An estimated 50 percent of Hawaii's uninsured, or more than
58,400 people, are on the job, according to the University of Hawaii
Social Science Research Institute, which performed an extensive analysis
of the 1996 to 2002 Current Population Survey conducted by the U.S.
Census Bureau. Based on a 7-year average of the survey, the university
derived these numbers. Uninsured sole proprietors and
the self-employed represent about 11,800 workers.
Hard at Work but “Gambling” on
Part-Time Workers. Reasons for part-time
employment vary. Some people may prefer part-time employment,
such as parents with young children, college students,
and retirees who are too young to collect retirement
benefits or qualify for Medicare. Others are unable
to obtain full-time work, and rely on a series of part-time
jobs that total or exceed 40 hours per week.
Sole Proprietors. Sole proprietors
are not required to carry health coverage or workers
compensation. Also, they do not qualify for group health
insurance rates. Many who want coverage feel that purchasing
insurance is unaffordable.
Some Classes of Government Employees.
Government employees and workers covered by collective
bargaining are exempt from coverage under the Prepaid
Health Care Act. Government workers classified as “emergency”
or “temporary” hires are not covered by
collective bargaining—nor by the Prepaid Health
Cost of Group Coverage: Businesses Carry the Burden
The cost of health insurance has escalated rapidly in recent years.
According to the 2002 report “Health Care Costs: Trends and
Relationships to Insurance Premiums,” issued by the University
of California Academic Senate, “…insurers are now passing
on to their policyholders cost increases that they might have absorbed
in past years—and are adding to them in the process of improving
their bottom lines.”
of Prepaid Health Care Act provisions, Hawaii employers pay the
highest percentage of health insurance premium costs in the U.S.
According to the Medical Expenditure Panel Survey - a national survey
of health care use - the average Hawaii health care insurance premium
in 2000 was $184 per month, of which the average employee contribution
was $16 (8.6 percent). Nationally, the average total premium was
$221 per month, with employees paying an average of $37 (about 17
Some businesses have sought to avoid paying for employee benefits,
including health insurance, by increasing the size of their part-time
workforce (employing more workers at less than 20 hours per week)
and contracting more services to self-employed individuals.
Cost of Coverage: Individuals Carrying the Burden
The actual costs for privately obtained individual health insurance
vary and are difficult to come by, except anecdotally, because insurance
rate information is confidential.
Health Insurance Is a Luxury Many Individuals
A Hawaii mother with one child pays $325 per month
for an individual HMO plan. (With one more child, her
monthly premium would be nearly $500.) If she earns
the average monthly wage in Hawaii -- $1,702 ($2,432
per month before taxes) -- her insurance costs would
represent nearly 20 percent of her net monthly income.
The copayments she makes for services are more than
double those required of people covered by group plans,
and she does not have drug, dental or vision coverage.
An unmarried Hawaii man who is a sole proprietor with
no pre-existing conditions pays $130 per month for his
insurance plan, which also requires higher copayments
and does not offer drug, dental or vision coverage.
At 7.6 percent of the average monthly income -- $1,702
($2,432 per month before taxes) -- the premium might
be considered affordable, but not when the costs of
his co-payments, drug, dental and vision expenses are
Uninsured Project has assembled a committee of community leaders
to develop affordable options that best serve the uninsured and
employers. Solutions may include creating an affordable and easily
accessible health insurance product.