KAILUA, KONA, Hawai'i — A healthcare task force is working on a number of plans to provide healthcare for the 10 percent of Hawai'i residents who are not covered by insurance.

Among the topics under discussion are a network of community health centers and a health authority to oversee all insurance plans.

"It's a very complex area and we don't want to simply adopt a plan that would have negative impacts because it's a very important issue for all our citizens," said state Insurance Commissioner J.P. Schmidt, a member of the task force. "One main challenge has been to focus down on manageable issues that hopefully we can have a positive impact on."

Schmidt said some 112,000 Hawai'i residents, or roughly 10 percent of the population, currently are not covered by health insurance.

Of that number, roughly 40,000 may be eligible for a government-sponsored program, but are not taking advantage of it. Hawai'i is second only to Minnesota in having the lowest percentage of adults without health insurance, Schmidt said. Other states average approximately 20 percent.

The 13-member Hawaii Health Care Task Force is made up of lawmakers, healthcare professionals and health insurance executives appointed by the governor, and is affiliated with the Hawaii Uninsured Project. It was created by the Legislature earlier this year with a mandate to develop a plan for implementing healthcare for all Hawai'i residents. The group began meeting in August and will continue through June.

One idea is to create a network of more community health centers across each of the islands, said task force member Rep. Josh Green, D-6th (Kailua, Keauhou). There are already 13 such health centers, which provide preventive and primary care services and charge patients according to income.

Green said he is optimistic the plan will get the approval of state lawmakers at next year's legislative session and enrollment could start within a year.

Medical care will be offered on a sliding scale, topping out at $30, he said.

Insurance also will be offered for under $100 per month, Green said, which will also cover stays at state hospitals, tests and some basic prescription drug costs.

"It won't be fancy, but it will be quality," Green said. "We already have a system in place. It's going to morph a little bit I'm sure but the core is there. The main goal is to get primary care to those without insurance."

Green said federal and state funds would help pay for the program. State hospitals already receive $650,000 in federal money and the state has $3 million to help cover uninsured patients.

Green, a medical doctor who frequently works at the Pahala and Kohala emergency centers on the Big Island, said part of the problem is the lack of affordable healthcare for those with minor or chronic ailments that, left untreated, become more serious.

For example, he said, a common kidney infection can be treated with antibiotics. But left untreated it can lead to a hospital stay and even kidney failure, making dialysis necessary. Instead of a quick $30 visit to a community health center, costs could escalate to $1,000 a day for a hospital stay and even the need for long-term dialysis treatment, Green said.

For patients who cannot afford such treatment, the state uninsured fund kicks in and is drained quickly each year. Between 1998 and 2003, the cost of such cases topped $500 million.

Schmidt said another plan under consideration would create a health authority to bring all healthcare coverage under one umbrella. In addition to ensuring coverage for everyone, the authority would centralize and streamline insurance programs.

The task force is considering hiring a consultant to evaluate the costs of converting to the so-called single payer system. If the task force is successful in getting affordable insurance and quality healthcare to each resident, Hawai'i would be first state to make that claim.

"We'd like to lead the way on this," he said. "We really have to light a fire here."