5 Things Hawaii: SDOH transformation plan, GET medical services exemption, Q&A on medication use disparities


Eli Kirshbaum


We’re glad to be back reporting in Hawaii after a brief hiatus last month. Reporter Shane Ersland has recently began reporting in the state, and his coverage of Hawaii’s SDOH improvement plan, an initiative to exempt medical services from the state’s general excise tax, and efforts to address medication use disparities among Hawaii’s indigenous populations are included in this newsletter.

We’re also underway with planning the 2023 Hawaii State of Reform Health Policy Conference! We are so thrilled to be back in Hawaii in-person and can’t wait to hold our event in Honolulu on January 11th. We will release the event’s Topical Agenda in the next week. If you know you want to join us, register here!

Thank you for reading!

Eli Kirshbaum
State of Reform


1. HMA helping Hawaii develop SDOH improvement plan

Hawaii’s MedQuest Division, in partnership with Health Management Associates, is developing a transformative, 5-year plan to address Hawaiians’ social determinants of health. The plan is part of the Division’s Hawai’i ‘Ohana Nui Project Expansion program and will incorporate government officials, CBOs, and health plans. HMA is currently evaluating different stakeholder groups to identify areas for improvement in the state’s current SDOH strategy

“Right now, there’s a lot going on [around SDOH], but it’s not synergistic,” said HMA Principal and the project’s Director Maddy Shea, PhD. “A hospital can’t solve poverty, and neither can a health plan, but if they’re working with government and community-based organizations, they can work together to solve some of these problems.” HMA plans to discuss the final implementation plan and next steps with stakeholders in February.


2. Initiative garners support for exempting medical services from GET

The Grassroots Institute of Hawaii is sponsoring an initiative to exempt medical services from the state’s general excise tax. According to supporters of the effort, eliminating this tax would increase the amount of money doctors make—something intended to help with the state’s health care workforce shortage.

In a recent interview with H. Hawaii Media radio network, GIH President and CEO Keli’i Akina explained that the exemption would save doctors and patients over $200 million annually. Some stakeholders are concerned that lawmakers might increase taxes in other areas if they’re eliminated from medical services. “But we believe the state’s budget is large enough already and could use some trimming,” Akina said.


3. Q&A: UH Hilo’s Karen Pelligrin on addressing indigenous medication use disparities

Karen Pelligrin, Director of Continuing Education and Strategic Planning at UH Hilo’s College of Pharmacy, is leading an initiative to direct $333,000 in grant funding to addressing disparities in medication use among indigenous Hawaiians. She recently spoke with State of Reform about how she plans to use the funding to bridge these gaps.

The funding will be used to develop a culturally competent pharmacist screening tool in order to leverage the expertise of pharmacists serving populations with medication use disparities. Pelligrin’s colleague, Professor Wesley Sumida, is leading development of the tool. “We believe the screening tool Dr. Sumida is developing will help community pharmacists efficiently and effectively screen for social needs barriers to medication adherence in the most vulnerable populations.”


4. Honolulu creates over 100 affordable housing units

Drawing on funding approved in this year’s city budget, Honolulu plans to create more than 100 affordable housing units at the Waikiki Vista building in the city’s Moiliili neighborhood. The building, which the city acquired for $37.75 million, is close to public transportation and recreational centers, and will be rented to individuals who earn 60% or less of the area’s median income.

According to the National Low Income Housing Coalition, Hawaii has a shortage of 23,492 affordable rental homes for its extremely low-income renters. Oahu is projected to have a shortage of 22,000 housing units in the next 3 years.


5. Health care discussions during Congress’s lame-duck session

Significant health care policy decisions are often made after Congress adjourns for the year, as was the case last year with the passage of the No Surprises Act and other key policies. In his November column, State of Reform columnist James Capretta explores the health care reforms on the table for the 2023 lame-duck.

Capretta explains that Medicare reimbursement will be a central area of discussion, with suspension of the Medicare PAYGO Sequester and cuts to Medicare physician fees being probable. He also lists permanent extension of COVID telehealth parity rules and additional COVID funding as possible discussions.