The recent election of a Republican senator in Massachusetts has upset the distribution of power in the Senate, creating considerable uncertainty regarding the final outcome of health care reform. However, that election does not change in any way the failures of America's health care system and the need for reform.

In the U.S. more than 45 million Americans do not have health care insurance, including 100,000 in Hawaii, which hinders access to health care. Moreover, Americans on average pay about twice as much for health care, and our health outcomes are worse than those in other developed nations. In the U.S. the already high health care costs are rising faster than inflation in general, making it less and less affordable to individuals and businesses. In short, America's health care system is unsustainable.

At its core, the health care reform legislation is designed to increase insurance coverage and access to care for the uninsured, decrease the artificial inflation in insurance premiums, focus on wellness and prevention of disease, pay providers appropriately as patients move through the health system from primary care to end-of-life care, provide incentives to improve quality, and encourage health industry involvement.

In Hawaii we are fortunate to have a health care system that is better than those of most other states. This is due in large measure to Hawaii's employer-mandated health care insurance law, called the Prepaid Health Care Act. As a result, Hawaii has traditionally had one of the lowest uninsured rates in the country, which is now about 10 percent.

But we still have serious health care issues in our state. The population of Hawaii is aging faster than anywhere else in the country. Our population faces health conditions, including high rates of heart disease, obesity, diabetes and asthma. Health care costs are already high, and health care inflation is outpacing the general rate of inflation. The current health care system in our state cannot continue in its current state. Hawaii needs health care reform.

Two provisions in the health care reform legislation are of particular interest to Hawaii. First, our congressional delegation has worked hard to include a provision that preserves the Prepaid Health Care Act. This provision seeks to ensure Hawaii residents that they will receive benefits that are no less than they are now receiving.

Second, Sens. Dan Inouye and Dan Akaka have been successful in including a provision that would permanently re-instate federal funds to support hospitals that provide care to patients who do not have health care insurance and who are so poor that they cannot afford to pay for their care. Hawaii is currently one of only two states that do not receive these federal funds, called Disproportionate Share Hospital payments, on a permanent basis.

These federal funds, which have been available to Hawaii on a year-to-year basis, must be matched by state funds. For several years the state Legislature has approved these appropriations, and the governor has released the state funds, resulting in tens of millions of dollars of combined state and federal funds to support Hawaii's hospitals for uncompensated care. This year the governor withheld state matching funds. Representatives of her administration are trying to develop an alternate source of funding. If they are not successful, she should release the state matching funds.

Individuals, organizations and government all have a stake in health care reform. Although the specific anatomy and the fate of the final bill are not yet known, this legislation promises to initiate a sea change in our current health care system. The president's signature on this bill would only be the beginning. If it becomes law, this legislation would serve as a foundation for reform that will continue for many years.

George Greene is president of the Healthcare Association of Hawaii, which represents Hawaii hospitals, nursing homes, home care agencies and hospices.