Further Clarification on HMA’s Role and Ongoing Developments in Nitta v. HMSA

FOR IMMEDIATE RELEASE

June 15, 2025

Contact:

info@hawaiihealthcaretaskforce.org

Hawaii Healthcare Task Force

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Honolulu, HI 96813

(808) 462-0334

Press Release: Further Clarification on HMA’s Role and Ongoing Developments in Nitta v. HMSA

Following our previous statement regarding the Hawaii Supreme Court proceedings in Nitta v. HMSA, the Hawaii Healthcare Task Force issues this updated release to address recent legal developments and persistent public mischaracterizations regarding the role of the Hawaii Medical Association (“HMA”) in the contracting process with HMSA.

I. Procedural and Legal Context

Nitta v. HMSA remains under consideration by the Hawaii Supreme Court. The litigation centers on the enforceability and conscionability of HMSA’s Participating Provider Agreements (“PPAs”), focusing on mandatory arbitration provisions and the absence of meaningful negotiation due to unequal bargaining power.

II. HMA’s Role: Legal Clarification

Contrary to repeated assertions in oral arguments and public commentary, HMA does not negotiate, draft, or execute PPAs with HMSA on behalf of individual physicians. HMA is not vested with legal, contractual, or fiduciary authority to act as agent, representative, or proxy for providers in the negotiation or execution of such agreements. Each physician independently reviews and executes HMSA’s standardized, nonnegotiable PPAs on a “take it or leave it” basis.

HMA’s function is strictly limited to professional advocacy, education, and support. It neither binds physicians to contractual terms nor participates in negotiation or representation in forming provider agreements.

III. Amicus Curiae Briefs: HMA and AMA’s Involvement

The Hawaii Supreme Court has granted the Hawaii Medical Association (HMA) and the American Medical Association (AMA) the right to file Amicus Curiae Briefs in Nitta v. HMSA. These briefs provide the Court with authoritative, independent perspectives on the legal and policy issues at stake. The Amicus Briefs:

• Reinforce HMA’s Non-Negotiating Role: Confirm that HMA does not negotiate, draft, or execute PPAs with HMSA, nor does it possess authority to act on behalf of individual physicians in contract matters.

• Highlight Systemic Concerns: Underscore that HMSA’s standardized, nonnegotiable contracts create barriers to fair bargaining, undermine physician autonomy, and threaten patient access to care in Hawaii.

• Reflect National Consensus: The AMA’s involvement emphasizes that the issues raised in this case have implications beyond Hawaii, affecting the national landscape of physician-insurer relations.

IV. Judicial Scrutiny and Evidentiary Record

The Supreme Court has expressly scrutinized representations regarding negotiation and HMA’s involvement. The record is clear:

• Justices have questioned whether HMA’s review and provider comment solicitation constitutes genuine negotiation or procedural formality.

• Testimony from Dr. Frederick Nitta and other plaintiffs establishes that HMSA’s PPAs are contracts of adhesion, imposed absent bona fide bargaining and under significant economic and clinical duress.

• HMA has publicly confirmed its lack of negotiating or contractual authority, as now further supported by the Amicus Briefs.

V. Implications for Hawaii’s Healthcare System

The imposition of nonnegotiable contract terms has contributed to Hawaii’s ongoing provider shortage and has significant implications for the sustainability of medical practices and patient access to care. Physicians are compelled to accept HMSA’s terms to maintain accessibility for insured patients, often under reimbursement structures lacking transparency or parity.

VI. Statement of Position

The Hawaii Healthcare Task Force, in alignment with HMA’s and AMA’s Amicus Briefs and recent public clarification, reiterates that misstatements regarding HMA’s role in contract negotiation cannot remain unchallenged. We continue to support a transparent, equitable contracting environment that recognizes the realities faced by Hawaii’s providers and prioritizes patient welfare.

We remain committed to providing timely, accurate information as the Nitta v. HMSA litigation develops.

Signed,

David Isei, MPH, MAOL

Executive Director, Hawaii Healthcare Task Force

Scott Grosskreutz, MD

President, Hawaii Healthcare Task Force

About the Hawaii Healthcare Task Force:

The Hawaii Healthcare Task Force is a statewide coalition dedicated to advancing healthcare access, supporting provider sustainability, and advocating for fair and transparent healthcare policy across Hawaii.

For professional correspondence, please direct inquiries to info@hawaiihealthcaretaskforce.org