Overview of Hawaii’s Legislative Health Bills

Hawaii’s Legislature opened on January 18, right after economists announced that State revenues were expected to grow just 3 percent, down from earlier projections of 5.5  percent . This revenue adjustment instantly took $155 million out of the state budget, and, in combination with pressing unfunded liabilities for the public worker retirement system, put a damper on the hopes of many for new legislative investments.  Nonetheless, more than 2,900 bills were introduced, including a range of progressive health legislation.  This session, those measures that don’t cost the State any money will have the best odds for passage.

Some health legislation highlights:

Health and consumer protection committee leaders have introduced bills that would include most of the benefits and mandates of the Affordable Care Act in state law.  Hawaii’s providers and health plans have been supporters of the ACA so the main concerns with upholding provisions stem from not having any idea how the Trump Administration and Congress will deal with repeal or repair, particularly in regard to Medicaid expansion and subsidies for individual coverage.

A number of bills address housing and homelessness, thorny problems for an island state with high land and constructions costs and the largest per capita homeless population in the nation. Some proposed bills innovatively connect health insurance and Medicaid payments to homelessness, which are encouraging some thoughtful discussions about how health status and socio-economic characteristics are linked as well as the appropriate role of insurance vs. investment in other human services.

Access to care concerns are regularly considered by the Legislature.  This year funding bills are in play to support expanded ground and air ambulance services, struggling rural hospitals and clinics, restoring basic dental coverage for adults enrolled in Medicaid, and creating a state loan repayment program for health care providers.  Other bills would address scope of practice to enhance the care that pharmacists, psychologists, dental hygienists, and occupational therapists are able to provide.

Coverage for in vitro fertilization has long been a benefit for Hawaii residents with commercial insurance.  In an effort to erase any discrimination based on marital status or sexual orientation, the Legislature is considering upping eligibility for coverage to male same sex couples and their surrogates.  Insurers are raising questions about the legal and cost implications for the surrogate who might otherwise not be a beneficiary.

Last session, legislators passed a medical marijuana bill.  This year several measures are being considered to address some of the unanticipated issues that have arisen with implementation.  One conundrum is the legality of travel from island to island for patients or their care-givers who are bringing with them their prescription marijuana.  Federal law, which doesn’t condone the use of marijuana for any purpose, controls the air space between most islands and Hawaii residents don’t have many options for intra-state travel outside of commercial flights.