Ka Wai Ola - Office of Hawaiian Affairs, Volume 30, Number 10, 1 October 2013 — Q&A Hardy Spoehr [ARTICLE+ILLUSTRATION]

Q&A Hardy Spoehr

lnterviewed by Lisa Asato Hardy Spoehr, who has served for two decades as executive director of the Hawaiian health-focused Papa Ola Lōkahi, will be retiring at the end of October. Along with retirement, he'll also give up his seat on the board of the Hawai'i Heahh Connector, the state-based insurance exchange created under the Affordable Care Act, or Ohamacare, whieh begins open enrollment Oct. 1. KWO: How does Obamacare affect Hawaiians? HS: "If you 'google' (the Act and 'Hawai'i' or 'Hawaiians,') you'll find that there is an oral health study. The Act does require that Native Hawaiians, Alaska Natives and American Indians are all lumped together as part of that study to be done. KWO: Anything else? HS: Other specifics in the Affordable Care Act that have direct relationships to Hawai'i or to Hawaiians: one is the data collection issue, whieh has been an ongoing

issue ever since OMB 15 (Office of Management and Budget Statistical Policy Directive No. 15) was revised in 1997. ... OMB disaggregated for data collection, analysis and reporting the old Asian American or Paeihe Islander category . . . and . . . formed a separate ... Native Hawaiian or Other Paeihe Islander category. . . . Despite 0MB 's policy statement, federal agencies, particularly Heahh and Human Services, have not disaggregated that category and so (Papa Ola Lōkahi), OHA, Alu Like, many of the Hawaiian agencies have been knocking the doors down at HHS, saying you have to get in concert with your own policy. . . . But now there is a law that requires HHS to report. So you'll start to see separate data being reported on Native Hawaiians, hopefully Native Hawaiians apart from Paeihe Islanders, but Native Hawaiian/Pacific Islanders data specific to all the different health concems and chronic disease and infectious disease and access. KWO: Why is that important? HS: Under the old rubric of Asian American or Paeihe Islander

- whieh lumped together all Asians and Paeihe Islanders - Hawaiians and Paeihe Islanders were like 2.5 or 3 percent of that total populahon. So the concerns of Asian populations dictated what policies were in plaee, what revenues were spent for in terms of federal dollars going to support issues around heahh care. Now at least you're going to get a breakout required of heahh status as directed by the Affordable Care Act for Native Hawaiian/Paeihe Islander, whieh we've never had before. KWO: Does Obamacare aeeomplish anything else directly affecting Hawaiians? HS: The reauthorization of the Native Hawaiian Heahh Care Improvement Act. ... What h did was at least keep alive the federal recognition and responsibility for Native Hawaiian heahh as a statute authority, whieh no other Hawaiian legislation has right now. The Native Hawaiian Education Act hasn't been reauthorized, NAHASDA, the housing act, hasn't been reauthorized. KWO: As someone who's been on the forefront of Hawaiian heallh for decades, do you Ihink Hawaiians are open to the idea of the heallh exchange? HS: I think they are. ... He (Nainoa Thompson) will talk about you can't go on a voyage unless you know where you're going. You have to have a sail plan. And I think more and more that's true with the younger folks in this Hawaiian generation. They're developing a sail plan. And that sail plan has as one of its tenets being healthy and well. KWO: Is Obamacare a game changer for Hawaiians and their health? HS: Too early to tell. I think all you ean say is that it will make heahh care accessible through insurance for Hawaiians. Now, the question is: does that mean they're going to be healthy or well? Just because you go to a doctor, that doesn't mean you're going to be healthy or well. You've got to take care of yourself. SEE SPOEHR ON PAGE 23

Hardy Spoehr. - Photo: LisaAsato

KWO: Hawai'i Ileallh Connector is partnering with community organizations, including Native Hawaiian Ileallh Care Systems on various islands, to get the word out and spread awareness through its Hi'i Ola Marketplace Assister program. How important do you Ihink that is for the Hawaiian community? HS: I think initially it would be very important only from the standpoint of getting people ma'a (familiar) to what it is, beeause there's so many questions out there. ... I know through the Conneetor and their puhlie affairs eommunieations staff there will be a big push to get people to use eomputers to tie into the projeet, but what about people that are on the heaeh? What about homeless folk? . . . There will be, I know, speeial efforts to go down to the heaeh to tie in folks down there with heahh care through assisters. I think the assisters are going to play a big role in that kind of thing. KWO: What would you like Hawaiians to know about the Act as far as being informed so they ean make a ehoiee for themselves? HS: I think they have to realize that under this Act, all individuals are required to have heahh care (insurance). If they don't play, they're going to be penalized for h. And that's not a good way of starting out the discussion, because that's sort of a negative statement. So I think probably the best way of putting that out there is, hey, if you ever need to see a doctor or if you want to take advantage of some of the preventive things (ie. exercise programs) around heahh care plans, . . . go talk to the (Marketplaee) Assister or somebody at the Connector, . . . and in the Hawaiian community these are going to be assisters from different Hawaiians organizations.

KWO: Can you say more about the prevention programs? HS: The Affordable Care Act is the first heahh care act that puts dollars behind preventive services. So for the first time organizations who provide heahh screenings or exercise programs will be reimbursed for doing that. Hawaiians will benefit from that as well. KWO: Anything else you want to say about Obamacare? HS: (The Act provides for) addihonal benefits for American Indians and Alaska Natives. There are probably 4 or 5 distinct things. They are considerable. And it's unfortunate that at this time there is not a direct governance relationship between the Native Hawaiian governing entity and the federal government or those could have perhaps been written into the Act for Hawaiians as well. But that's something for the future. KWO: When you look back on your time at POL, what are you most proud of having aeeomplished? HS: I've always said that our legacy - it's not my legacy, it's the legacy of the organization - is the Native Hawaiian Heahh Scholarship Program, because we currently now have (some) 230, 240 individuals who are doctors, nurses, social workers, puhlie health workers who have gone through the program and are out there in the community. All Hawaiians who are making a difference. KWO: When you leave POL, are you going to be taking advantage of the Ileallh Connector? HS: I'm on Medicare already, so I probably I won't be taking (advantage of it) unless I find another job somewhere. (Laughs.) KWO: Medicare? Can I ask how old you are? HS: I'll be 70 in about two months. KWO: It's amazing. You don't look 70. HS: (Laughs.) Laugh. You gotta laugh. Have a sense of humor and you'll be young forever. ■

SP0EHR Continued from page 16