Health care organization aside, the above should be underlined. It's true for education too -- factors outside schools affect what goes on inside schools. I know, what a concept. But this has been documented empirically, and this information ought to be useful in the political arena.
Narrowing the focus to health care organization or education per se can lead to excessive policy- wonkization of the topic.
Getting back to wonkery, however, I am curious about Hawaii. My impression was they had achieved high coverage rates at the cost of a somewhat regressive financing scheme. What is the nature and source of the missing coverage?