You know the session is four months long. So Less than four months long actually So then we have a matter of weeks, you know, and then there's a break in the middle Yeah, and we have a matter of weeks to get our act together and figure out what they did what the effect of it is How that affects hawaii. Yeah, uh, what hawaii has to do not only in healthcare, but in these credits Um, and and figure out all the financial implications of that get the parties to the table go through the sausage process Can we do that? I doubt it actually carl. Well, it might require Uh, no one liked to hear this either, but it might require a special session devoted to that only that's what bob said Devoted to that. Yeah, and maybe we ought to you know start practicing start doing our homework Start figuring out what the options are what the issues are getting a team together Maybe the hh I come back to what I was saying who's supposed to be doing that hh a hawaii health association Right, it's got to be very astute group and they got to be very akamai. They got to have money They got to have resources. They got to have access Um, everybody has to cooperate with them. They got to figure it out in short order Yeah, this is not a likely of success. No, it's it's a problem and we need to be thinking about it now Not in three months six months or whatever. So no, it's a huge thing. So Um, what I want to do you mentioned something people are people are wary of tax credits people don't trust what tax credits are people They hear it and they walk away I want to find the right person to come in and I want to talk about tax credits from a policy perspective Here in hawaii what they really mean how they function how they should and could function I want to do that. So I'm going to find someone to come in and if you know someone Oh, my tax foundation Yeah, let's bring them in and I want to have that conversation so that we can learn what those tax credits Really are how they really work to try to remove some of the mystique around them Good idea. That's what I would like to do It's very important because legislative policy one of the most important things the legislature can do Is use tax policy as a way to effectuate a goal of some kind change conduct, you know, for example You can use tax policy To change people of fossil fuel, right, you know, absolutely and into photovoltaic exactly some other non-fossil fuel It initiates And builds opportunities for jobs. It can create jobs That those are you know, that's some of the tools there are others and businesses Frankly, businesses are the things that create jobs. Exactly. So you want to create businesses tax credits Sometimes creating tax credits creates an industry and that's what the one of the bills that's going to be introduced is Or one of the resolutions going to be introduced That I got to be a part of is the hawaii green fuels initiative Which is all about saying, you know what? This is a jobs thing. This creates a job This what this does is it takes over where the sugar cane industry Stopped we can now get all of these people jobs through a biofuels industry. So we are out of time So but I'd like to continue talking. Thank you for joining us This is to think tech hawaii is movers shakers and reformers politics in hawaii. Thank you to jay fidel Thank you to think tech hawaii. Thank you to the entire staff crew next week i've got Someone or a couple of people that I think are going to be amazing to talk to specifically we're going to talk about