Ige’s budget cuts | Bills moving | Three things from DC

We are a few weeks removed from our 2017 Hawaii Health Policy Conference, a time when the legislature had yet to begin.  The session is now underway, bills are moving and revenues are falling.

Those are some of the 5 Things We’re Watching this month in Hawaii health care.  As always, mahalo for reading!


1.  Health care legislation moving

We have our eye on a few bills this session we think are noteworthy.  A “Death with Dignity” bill passed out of a Senate committee yesterday, gaining some momentum for a bill some thought might stall.  Legislation from Rep. Belatti (HB 552) and Sen. Baker (SB 403) is moving forward that would integrate some of the consumer protections of the ACA into Hawaii state statute.  Three bills have been introduced to help offset the budget challenges facing Maui Memorial Medical Center ahead of Kaiser taking over in July.

Beth Giesting has a run down of legislation from earlier in the week.  She’ll be posting legislative highlights for us once a week through the legislative session.

2. Looking back on our annual conference

Our 2017 Hawaii State of Reform Health Policy Conference was an honor to convene and host last month.  We had about 260 attendees from all across the spectrum of Hawaii’s health community.

We have also posted our keynote addresses.  Michael Stollar from HMSA kicked things off.  Key legislators talked through the session at lunch.  And, John Kitzhaber, formerly the governor of Oregon, highlighted the role of social determinants to the success of financing and delivering health care during our afternoon session.

3.  Three items out of Washington DC

You know that individual mandate thing? Don’t worry about it. The IRS just quietly made the reporting of your coverage optional rather than a requirement on your tax form. Sort of like an optional mandate? I was also recently told he block grant conversation in DC is specific to traditional Medicaid. The expansion population is not part of the policy discussion as it would be applied unevenly across states.

The Freedom Caucus of the House Republicans (a 40-member conservative bloc borne from the Tea Party movement) voted Monday night to not accept any replacement without a full repeal of the ACA, including Medicaid expansion. Moderate Republicans in the Senate reportedly disagree. I think the pathway for replacement gets more difficult as things drag on.

4. Video: Bob Toyofuku on the budget

Bob Toyofuku is one of Hawaii’s most prominent and respected lobbyists. Bob serves as the President of Hawaii Advocates, and has a number of clients in the health care sector. He joined us in this edition of What They’re Watching to highlight questions surrounding Hawaii’s budget in the 2017 legislature.

“If the ACA gets repealed, depending on how, with no replacement, then the question will be the people that now have insurance, will they lose insurance and will they go to Medicaid?  That’s going to increase the cost of Medicaid.  Then, because the Medicaid dollars are split between the federal government and the state, then is that going to increase the state share… and the legislature is going to have to look at how they are going to raise that money to pay for that.”

5.  Ige’s 26-page budget letter

The shortfall in revenue from a growth rate of 5.5% to 3% for the budget, announced in January, has warranted a 26-page letter from Gov. Ige on proposed cuts to the budget. The cuts include a hit of $9.5m to the Maui Health System and Kaiser in FY18, funds intended for “incremental cost due to transition delay.”

Ige says he expects the revenue forecast to fall again in its March forecast, meaning even more cuts could be likely.  Historically, March actual revenues have missed forecasts each of the last 6 years by an average of 1.9%, according to the Council on Revenues.