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State of healthcare in the territory: much left undone

“Our collective expectations on healthcare service improvement at the LBJ Tropical Medical Center did not materialize. The mandate calling for major changes at LBJ remains unfulfilled,” said Governor Lolo M. Moliga in his State of the Territory Address at the Fono’s opening on Monday.


Lolo admitted “there are a lot of problems at the hospital” but also said he’s thankful to the Fono for confirming the hospital’s full board who are now working to help improve the hospital. The board’s efforts to readjust the “unrealistic salaries of key management staff” in reference to the financial capacity of LBJ having been stymied by administrative controversy, he said, adding the hospital board has been urged to focus its attention on improving the quality of healthcare services to the people.


The governor also noted he will continue to request the Fono’s support to repeal the Wage Tax Legislation for the hospital — for fairness reasons — although the hospital is in need of funding to finance its operating needs.


He requested a legislative initiative to facilitate the enactment of a revenue stream to replace lost revenues caused by the repeal of this measure.


Lolo pointed out the hospital will dedicate its energies to chronic care services. As such, hospital services like Dental, Primary Clinics, EMS and others identified subsequently will be transferred to the health department. The DOH Director and the hospital board will collectively identify functions, which should be placed under DOH.




Governor Lolo stated the mandates issued to the hospital board to reduce the current $20 fee to $10 to see physicians did not materialize. The recommendation to establish one fee structure for all residents of American Samoa regardless of immigration status was also not fulfilled.


The intended separation of primary care activities from the hospital was also not accomplished, he noted.


Lolo also said the intention to reconsider the free Medical Attention Mandate did not receive any attention, and the government can no longer continue to assume the full financial burden associated with the provision of health care services.


The free medical attention provision is in the current law and must be changed to reflect the government’s financial capacity, he said. Appropriate amendments will be submitted to meet this needed change, and these mandates will also be reaffirmed and are expected to be achieved this year.




The governor pointed out that off-island care for the territory’s residents is also mandated by law, but it has remained unfunded for several years. This service, he said, was not reactivated, leaving our chronically ill patients to the financial wherewithal of their families, and the lack of financial resources was again cited as the primary concern.


The Fono supported the proposed budget increase for the hospital’s Fiscal year 2014 making available an additional $10,270,000, which is 29.9% higher than the previous FY budget for health care services. “This demonstrates our collective commitment and recognition that healthcare services… “must improve”.




On other issues, the governor stated that during his last visit to Hawai’i, he initiated inquiries with the leadership of Tripler Hospital to revisit the possible reconnection with our local hospital for accommodation of the patients sent-off island for chronic illness, and collaborating with local physicians on diagnosis through telemedia to expand the local diagnostic capacity.


Governor Lolo also noted efforts to access declared benefits inherent in the Affordable Care Act (ACA) revealed major obstacles precluding immediate ascertainment of insurance coverage for the territory’s residents.


The major flaw is the absence of a defined process contained in the ACA legislation similar to states for the territories, he said, and “consequently American Samoa with other territories are effectively preempted from establishing an Insurance Exchange Program allowing for the accommodation of 20% of our population not covered under the Medicaid program.”


“American Samoa is also administratively hampered from maximizing its Expanded Medicaid Program due to the established funding cap,” the Governor said, and it was program prohibition revelations, which prompted his meetings with Hawai’i’s Governor Neil Abercrombie to explore the possibility of joining Hawai’i’s Insurance Exchange program.


 The recommendation he received was “to focus on developing the territory’s own program to meet our needs.”


Since then, he has appointed a task force to develop options from which he will determine the best course of action to pursue in order to maximize the use of available funds to which American Samoa is entitled from Medicaid. The Task Force will also assess the sufficiency of the current Medicaid program, and eliminating the Medicaid cap.


In a new development, the Centers for Medicare and Medicaid Services (CMS) announced yesterday a decision to increase the Federal Medicaid Assistance Percentage (FMAP) for eligible U.S. Territories.


The decision provides for each eligible Territory to receive two increases to their FMAP and Cong. Faleomavaega’s office released a statement saying CMS will be sending a letter to Medicaid directors in the five U.S. Territories outlining the specific information needed to determine the eligibility of each Territory.


 The task force was given 45 days in which to complete its work.


More on the governor’s address on “Healthcare” in later editions.