Hawaii was the first state to pass legislation, Hawaii’s Prepaid Health Care Act 1974, which requires employers to provide employees with health insurance. The state has remained consistently pro-health reforms and this is evident in the legislation that was passed in 2009 that created the Hawaii Health Authority. This authority has been mandated to plan for healthcare needs of the state and to determine future capacity needs for the state’s health providers, support services, equipment, and facilities. Hawaii’s support for health reforms is also seen in Hawaii Health Authority’s task of determining, implementing and maintaining the waivers that are available to the state’s residents under federal law.
Similarly, Massachusetts has demonstrated its support for health reforms by adopting health care reform laws like the one it adopted in 2006. This law required residents to have insurance coverage, employers to provide employees with health insurance cover and pledged that the state would provide residents earning below 150% of the federal poverty level (FPL) with free health care insurance. The state amended this law in 2008 and 2010 in order to realign its health reform goals to those of the Federal Affordable Care Act. The Commonwealth Health Insurance Connector Authority is Massachusetts’ equivalence of Hawaii Health Authority (Bauer & Hollier, 2012).
Despite their support for health reforms, there exist disparities in how these reforms play out in the two states.