When Hawaii created the nation’s first “universal” health insurance law  -- known as the Prepaid Health Care Act – in 1974, it set a national standard for employer-funded health insurance benefits.

But to settle the law in place, Hawaii’s congressional delegation at the time had to win Hawaii an exemption from the federal Employee Retirement Income Security Act, which sought to set a baseline standard for all employee benefits. The exemption was because Hawaii’s law was, at the time, more generous than the minimums required in the federal law.

Now that Congress is moving toward a new federal health care law, Hawaii once again has to fight to make sure its law is not superceded by a federal statute that might not be as all-encompassing as the local law.

So far, at least in the U.S. House, an exemption seems likely. But what will be interesting is how Hawaii’s Congressional delegation will react if the final health care reform bill that emerges in Congress reaches beyond what Hawaii now offers. Will they still fight to keep a Hawaii exemption?

There’s no question that Hawaii’s law has been bloated by “Christmas Tree” add-ons never intended in the original legislation. It has also been weakened by employers who find ways around its requirements (Such as giving people fewer than 20 hours of work per week.

So the thing to watch is whether the national  effort will move ahead of Hawaii and whether this state will join the parade or stick to its own pioneering program.