Much national debate centers around national models in which an employer mandate plays an important role in providing for health care coverage for all Americans. Hawaii has had the nation's only health insurance employer mandate for almost 20 years, yet little is known nationally about the mandate itself or Hawaii's experience with it. This article describes the long-term effects of Hawaii's employer mandate on health care access and costs, and offers reflections on the potentials of national health care reform based on Hawaii's experience.
John C. Lewin, Peter A. Sybinsky. Hawaii's Employer Mandate and Its Contribution to Universal Access. JAMA. 1993;269(19):2538–2543. doi:10.1001/jama.1993.03500190082040