Largest health insurance purchaser in Hawai’i lets members leave Kaiser over mental health concerns

NewsDecember 19, 2022

In a major victory for Hawai’i patients and NUHW members that have been on strike for more than three months, the state’s largest health insurance purchaser is allowing members to leave Kaiser Permanente if they report being unable to access timely mental health care from the giant HMO.

Under normal circumstances, members of the Hawaii Employer-Union Health Benefits Trust Fund (EUTF) who want to switch insurers outside of the open enrollment window must file an appeal that is investigated by the Trust Fund and voted on by its Board of Trustees. But amid growing concerns that Kaiser members cannot access timely mental health care with its therapists on strike for more than three months, the trustees voted to create an expedited appeals process that will allow members to leave Kaiser without any investigation as long as their reason for switching is that they are receiving inadequate access to mental health care.

With the EUTF providing health insurance to nearly 200,000 active and retired public employees and their dependents, the move was big news in Hawai’i with coverage by the Honolulu Star-Advertiser, Honolulu Civil Beat, KITV, Hawaii News Now, Becker’s Hospital Review and Hawaii Public Radio. The Star-Advertiser also wrote an editorial supporting the move

The expedited process will remain in effect for as long as Kaiser therapists remain on strike or until June 30, 2023, if the strike is still ongoing.

“We applaud the EUTF for taking action to protect its members whose struggles to access mental health care from Kaiser Permanente have long predated the strike by Kaiser therapists,” said Sal Rosselli, president of the National Union of Healthcare Workers, which represents the striking workers. “This action will help Hawai’i residents get potentially life-saving mental health care and send a strong message to Kaiser that it can’t get away with ignoring the mental health needs of its members in Hawai’i.”

Prior to taking action, the trustees heard from several EUTF members with Kaiser insurance who described their struggles trying to access mental health from the HMO. “During the strike Kaiser has canceled five appointments with my therapist and this has been very hard on me,” Kimberly Steward, a teacher, told the trustees. Dr. Tami Swonigan, a psychologist at Kaiser’s Waipio office, told trustees that trustees that Kaiser members who dial the HMO’s mental health call center are having to wait three weeks for a callback, unless they are deemed to be suicidal.

EUTF members who seek to leave Kaiser would be allowed to switch to its main competitor in Hawai’i, HMSA. Kaiser declined to have a representative at Tuesday’s Board of Trustees meeting, but a representative for HMSA said it has capacity to provide mental health services to Kaiser members who decide to switch carriers.

EUTF Trustees were furious that Kaiser officials refused to attend the meeting, especially since the HMO is contractually required to attend board meetings.

“So for them to not attend, I think, is unacceptable,” said Fern, who is also executive director of the University of Hawaii Professional, which represents university faculty. “I think somebody with some authority should be here to answer questions, and it doesn’t have to be about the ongoing negotiations.”

Fern added, “I’m sick and tired of hearing about Kaiser’s long history with labor, because obviously, there are labor representatives on this board and they are just essentially giving us the middle finger, which I think is unacceptable as a state contractor.”

Kaiser therapists have been on strike in Hawai’i since Aug. 29 primarily over severe understaffing that forces patients to wait months for therapy sessions in violation of clinical standards and state law. In May, the National Committee for Quality Assurance (NCQA) downgraded Kaiser’s accreditation status in Hawai’i by placing it under “corrective action” for deficiencies in providing accessible mental health care. The agency concluded that the lack of access to mental health care posed “a potential patient safety risk” and that “Kaiser’s prior efforts to improve access… have largely been ineffective.” Currently, Kaiser is the only health plan in Hawai’i under corrective action.

In a recentletterto the accreditation agency, NUHW warned that Kaiser was failing to implement its Corrective Action Plan. The letter documented that Kaiser is failing to hit its targets for increasing staffing because therapists have been leaving faster than Kaiser can replace them and that only 13 percent of therapists in Kaiser’s external provider network are actually accepting new Kaiser patients.

Kaiser currently has just 52 psychologists, licensed clinical social workers, psychiatric nurses and chemical dependency counselors serving its 266,000 members in Hawai’i.