Q&A: Representative Yamane looks back on the 2021 session

Representative Ryan Yamane currently serves as the Chair of the Health, Human Services, and Homelessness Committee. He previously chaired the House Committee on Health from 2009-2012. He also previously chaired the House Tourism and Culture Committee from 2006-2008. Yamane has dedicated himself to public service as a social worker, instructor and disaster volunteer for the State of Hawaii. Yamane represents the 37th State House District and has served in the Hawaii House of Representatives since 2005.

In this Q&A, Yamane discusses where health showed up in the 2021 session and the budget, and what plans he has for health policy going forward.


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Sydney Kurle: What would you call a theme of the session not only overall, but more specifically for healthcare?

Representative Ryan Yamane: “In Hawaii,  we had the looming budget crisis. Hawaii was significantly impacted by COVID, economically, because our primary source of outside revenue is tourism. So when the tourism industry shut down, that not only increased our demand on services, health and human services, but it also reduced the economic taxes that we could collect. So, going into the session, our primary focus was looking at what is our core mission? And how do we meet the ever growing need for them?”

SK: What issues surrounding health were important for you going into the session, knowing that it was going to be a short session, knowing that the pandemic was happening? And did your priorities change at all, as the session progressed to you specifically?

RY: “Going into the session, because of the fiscal issue, I went in looking at what programs are must haves, and what programs that we might have to cut. Going through all of that, I spent hours going through the budget. I looked at ways of being creative, to try to reformat how we provide healthcare in Hawaii, to not only try to be innovative but also increase efficiency. So what happened was, during that process, two major consolidation changes came up, that we put into law and two bills. One was the transferring of Honolulu, our biggest County’s emergency medical service system, transferring all that to the county [from the state system].

And then the second one was taking two of our long-term care hospitals that we’re currently in, like a pseudo public private partnership, and bringing them back into the Department of Health as two long-term care facilities within the state. And by doing that we not only increase the efficiency on all facets, but we were able to also bring in a fresh insight into how to address our various needs, with limited resources available. And it did switch mid session, once we started being aware of the federal stimulus monies that would be available to the state and our counties. It made some of those issues even more important, because we knew that the transitions would be better if they happened now while we had the support of what the federal government was giving the state.”

SK: Would you say that the federal funds allowed you to do programs that you had wanted to do for a while, but they just weren’t feasible?

RY: “Yeah. I mean, that helped, right? Because going in, we’re facing a $1.4 billion budget shortfall. Right. So, we went from looking at programs that we might have to cut or scale back to being able to maintain them, and then looking at the ideas that we have, as ways of improving how we deliver health care.”

SK: In the governor’s budget, there were a bunch of cuts to Social Services. How important was it to the legislature to preserve those services?

RY: “Very important. So we actually figured out ways to restore most of those cuts. Restoring HIV services, restoring sexual abuse treatment services for women. We were able to also ensure that our homeless service programs are funded. So we made it a priority to look at what we felt were the core services that the state should provide, and then make those a priority. And then the stimulus money made it much more, it allowed us to see and protect a lot more programs.”

SK: Looking forward to the next few years, in what ways does Hawaii need to continue to reform health care and how it’s delivered in the state?

RY: “For us, this really indicated how vulnerable we are to outside economic factors. And so, what we need to do is figure out ways to make our various health care providers much more sustainable. I think it was a wake up call for everyone to realize that you cannot be coming in only for state monies or only for federal dollars. You have to be creative or multitask. So you can do a wide variety of services from a potentially wide variety of funding sources. So going forward, one of the issues that I will be looking into as we move forward into 2022, is trying to make sure that our mental health framework is improved. COVID impacted all types of levels of social, economic, geographic, ethnic groups. It went over the gamut of who was impacted with mental health issues like depression and manic issues. We’ve been hearing issues of increased domestic violence and substance abuse incidents. So, going forward, we’re going to put an emphasis on trying to address mental health and how we ensure that our delivery system is, I wouldn’t say disaster proof, but is more sustainable through a wide variety of issues.”

SK: Do you think that Hawaii will be investing in its public health infrastructure going forward?

RY: “I would hope so. That would take the commitment from the whole legislature as well as our governor. We made a great first step with this transition I talked about regarding the Oahu Regional Health Care System hospitals coming through the Department of Health. That bill in itself will actually work with some of the changes we’ve been working on for the last year to hopefully do better triage for the chronic homeless, and those with significant substance abuse issues. So rather than inundate our emergency rooms and have them go through the hospitals, and take up needed beds there. The goal with this is that we identify them early before they’re actually brought to the ER, to make sure that when they do go into the ER, it’s for medical reasons. If they are having chronic mental health issues. The goal then is to have them go to let’s say Leahi Hospital, where we will have SAMSA funded beds to treat chronic behavioral health issues. We would like to have other bills that have homeless programs that we can address that transition from those long-term care hospitals, to the community, rather than them having to take up needed acute medical beds.”

SK: There is a healthcare workforce shortage nationwide, but specifically for Hawaii that existed pre-pandemic. How is Hawaii investing in building that workforce and retaining providers?

RY: “One of the things that we have been looking at is how to support our physician shortage. We passed a bill this year that would hopefully continue the loan repayment program that our local medical school has. We’re also trying to look at ways where we can expand services through telehealth. We have been one of the states that has been investing in allowing our APRNs to do a wide variety of services. So we’re trying to look at ways in which we can partner with our federally approved health centers and our clinics to figure out how we can share our resources. But, as you mentioned, nurses are at a premium right now. And a lot of the COVID has changed how healthcare delivery happens, even at a hospital setting. So moving forward, what we need to do is look at ways to make it easier and incentivize students to go into the health field.”

SK: Is there anything that I missed that you would like to touch on?

RY: “Because we are a unique state, we’re surrounded by water, right? And we’re 5,000 miles away from the closest state neighbor. So we have a very unique role. So, moving forward, what we’re going to do is look at how to make our safety net system sustainable. And that will require looking at all the federal funds available. How to reduce duplication of services. So we have to get started on that. We even came up with the idea of looking at ways of having the various funders, which are state departments and others, figure out ways of how we can interdepartmentally maximize our dollars. So that’s a first for Hawaii, where we’ll be starting looking at a copayers group. We’re going to look to see if Medicaid can be used for different approved services that overlap with other state programs. So we can maximize every dollar that we have. And I think that’s where most states are going to look at, is once the stimulus money goes away, or is used up? How do we sustain those programs that we stood up during this public health emergency? And that’s where we have to determine what our role is. And going forward, we do think it’ll be a combination of not only workforce, but service availability to clients. But we’re also trying to figure out ways where we can partner with our federal partners, to maximize how we are providing care through various forms. So not necessarily just in person, but through telehealth, and even maybe, phone contacts.”

This interview has been edited for clarity and length.