Preserving Health Care

Preserving Health Care2018-07-12T00:37:46+00:00

For low-income families, access to medical care through the federal Medicaid program (Med-QUEST in Hawai‘i) is critical to their health. For some, it is a matter of life and death.

In 2010, LEJ and pro bono partners and Alston Hunt Floyd & Ing intervened to prevent the state of Hawai‘i from cutting off Med-QUEST medical coverage to thousands of Hawai‘i residents who relied on the program for their health care needs, including life-sustaining treatments such as dialysis and chemotherapy.

LEJ was successful in fending off the cuts for five years as the the case was litigated successfully at the trial court level, overturned by the Ninth Circuit Court of Appeals, and then turned down for reconsideration by the U.S. Supreme Court. Fortunately, during the five years of litigation, the Affordable Care Act (“Obamacare”) was passed, providing an opportunity for nearly all of the residents affected by the cuts to secure health coverage without interruption.


In 2010, as a cost-saving measure, the state intended to cut Med-QUEST for Hawai‘i residents living here under the Compacts of Free Association. These members of our community, commonly known as Micronesians, face many challenges in the United States, including widespread discrimination.

The Republic of the Marshall Islands, the Republic of Palau, and the Federated States of Micronesia have special relationships with the United States, which are defined under Compacts of Free Association (COFA) between the U.S. and each of the three sovereign states. The U.S. and COFA states have reciprocal economic and military agreements that allow citizens of COFA states to live and work in the U.S. Hawai‘i is home to a number of Micronesian individuals and families, who work, attend school, and contribute to the strength and diversity of the islands.

Beginning in 1997, the state had covered eligible COFA residents through Med-QUEST programs. In response to reduced revenues, the state of Hawai‘i decided in 2010 to save money by ending Med-QUEST coverage and creating a markedly inferior plan, Basic Health Hawai‘i. Annual coverage is limited to ten days of inpatient hospital care, twelve outpatient visits, and a maximum of four prescription medications per month. This level of coverage is inadequate for the typical Medicaid patient, let alone one with severe chronic illness. BHH’s meager coverage cuts off life-saving treatments such as chemotherapy and dialysis, making this cost-cutting measure life-threatening for Micronesian elders and people with disabilities. These residents have no access to comparable health care in their countries of citizenship and no means to afford expensive medical treatment.

Legal Challenges

The state first announced the new plan in 2010, but failed to provide sufficient notice of the changes or an opportunity for public comment. LEJ and its partners, Alston Hunt Floyd & Ing and Bronster Hoshibata, brought a class action lawsuit, Sound v. Koller, which successfully challenged the state’s actions as a violation of due process.

After the lawsuit, the state went through the necessary administrative procedures and implemented Basic Health Hawai‘i in July 2010. In response, LEJ and its co-counsel brought a second federal class action lawsuit, Korab v. Fink (formerly Korab v. Koller), asserting that the cuts constituted discrimination on the basis of national origin and alienage and were in violation of the Equal Protection Clause of the U.S. Constitution.

In December 2010, the U.S. District Court in Hawai‘i granted a preliminary injunction that halted BHH and required that the state continue the more comprehensive Med-QUEST coverage. The State appealed to the U.S. Court of Appeals for the Ninth Circuit, and oral arguments were heard in September 2012. On April 1, 2014, the Ninth Circuit ruled that the state of Hawai‘i is not constitutionally obligated to provide state health insurance with the same level of benefits as the federally-funded Medicaid program covering non-COFA residents. The state agreed to continue to provide Med-QUEST coverage for COFA residents pending a request to the U.S. Supreme Court to reconsider the case.

On November 3, 2014, the U.S. Supreme Court denied the request to take up the case. LEJ and its partners continued to litigate the case, pursuing state claims after the federal constitutional claims had been foreclosed, exhausting all options in an effort to preserve health care coverage for thousands of COFA residents. Ultimately, after it became clear that the passage of the Affordable Care Act would provide a viable option for health coverage for nearly all of the people affected by the Med-QUEST cut, the case was dismissed. LEJ then worked with community partners to encourage the administration to implement the cuts in a way that would ensure minimal impact to the health of COFA residents. To its credit, the administration adopted many of the recommendations and the harm to the COFA community was significantly reduced.

In 2012, Keola Diaz released the documentary Basic Health Hawaii: Broken Spirits, Healing Souls, detailing the plight of Hawaii residents who were facing health care cuts.

Korab v. Fink (formerly Korab v. Koller)

Sound v. Koller

Go to Top