What to make of this

So, yesterday as I read the Washington Post website, I noticed this AP Story praising Hawaii, which under the Pre-Paid Health Care act has an exemption from the Employee Retirement Income Security Act (ERISA) of 1974, Pub. L. 93-406. Overall, I have always been happy that Hawaii has sought to expand access.

However, I would like to point out some other issues. First, the employer mandate has strict as Hawaii's likely would not work nationally. Businesses often complain about the various situations regarding this expense, but in some other way there is a cultural desire to hold the center. Furthermore, there are other more problematic issues with ESI, which I and others have pointed out.

Secondly, Hawaii has some interesting risk pools. Their BCBS does have a huge amount of the market share, however, it does differ from other BCBS systems, because of how it operates. HMSA is a weird duck in the normal insurance market. The other large group is Kaiser Permanente, which many have cited for high quality care.

So Hawaii has some other factors that make it unique. I wish we could just export these ideas wholesale, but it's far more complicated and nuanced.

One other weird Hawaii fact is that even if you did start including ESI in income, Hawaii residents actually will see smaller tax increases than comparable individuals in other states. Again, this points to lower costs in the system.