WASHINGTON — Before health care reform dominated debate on Capitol Hill, Hawaii and several other states worked aggressively to increase the number of low-income residents covered by Medicaid, the federal-state insurance program for the poor.
Now, those efforts could end up hurting them.

The health care bill that the Senate Finance Committee approved last month would expand Medicaid coverage to people earning up to 133 percent of the federal poverty level.
But states like Hawaii, that already have expanded eligibility for Medicaid, wouldn’t see as much of a bump. Hawaii already covers people earning more than 100 percent of the poverty level.
At a time when state governments are facing budget shortfalls, some senators say their states shouldn’t be penalized for leading the expansion of health care coverage for low-income residents.
For Hawaii’s poor residents, it could mean stagnant Medicaid benefits as health care costs rise.
“We proudly represent states that have taken the initiative to expand Medicaid,” Sen. Daniel Akaka, D-Hawaii, and 13 other senators wrote in a letter to Majority Leader Harry Reid, D-Nev.
Reid is now blending two Senate health care bills into one measure that could be ready for debate within weeks.
“We are disappointed that current health care reform legislation disproportionately burdens our state, simply because we are leaders in expanding health coverage for our low-income residents,” the group of 14 senators wrote.
Hawaii’s insurance requirements are credited with making it the second most medically insured state in the nation, behind Massachusetts.
More than 92 percent of Hawaii residents have insurance, according to the independent Kaiser Family Foundation. About 84 percent of the nation is insured.
A health care overhaul bill that the House passed Nov. 7 contains language to ensure that Hawaii’s expansive health coverage requirements wouldn’t be weakened.
Specifically, the provisions inserted into the almost 2,000-page House bill by Hawaii’s congressional delegation would protect the state’s Prepaid Health Care Act of 1974 from any changes imposed by the new federal legislation.
The health care act requires nearly all employers in Hawaii to provide health insurance to employees who work at least 20 hours a week for four consecutive weeks.
Under the Senate Finance Committee bill, states that already offer Medicaid to people earning at least 100 percent of the poverty level would start off getting 10 percent less in federal assistance than other states in 2014. The differential would narrow over five years, disappearing in 2019.
Along with Hawaii, the so-called expansion states include Arizona, Delaware, Vermont, Maine, Maryland, Massachusetts, Minnesota, New York, Pennsylvania, Washington, Wisconsin and the District of Columbia, according to the Finance Committee.
Senators from these states met last week with Reid to seek some form of parity in whatever health care bill comes to the Senate floor.
So far, talks have produced nothing definitive, and a spokesman for Reid has declined comment.
Reid’s state and three others — Michigan, Rhode Island and Oregon — would fare well under the Finance Committee bill because of a deal Reid said he struck with the committee’s chairman, Sen. Max Baucus, D-Mont. Those states would qualify for full federal funding for new Medicaid recipients for five years because they have lower-than-average Medicaid enrollment and unemployment of at least 12 percent.
“The people of Nevada are hurting, and I make absolutely no apologies, none, for helping people in my state and our nation who are hurting the most,” Reid said on the Senate floor in September.
The House health care legislation takes a different approach.
It would expand Medicaid eligibility to people earning up to 150 percent of the poverty level and would treat states equally in terms of federal matching payments.
Those payments would cover 100 percent of expanding Medicaid eligibility in 2013 and 2014 and would cover 91 percent of expanding it beginning in 2015.

Reach John Yaukey at jyaukey@gannett.com.