The office of U.S. Sen. Daniel Akaka, D-Hawaçii, released this statement today after the Senate approved the Patient Protection and Affordable Care Act:
WASHINGTON, D.C.—Today, the United States Senate passed its version of comprehensive health care reform, H.R. 3590, the Patient Protection and Affordable Care Act, by a vote of 60-39. Senator Daniel K. Akaka voted in support of the measure.

“The Patient Protection and Affordable Care Act will expand access to coverage, improve the quality and availability of health care services, and attempt to slow increasing health care costs. The legislation will also ensure that individuals with preexisting conditions will be able to get insurance, and prohibit unfair lifetime limits imposed by health insurance companies on individuals,” said Senator Akaka.
The Senate bill also includes a provision, based on an amendment offered by Senator Akaka and cosponsored by Senator Daniel K. Inouye, that permanently restores a Medicaid Disproportionate Share Hospital (DSH) allotment to support hospitals that care for significant numbers of Medicaid and uninsured patients. It is expected to provide access to $100 million for Hawaiçi hospitals through FY 2019. The state of Hawaiçi will have to provide matching funds to draw down the federal money.
“This bill will permanently restore Hawaiçi’s Medicaid DSH allotment. The DSH allotment will provide additional funding to the state of Hawaii to permit a greater contribution toward the uncompensated care costs of hospitals that treat the uninsured and Medicaid beneficiaries,” said Senator Akaka.
"Very few health-care professionals in Hawaiçi turn away those seeking basic medical care. Hawaii hospitals have long absorbed the costs associated with treating the uninsured and have not taken full advantage of the DSH reimbursement program," said Senator Inouye. "By permanently enrolling in DSH, hospitals can worry less about their bottom lines and focus on providing whatever care the needy or uninsured may require."
The Balanced Budget Act of 1997 created specific DSH allotments for each state based on their actual DSH expenditures for FY 1995. In 1994, Hawaiçi implemented the QUEST Medicaid demonstration program. The prior Medicaid DSH program was incorporated into QUEST. As a result of the demonstration program, Hawaii did not have DSH expenditures in FY 1995 and was not provided a DSH allotment.
The Tax Relief and Health Care Act of 2006 temporarily restored Hawaiçi’s allotment. Hawaiçi’s temporary allotment was extended by the Medicare, Medicaid, and SCHIP Extension Act of 2007, the Medicare Improvements for Patients and Providers Act of 2008, and the CHIP Reauthorization Act of 2009. However, Hawaiçi’s temporary DSH allotment will end after December 31, 2011.
H.R. 3590 also includes a provision requested by Senator Akaka which preserves Hawaiçi’s system of employer-mandated health care. A large percentage of Hawaiçi residents have health insurance because of the state’s employer-mandated health care system which depends on a long-standing exemption from the Employee Retirement Income Security Act (ERISA). The Patient Protection and Affordable Care Act includes a provision that is intended to preserve Hawaii’s unique ERISA exemption and the employer-mandated insurance that the exemption enables.
“This rule of construction will ensure that employer-provided insurance, as mandated by the Hawaii Prepaid Health Care Act, is maintained. It is essential that as we try to expand access to health care that we build upon the existing system of coverage in Hawaii rather than replace it,” said Senator Akaka.
The House of Representatives passed its version of health care reform, H.R. 3962, the Affordable Health Care for America Act, on November 7, 2009. Differences between the House and Senate measures will be resolved by a conference committee consisting of House and Senate Members