5 Things Hawaii: Sen. Chang, Trish La Chica, Assisted Community Treatment

State of Reform is very much a team effort. You see that at our conferences, as well as in the community that leads Hawaii health care.  The same is true with this newsletter.  While my name is at the top of this email, this is a product of a number of contributors, including folks like Karianna Wilson, Sara Gentzler, and Emily Boerger.  They each do a significant amount of the work on this newsletter each month.

So, with gratitude for the team that produces this, and for our community in Hawaii that supports us, here are 5 Things We’re Watching in Hawaii health care for March, 2019.


DJ 5 Things Signature

With help from Emily Boerger
and Sara Gentzler.



1. Costs in health care: deck chairs and the Titanic

Cost is increasingly the paramount issue in health care today. That’s not news. But, for as common as this knowledge is, we aren’t always as honest about cost as we could be. We also sometimes try to make it more complicated than we should. In this series, I suggest there are two ways to think about costs: deck chairs and the Titanic.

I spend a fair amount of time with numbers, data, and metaphor in the series. But, after stewing in the national health expenditure data from CMS for a while, this is the bottom line: Market leverage has more impact on driving cost increases than both utilization and the costs from service delivery combined. And, it appears that this is the first time in American health care history that this is the case.


2. Q&A: Sen. Stanley Chang

Sen. Stanley Chang is Chair of the Senate Committee on Housing and Vice Chair of the Committee on Commerce, Consumer Protection, and Health. In this Q&A, State of Reform Reporter Sara Gentzler asks Chang about the big pushes in health care this session and the ways in which housing and health care intersect uniquely in Hawaii.

Chang talks about efforts to expand Kupuna Care, curb vaping, and emphasize mental health. On the housing side, Gentzler asked about Chang’s ALOHA homes bill and its potential ripple effects. “It’s going to have profound impacts on mental health, on public health,” Chang said. “And, I don’t even know that people will be aware that that’s happening. It will be happening under this new proposal.”

3. Medicaid adult dental benefits update

Legislation to expand dental care benefits for adult Medicaid enrollees in Hawaii passed off the Senate floor this week. The bill, SB 467, would appropriate general revenue funds to restore Medicaid enrollees’ preventative and curative adult dental benefits, with the expectation that the Hawaii Department of Human Services (DHS) will obtain maximum federal matching funds.

The bill has received supportive testimony from representatives from the Hawai’i Public Health Institute, the Hawaii Dental Association, the Queen’s Health Systems, the Healthcare Association of Hawaii, the Hawai’i State Rural Health Association, and AlohaCare, among others. The bill will now cross over to the House.

4. Video: Trish La Chica, Hawaii Public Health Institute

Trish La Chica is the Policy and Advocacy Director at Hawaii Public Health Institute. She joins us in this edition of “What They’re Watching” to discuss tobacco control and prevention.

“You know, our state has really benefited from a decline in our adult smoking rates. We’re among the lowest in the nation at 13.1 percent, but we’re seeing the opposite with the rise of youth vaping rates, and we are experiencing a vaping epidemic… Our youth continue to be marketed to by products that look and feel like candy, and so our youth advocates this year will be focusing on ending the sale of flavored tobacco.”


5. Changes to Assisted Community Treatment

The Legislature has taken up the task of improving Hawaii’s Assisted Community Treatment (ACT) law. The ACT law, which passed in 2013, allows judges to require individuals with severe mental illness to undergo intensive outpatient treatment — but there are some portions of the bill that advocates think are broken.

Four bills that would introduce changes to ACT (SB1124SB567SB1464 and SB1465) recently passed unanimously in the Senate. Lt. Governor Josh Green, who introduced an update to ACT when he was a state senator, recently spoke with Hawaii News Now where he discussed the benefits of the law and vowed to continue working to improve it.