Lucky we live Hawaii.

If you live in Texas, your odds of having health insurance are the worst in the country and, according to Gov. Rick Perry, you won’t be getting any help with insurance on his watch. A recent article noted that Texas, with 6.2 million uninsured residents, will refuse to participate in the benefits of the Affordable Care Act (ACA). Nearly 60 percent of adults with incomes below 139 percent of poverty in Texas are uninsured. It is this group — the most likely to suffer poor health — which the ACA Medicaid expansion would cover almost entirely at federal expense.

In a state like Texas, the uninsured crowd emergency rooms and their chronic diseases go unaddressed. If they’re unlucky enough to get a serious but treatable disease like cancer, it could be a death sentence. This is not only inhumane but expensive, leaving providers like hospitals and private insurers to pick up the tab for uncompensated care with the costs shifting to the rest of us who are paying our health insurance premiums.

In stark contrast, Hawaii, with our 40-year-old prepaid health care law, has the second highest insured rate in the country and intends to take full advantage of the opportunities under the ACA to move toward universal coverage and a more sustainable system for all residents.

Hawaii’s Medicaid eligibility standards for low-income adults are already aligned with the Affordable Care Act to ensure coverage for low income adults below 133 percent of poverty. That translates to $17,104 for a household of one; an additional $6,502 per person for larger households. Higher eligibility standards are in place to protect our most vulnerable residents including children, pregnant women, adults over 65, and blind and disabled persons.

Under Gov. Neil Abercrombie’s leadership, Hawaii was the first in the nation to declare our intent to establish an insurance exchange. Called the Hawaii Health Connector, the exchange is a way to make it simple to comparison-shop for health insurance and obtain tax credits for small business to make coverage affordable.

The ACA includes a host of insurance reforms to require insurers to offer coverage for preventive services and insure people regardless of pre-existing conditions. It changes the rules to allow parents to cover adult children up to age 26, and it ensures that premiums are invested largely in health care and not in profits and overhead. Hawaii’s insurers were already in line with many of these reforms and easily transitioned to new ones.

There is much more to the ACA than insurance coverage — too much to name in this piece. But it does fund access to the kind of care people need by supporting Hawaii’s Community Health Centers, the health professional loan repayment program called the National Health Service Corps, and increases the reimbursement rates for primary care providers.

The ACA also helps Medicare recipients by eliminating the dollar gap between government and personal payments for drug benefits commonly known as the "donut hole."

Of great importance to all of us, the ACA includes provisions to make health care both better and less costly.

We recognize that there are some inconsistencies between the provisions of the ACA and Hawaii’s Prepaid Healthcare Act. We are working with experts internal to state government and outside to compile the best thinking on reconciling the two. While federal law supersedes state regulation, we believe we have built up some best practices and gotten some protections for Prepaid that will help us succeed.

This administration is determined to ensure that every Hawaii resident receives the care that the ACA provides, and we are proud to be leading the great health care revolution currently under way.