Ka Wai Ola - Office of Hawaiian Affairs, Volume 11, Number 2, 1 February 1994 — Clinton health care plan: where do Hawaiians fit in? [ARTICLE+ILLUSTRATION]

Clinton health care plan: where do Hawaiians fit in?

by JefT Clark "Where Hawaiians fit into the (proposed national health care) plan is still relatively unclear," says Hardy Spoehr, who heads Papa Ola Lōkahi, the board overseeing the island centers of the federally funded Native Hawaiian Health Care System. He adds, however. that Rep. Pat Williams.

D-Montana. indicated at a hearing on Maui Jan. 10 that the desires and needs of native Hawaiians would be discussed and looked out for by his committee. (Williams chairs the Committee on Education and Labor, whieh held hearings in Hawai'i

in early January. Hawai'i Rep. Patsy Mink is a committee member.) "The congressional committees and Mrs. Clinton have been briefed, so the major players are aware of native Hawaiian health issues," Spoehr says. As for

specifics of Hawaiian inclusion in the plan, "We're far from getting to that." The goal of Clinton's plan, other than containing costs, is ensuring everyone is covered by heahh insurance. In its current form. however, the plan might not mean mueh of a change in the health of Hawaiians, because in large part they are already covered. That's according to Dr. John Lewin, director of the state Department of Heakh.

OHA heahh officer Lorraine Godoy agrees, saying that, in many instances, access is available but not used by Hawaiians.

"The number of Hawaiians that don't have insurance is not that great," she states. According to recommendations made by Papa Ola Lōkahi to First Lady Hillary Rodham Clinton's Task Force on Heahh Care, Hawaiians in many cases will not seek treatment despite being covered. The recommendations stat-

ed that the statistics illustrating Hawaiians' poor heahh "point to late intervention for otherwise curable or treatable conditions. There is an obvious need to eliminate the Hawaiians' eultural disinclination to seek early and regular medical care. Thus, it is

important that heahh care reform address the issue of Hawaiian heahh, because Hawaiians are obviously not responding to typieal heahh care sehings. "Universal heahh coverage does not equal universal access to medical care. Hawaiians' poor

health stems from a laek of access to timely and eulturally appropriate care, not from a laek of coverage." Lewin says the heahh of Hawaiians entails mueh more than coverage and access. They suffer from "factors

that go way beyond health care," he says, factors whieh stem from the conquest of their nation by outsiders. "I think when we look

at Hawaiians we have to realize how important factors like eommunity, and family, and eeonomie well-being relate. Hawaiians are, frankly, in a situation in whieh poverty and the disintegration of family and community life and of the Hawaiian culture for many Hawaiians, contribute very heavily to the poor heahh status. In other words, people's spiritual and emotional well-being, and one's attitude about life, to me, is the single most important factor in heahh and well-being. And given the stress and the strain on the Hawaiian family and the Hawaiian community in Hawai'i today with the emphasis on highvolume tourism, the displacement of Hawaiians from their land and from their culture, really you have factors that go way beyond health care." That aside, Hawaiians should have access to heahh care, be it Western or Hawaiian, Lewin says. "Having good health coverage is appropriate, and is an important step that we need to take, and there are too many Hawaiian peo-

ple who still don't have in their hand a heakh coverage card. Many Hawaiians who are eligible for Medicaid won't use it because they feel that it's demeaning to go stand in line at a welfare office to get a heahh benefit card. And they also feel as though they're being treated like - and they

probably are being treated like - second-class citizens when they actually go to receive their heahh services.

"The Hawaiian traditional healing practices and cultural practices need to be encouraged and strengthened. Society needs to provide opportunities for Hawaiians to access that kind of approach, because that holistic approach is going to heal Hawaiian families and bring communities back together and set up the networks where people take care of eaeh other, and in a way that will work to everybody's benefit, so that's very important." ^

Traditional Hawaiian heahh care practices such as use of lā'au lapa'au ean be accessed with the help of the five island centers of the federally funded Native Hawaiian Heakh Care System. The centers are also "user friendly" for Hawaiians because they are staffed by Hawaiians. OHA's Godoy says the ehallenge presented by Clinton's plan will be to ensure that the Native Hawaiian Health Care System is incorporated into the larger continued on page 15

Hardy Spoehr

Lorraine Godoy

tgr- V ~ graphic by Jacob McGuire

Health care and Hawaiians

from page 10 national system. Among other things, this job will entail getting Hawaiian healers certified for acknowledgement and payment. The act addresses Indian health but not native Hawaiian heahh because of the uncertain status of the federal trust responsibility to native Hawaiians, Spoehr explains. The federal legislation that created the Native Hawaiian Heahh Care System (the Native Hawaiian Heahh Care Act) is valid through the year 2002, with

funding determined every two years. Current funding is $2.4 million annually, whieh covers the five island heahh centers and a scholarship program for Hawaiians planning to enter the heahh profession. "The question is where we (the Native Hawaiian Health Care System) would fall into the hierarchy of heahh alliances, whether we would be exempt from being included — or engulfed - in the alliances," says Spoehr, who adds that there are pros and cons to both sides.

There has been some discussion about whether to include Hawaiians in the Indian Heahh Service, a division of the federal Department of Health and Human Services whieh operates in all states where there are Indian tribes, Spoehr says. A drawback to that route would be being caught up in a federal bureaucracy, "whieh is always difficult," he adds. Right now the Native Hawaiian Heahh Care Systems don't have enough funding to open hospitals and clinics and become directservice providers. "If funding levels are increased, then maybe we could open up satellite clinics

in homelands and rural areas" and field a roving corps of heahh care professionals Spoehr says. He emphasizes that there is a long way to go before Clinton's national heahh care plan reaches its final form. "The current Health Security Act is a huge document - roughly 1 ,350 pages. Whatever happens, the (final) act won't look anything like this act." Trustee Moanike'ala Akaka, chairperson of OHA's heahh and human services committee, hopes that, when the dust clears and the federal plan is in plaee, OHA could establish its own program. "a supplemental heahh plan that

would piek up where the state and federal programs would leave off." Akaka articulates two points on whieh all seem to agree: the finalization of Clinton's plan is so far off that "we really don't know what we're going to end up with," and the best possible outeome would be that "all Hawaiians would get the adequate heahh services that they need." The Papa Ola Lōkahi recommendations warn that "failure of any policy to address the special cultural needs of Hawaiians will be equivalent to~writing a death sentence."