In today’s complex and expensive health-care world, consumers have had to learn the tough art of patient advocacy. Not only in getting versed on an array of medical procedures, but also in fighting to know what’s wrapped into health insurance and rising premiums.

It’s within this cost landscape that state legislators need to delve into uneven laws that essentially shield Hawaii’s nonprofit health insurers, which enjoy generous tax breaks from the state, from having to disclose the compensation of their top executives and board members.

The latest nondisclosure obstacle came via the state Department of Commerce and Consumer Affairs (DCCA) in April, when it rejected a public-records request from Star-Advertiser reporter Sophie Cocke for documents filed annually by health insurers — specifically disclosures of top executives’ salaries of nonprofit mutual benefit societies. These include Hawaii Medical Service Association (HMSA), Hawaii’s largest health insurer; University Health Alliance; and Hawaii Management Alliance Association.

DCCA based its refusal to disclose on competitive proprietary interests and individuals’ privacy interests overriding the public’s right to know.

That’s highly debatable, as the documents sought contain information that the DCCA Insurance Division had released in past years. Further, DCCA’s April decision now allows Hawaii’s health insurers operating as nonprofit mutual benefit societies to keep secret the pay of their top executives and board members.

That clashes with the transparency intent of a 2009 state law that requires all Medicaid contractors, profit or nonprofit, to file public reports full of financial information, including the compensations of their five highest- paid Hawaii employees. These reports pertain to HMSA, AlohaCare, Kaiser Permanente, Ohana Health Plan and United Healthcare.

As a Medicaid provider, HMSA must disclose its top-earning executives’ pay — but as a nonprofit mutual benefit society, can withhold from the public the compensation of board members.

In April, Cocke reported that HMSA CEO Mark Mugiishi’s total compensation for 2022 rose to $3 million from $2.5 million; from 2020-22, its top execs got a hefty 48% increase in salary and bonuses.

Further, for the first time in the nonprofit’s history, HMSA’s board of directors began compensating themselves, averaging about $100,000 yearly for the highest- paid directors, citing tougher workloads and complexities. HMSA did eventually provide salaries of its top execs and board to the Star-Advertiser, even if DCCA did not.

The need for HMSA transparency and disclosure go well beyond pay envy or even bad optics; it speaks to decisions being made by its leaders, enriching themselves internally while 107 rank-and-file employees lost their jobs in a company restructuring last year; another 89 workers were transferred — “rebadged” — to firms based in India and Maryland.

It’s decisions like those that have trickle-down effects on HMSA’s bottom line, on quality of service and reimbursements, and on the medical coverage of more than half of this state’s population.

All this, as HMSA’s particular nonprofit status exempts it from transparency rules on board compensation — and significantly, from paying state taxes on revenue from its insurance premiums.

Both House Speaker Scott Saiki and Sen. Joy San Buenaventura, the Health and Human Services chair, are right in saying that lawmakers should look into the transparency issues involving health insurers. Said Saiki: “If the public interest favored disclosure in 2009, then the Legislature should take this up in the next legislative session.”

The DCCA Insurance Division, too, said it would be open to law amendments, to clearly state that compensation documents are open and accessible to the public.

Good — so do it, legislators. It’s high time to be crystal clear that the pay and compensation of all health insurers’ top executives and boards of directors are a matter of public record. Further, while on the subject of health insurers: Delve into the nonprofit status of HMSA, and call on the insurance commissioner to do a corporate audit of HMSA. There is a compelling public interest to know how much tax revenue the state is forgoing due to HMSA’s nonprofit status, and whether it’s justified.