Congressman Faleomavaega announced today that, in light of current consideration in Congress, he has requested the Fono to review of our own health care system in American Samoa. The letter was addressed to the Speaker of the House, the Honorable Savali T.Ale, and the President of the Senate, the Honorable Gaoteote P. Tofau, with copies distributed to all members of the Fono. The full text of the letter is included below:

President Gaoteote & Speaker Savali:

As Congress is considering legislation to overhaul health care in the United States, I write to draw your attention to the comprehensive report on American Samoa health care system that was issued on September 29, 2007. The Coverage for All in American Samoa (CAAS) report discloses several findings critical to our assessment of the existing health care system in American Samoa.

In early 2003, a Task Force was commissioned to make recommendations for a new health coverage system that would significantly reduce government subsidies. Its mission was to develop a financially viable health plan for our Territory. Subsequently, from September 2004 to August 2007, the Task Force conducted the CAAS project to develop a comprehensive and feasible plan to provide health care coverage for the Territory. The three year project was awarded $1.2 million, which included a grant of $868,841 that was received under the State Planning Grant, from the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (DHHS).

I want to thank the late Governor Sunia for his foresight and to Governor Togiola for assuming the lead on this important task. I also want to commend the leadership by research project leader, Lieutenant Governor Ipulasi Aitofele Sunia, and Project Manager, Keniseli Lafaele. Moreover, I thank all contributing partners, only a few are mentioned here, including HRSA, DHHS, the American Samoa Medical Center Authority (ASMCA), American Samoa Community College (ASCC), Department of Health (DOH) and the Social Science Research Institute-University of Hawaii (SSRI-UH). The amount of work put in by everyone is reflected in the quality of policy recommendations in the final report.

In addition to group meetings, surveys and interviews, the CAAS report drew from information provided by AcademyHealth, one of the nation’s leading health policy resource centers in research analysis, facilitation, education and training, strategic planning, and program management. Moreover, the report drew from the experience of developing countries in Sub-Saharan Africa, Latin America, and Asia, relating to user fees and self-insurance as health care financing tools.

Overall seven policy recommendations are suggested for consideration. These recommendations are as follow:

1. Amend Free Medical Care Mandate –while the free medical care mandate can and should be maintained, it should be pursued through realistic endeavors mindful of the economics of health care.
2. Mandate Coverage Options – Part 5 of the report, Options for Expanding Coverage and other Reform Initiatives can be legislated.
3. Allow Health Savings Account by Law – the report recommends that legislation be enacted for the establishment of Health Savings account (HAS) as proposed in Part 5 of the report, in conjunction with High deductible Catastrophic Health Plans in American Samoa.
4. Establish/Encourage Use of Tax Incentive Programs – eligible employers be encouraged to establish Section 125 Plans that include health coverage plans for their employees as discussed in Part 5 of the report. Consider other tax incentives (deductions or credits) associated with health care plans.
5. Health Care Delivery Reform – decentralization of the delivery of health care services in the territory
6. Healthy American Samoa – mandate healthy lifestyle utilizing existing and dormant traditional infrastructure
7. Health Care Work Force – development of a comprehensive human capital development policy for the territory.

After discussions with some of our local leaders, LBJ officials and health care professionals, I respectfully request that the Fono should hold hearings and thoroughly review the recommendations in the CAAS report to reform the health care system in American Samoa. In conducting these hearings, I also hope that you will reach out to our local experts and to those with the experience and understanding of health care issues in our Territory.

In a recent meeting with our Executive Director Ms. Patricia Tindall of LBJ Hospital, she indicated that our whole health care system is “fragmented” and I totally agree with her assessment. As suggested also in the CAAS report, the problem is threefold. First, the user fees charged by ASMCA are no longer affordable. Second, the quality of services at LBJ Hospital is perceived by many to be substandard. Finally, certain needed specialized services are not available locally.

Faleomavaega concluded his letter by stating, “Overall, our health care system is in great need of reform and we must take immediate action and follow through on the recommendations suggested in the CAAS report. Please feel free to contact my office in American Samoa if you want a copy of the report. I look forward to working with you on this important matter.”