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May 19, 1993, Vol 269, No. 19 >
ARTICLE | May 19, 1993

Hawaii's Employer Mandate and Its Contribution to Universal Access FREE

John C. Lewin, MD; Peter A. Sybinsky, PhD
[+] Author Affiliations

Reprint requests to the Department of Health, State of Hawaii, 1250 Punchbowl St, Honolulu, HI 96813 (Dr Lewin).


JAMA. 1993;269(19):2538-2543. doi:10.1001/jama.1993.03500190082040
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References

Much national debate centers around national models in which an employer mandate plays an important role in providing for health care coverage for all Americans. Hawaii has had the nation's only health insurance employer mandate for almost 20 years, yet little is known nationally about the mandate itself or Hawaii's experience with it. This article describes the long-term effects of Hawaii's employer mandate on health care access and costs, and offers reflections on the potentials of national health care reform based on Hawaii's experience.

(JAMA. 1993;269:2538-2543)

REFERENCES

1 +
Section 1, Act 210, Hawaii Session Laws, 1974.
2 +
Stenson RV.  Comparison of health expenditures in US and Hawaii economies. Hawaii Med J . 1992;; 51( (1) ):14.
3 +
Friedman E. The Aloha Way: Health Care Structure and Finance in Hawaii . Honolulu: Hawaii Medical Service Association; 1993;.
4 +
Consumer Reports . (August) 1992;;57:530-531.
5 +
Riesenfeld SA. Prepaid Health Care in Hawaii . Honolulu: Legislative Reference Bureau, State of Hawaii; 1971;. Report 2.
6 +
Van Steenwyk J, Fink R. Evaluation of Impact of Hawaii's Mandatory Health Insurance Law: A Report on the Prepaid Health Care Act . Washington, DC: US Dept of Health, Education and Welfare; 1978;. Contract 299-77-0014.
7 +
Nakamura A, Johnson D, Oyama N, Peterson J. Research and Statistics Report: Cost of Medical Care . Honolulu: Dept of Health, State of Hawaii; 1981;.
8 +
Dept of Health, State of Hawaii. The Medically Indigent in Hawaii: A Preliminary Report to the Legislature in Response to SR 149-86, SD1 . Honolulu: Dept of Health, State of Hawaii; January 1987;.
9 +
Policy Working Paper: Universal Primary and Preventive Health Care for Hawaii . Honolulu: Dept of Health, State of Hawaii; 1989;.
10 +
Rubin W, director, Dept of Human Services. Testimony before Hawaii State Legislature Joint House Health and Human Services Committee, February 1993.
11 +
Dept of Health, State of Hawaii. Measuring the Uninsured Population in Hawaii . Honolulu: Dept of Health, State of Hawaii; November 1992;.
12 +
National Governor's Association Regional Hearings on Healthcare . Vancouver, Wash: June 27, 1991; (testimony of M. Ramil, director of labor and industrial relations, state of Hawaii).
13 +
Hawaii Health Profile, 1992 . Atlanta, Ga: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention; 1992:2-5, 9.
14 +
The Northwestern National Life State Health Rankings, 1991 Edition . Milwaukee, Wis: Northwestern National Life Insurance Co; 1991;.
15 +
America's Public Health Report Card: A Stateby-State Report on the Health of the Public . Washington, DC: American Public Health Association; November 1992;.
16 +
Universal Healthcare Almanac . Phoenix, Ariz: Silver and Cherner; 1993;. Tables 2.2.1 and 2.14.1.
17 +
Siegel PZ, Brackbill RM, Frazier EL, et al.  Behavioral risk factor surveillance, 1986-1990. MMWR CDC Surveill Summ . 1991;;55( (4) ):1-23.
18 +
Centers for Disease Control and Prevention. Hawaii Health Profile—1992 . Atlanta, Ga: US Dept of Health and Human Services; 1992;:20-21.
19 +
Kaiser Family Foundation, Queen Emma Foundation, Louis Harris & Associates. Hawaii Health Care Survey . New York, NY: Louis Harris & Associates; February-March, 1992;.
20 +
Zedlewski SR, Aos GP, Wheaton L, Winter-bottom CL. Pay or Play Employer Mandates: Effects on Insurance Coverage and Costs . Washington, DC: Urban Institute; 1992;.
21 +
Swartz K.  Why requiring employers to provide health insurance is a bad idea. J Health Polit Policy Law . 1990;;15:779-792.

Figures

Tables

Interactive Graphics

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Section 1, Act 210, Hawaii Session Laws, 1974.
2 +
Stenson RV.  Comparison of health expenditures in US and Hawaii economies. Hawaii Med J . 1992;; 51( (1) ):14.
3 +
Friedman E. The Aloha Way: Health Care Structure and Finance in Hawaii . Honolulu: Hawaii Medical Service Association; 1993;.
4 +
Consumer Reports . (August) 1992;;57:530-531.
5 +
Riesenfeld SA. Prepaid Health Care in Hawaii . Honolulu: Legislative Reference Bureau, State of Hawaii; 1971;. Report 2.
6 +
Van Steenwyk J, Fink R. Evaluation of Impact of Hawaii's Mandatory Health Insurance Law: A Report on the Prepaid Health Care Act . Washington, DC: US Dept of Health, Education and Welfare; 1978;. Contract 299-77-0014.
7 +
Nakamura A, Johnson D, Oyama N, Peterson J. Research and Statistics Report: Cost of Medical Care . Honolulu: Dept of Health, State of Hawaii; 1981;.
8 +
Dept of Health, State of Hawaii. The Medically Indigent in Hawaii: A Preliminary Report to the Legislature in Response to SR 149-86, SD1 . Honolulu: Dept of Health, State of Hawaii; January 1987;.
9 +
Policy Working Paper: Universal Primary and Preventive Health Care for Hawaii . Honolulu: Dept of Health, State of Hawaii; 1989;.
10 +
Rubin W, director, Dept of Human Services. Testimony before Hawaii State Legislature Joint House Health and Human Services Committee, February 1993.
11 +
Dept of Health, State of Hawaii. Measuring the Uninsured Population in Hawaii . Honolulu: Dept of Health, State of Hawaii; November 1992;.
12 +
National Governor's Association Regional Hearings on Healthcare . Vancouver, Wash: June 27, 1991; (testimony of M. Ramil, director of labor and industrial relations, state of Hawaii).
13 +
Hawaii Health Profile, 1992 . Atlanta, Ga: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention; 1992:2-5, 9.
14 +
The Northwestern National Life State Health Rankings, 1991 Edition . Milwaukee, Wis: Northwestern National Life Insurance Co; 1991;.
15 +
America's Public Health Report Card: A Stateby-State Report on the Health of the Public . Washington, DC: American Public Health Association; November 1992;.
16 +
Universal Healthcare Almanac . Phoenix, Ariz: Silver and Cherner; 1993;. Tables 2.2.1 and 2.14.1.
17 +
Siegel PZ, Brackbill RM, Frazier EL, et al.  Behavioral risk factor surveillance, 1986-1990. MMWR CDC Surveill Summ . 1991;;55( (4) ):1-23.
18 +
Centers for Disease Control and Prevention. Hawaii Health Profile—1992 . Atlanta, Ga: US Dept of Health and Human Services; 1992;:20-21.
19 +
Kaiser Family Foundation, Queen Emma Foundation, Louis Harris & Associates. Hawaii Health Care Survey . New York, NY: Louis Harris & Associates; February-March, 1992;.
20 +
Zedlewski SR, Aos GP, Wheaton L, Winter-bottom CL. Pay or Play Employer Mandates: Effects on Insurance Coverage and Costs . Washington, DC: Urban Institute; 1992;.
21 +
Swartz K.  Why requiring employers to provide health insurance is a bad idea. J Health Polit Policy Law . 1990;;15:779-792.

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