Ka Wai Ola - Office of Hawaiian Affairs, Volume 11, Number 5, 1 May 1994 — Pacific Americans come together on health reform [ARTICLE+ILLUSTRATION]

Pacific Americans come together on health reform

by Patrick Johnston They eame from all over the Pacific, sharing a maritime heritage, poliūeal ties to the United States, and heahh problems that demand closer attention in light of heahh care reforms being proposed in Washington. Sponsored by the Pacific Amenean Foundation and the Queen's Heahh Systems, the Pacific American HeaUh Symposium brought together Hawaiian, Samoan, and Chamoru leaders for a two-day meeting to discuss their heahh care needs and formulate a strategy to present to Washington policy-makers. Guam Senator Ben Pagelinan explained at a press conference, "We want to build consensus in

terms of policy direction for Pacific Islanders and give this to Congress when it drafts national policy." His colleague from Guam, Congressman Robert Underwood, said in his keynote address that, given the importance of the heahh care issue, a unified front would make their lobbying efforts more effective. "The issues we are dealing with are of such magnitude that they ean perhaps only be dealt with by joint efforts." Indigenous islanders from American Samoa, the Marianas, and Hawai'i all have shared the eeonomie benefits of close ties with the U.S. But having taken a bite out of the eeonomie pie they now have to face the heahh eon-

sequences: high rates of diabetes, heart disease and cancer. Conference participants agreed that, given the relatively poor heahh of indigenous island people, it is important to customize the health care system of eaeh of the island groups. Pacific American islands all have unique, relatively progressive systems whieh run the risk of being adversely affected by heahh care reform if their needs are not clearly stated to policymakers in Washington.

Amenean Samoa, whose indigenous population is close to 90 percent, has an entirely gov-ernment-run and funded heahh care system. Island residents pay nothing. However, if patients continued on page 8

Members of Pā Ku'i-a-lua demonstrate the lua chant E Hea I Ke Kanaka at a reception for health symposium delegates. Photo by Patrick Johnston

Pacific health symposium

from page 1 require more sophisticated types of treatment, limited medical equipment in Samoa means they must go to Hawai'i to receive it. OfFicials in American Samoa are concemed that the alliances proposed in the Clinton health-care package would prevent Samoans from accessing Hawai'i facilities. "We are dependent on the state of Hawai'i for health care services," explained Charles McCuddin, Special Assistant to the Governor for Health in American Samoa. "We have to have access to health care in Hawai'i."

American Samoa supports the government-run, single-payer program proposal in Congress because it is similar to their own. However, because it is unlikely that such a system will make it through Congress, in its plaee they propose waiving any health care reform requirements for Samoa and allowing the islands to maintain their present system. As part of the reforms, health officials in American Samoa would also like to see facilities improved so that more services could be provided on-island. Guam, with a Chamoru population of nearly 40 percent, has a system similar to Hawai'i's - employer-mandated insurance where the state or territory assumes a large share of the cost of uninsured health care users - and would benefit from the universal coverage offered in the Clinton initiative. However, because Chamorros are particularly susceptible to some diseases, health officials there want

a health package to include coverage and education programs for these illnesses. In Hawai'i, where a thorough and comprehensive health care system is already in plaee - and cost containment measures are already in the works - health officials are worried that an inflexible and ignorant Washington will introduce reforms that will hurt rather than help the islands' heahh care delivery. Health officials would also like health care reforms to provide native Hawaiians the opportunity to create their own unique health plan. The plan would be similar to others in the state but would include elements of traditional culture. A critical issue for indigenous islanders is funding.

"The cost of our system is high," explained Guam Senator Pagelinan. "As people quit their jobs or are fired the cost of health coverage is transferred to the government." In American Samoa, close to a quarter of the its heahh budget is spent on 318 patients receiving treatment in Hawai'i. The enormous burden this places on the finances of the small islands has forced officials there to consider abandoning the free medical policy and begin charging a fee for services. For native Hawaiians, the federally funded Papa Ola Lokahi is the primary vehicle for delivering culturally sensitive health care programs to native peoples. Any expansion of this and similar programs will require finding new funding sources.

Hawaiians, Samoans and Chamorros see advantages to changing their census classification to one similar to that of native Americans, making them eligible for federal heahh programs used by those peoples. State Director of the Department of Health, Jack Lewin, said at the symposium that such a change would have a positive effect on all Hawaiian residents. "Solutions are going to cost a lot of money. If the federal government pays for a larger share of health costs then the state ean spend that money on things like education."

Conference participants also agreed it was important to recognize that Samoans, Hawaiians and Chamorros also live in all the states and territories and should be seen as classified according to their island of origin - not simply as Asian-Pacific peoples or Pacific Islanders. This would allow for medical researchers to get more specific health data on the island peoples and understand what their health needs are. Symposium organizers had hoped to have FIrst Lady Hillary Clinton speak at the conference but her schedule did not permit it. In her plaee was Dr. Robert Valdez, Deputy Assistant Secretary of Health for Interagency Policy. In his address to the delegation he said that in the past, "There had not been a lot of personalized attention" paid to the territories and the indigenous people of the Pacific islands but that he was "committed" to changing this.