In 1991, Democratic Sen. Joy San Buenaventura was appointed as a per diem district court judge at the age of 32, which made her the youngest judge in Hawaii. By 2020, she was elected to the Hawaii Senate, where she currently chairs the committee on Health and Human Services. Buenaventura recently spoke with State of Reform about what she sees as the successes, and some failures, of this year’s legislative session.
SOR: I would love to hear your opinion on how the session went as it relates to healthcare and your position on the Senate Health and Human Services Committee.
Sen. Joy San Buenaventura: “I think it went really well. The first thing we did straight off the bat was we protected physicians from the overreach of states who had banned abortion against subpoena expeditions and the like, so that’s SB 1, and that’s the one that the governor fast tracked and signed into law before any other legislative bills this session.
That was one of the first bills that came out of my committee and we fast tracked, and so we reaffirmed the reproductive rights of the women and the people of the state of Hawaii and increased their access by allowing APRNs and physicians assistants to be able to do some types of abortions, and we ensured the state’s commitment to protecting physicians and medical providers.
Especially those tourists who come to Hawaii and find out that they’re pregnant and should they end up going back home when they will not be able to have those types of services in their home state. We’re protecting the physicians and the medical providers from being subpoenaed and extradited.
We increased Medicaid payments to at least Medicare rates in the state for the first time this year. It required funds of about $140 million—I think $70 million a year— in exchange for drawing down Medicaid similar amounts.
We’re looking at around $70 million a year in general funds that brought in more in Medicaid dollars to reimburse medical providers to at least Medicare rates, which isn’t much. It’s better than Medicaid rates and hopefully we will prevent the exodus of physicians [who provide] medical services to the poor. It’s especially super difficult in rural Hawaii to find local providers who accept Medicaid because there is such a shortage and they’re losing money.
A failure in the legislative session that occurred really at the very end was a budget request for more behavioral health services. The state had over $200 million to fund various emergency behavioral health centers on Oahu and at least one on the neighbor island, and I think we got one that is only federally funded for the neighbor island but the monies for Oahu was in negotiations with the House and did not make it to the budget.
We had high hopes when Gov. Green, the Senate, and the House made behavioral health a priority this year, that it would pass. That’s why it was surprising that we didn’t get House cooperation as far as … the money committee in the House to fund behavioral health. Hopefully next year we’ll be able to do it and after talking with Dr. Marian Tsuji, who is the adult behavioral health deputy director for the Department of Health {DOH), is in talks with Gov. Green to hopefully find some monies. Maybe in the so-called slush fund that ended up being negotiated as a stop gap [because] they couldn’t agree on a number of budget items.”
SOR: How do you feel about that bill not being passed, especially when states are seeing a rise in people experiencing behavioral health crises?
JSB: “It was super disappointing but it wasn’t so much the bill, it was the budget request. Usually if a bill dies, we see it in the budget. Like the Medicare match of Medicaid—the bill died but you saw it in the budget. I was hoping when the bill died for behavioral health services that it would be on the budget because…when we were in conference it was certainly in the Ways and Means [committee] ask from the Senate—that after negotiations of both finance committees about health in the Senate that it would survive, but it didn’t.
The monies weren’t there and it’s one of those things. I don’t know whether or not it’s because we have a new finance chair that there were problems with getting the budget out on time—it ended up going out on time, but there were extensions in the actual vetting of the budget for it to go out on time, and it wasn’t exactly what I was hoping for when we were in conference.
We also increased the access for Our Care Our Choice so that rural communities would be able to manage a bit more. And that is allowing APRNs to provide end of life prescriptions, reducing the waiting period and allowing for more counselors, because we have a huge shortage of counselors, especially in rural communities—we have more general, not specialized, counselors, like family counselors who are frankly far more equipped to do end of life counseling. So we’ve increased the types of counselors who are allowed to do end of life counseling, so that’s another big win for the medical committee.”
SOR: What are you most excited about for the rest of the year in terms of healthcare in Hawaii?
JSB: “I’m excited that we have a governor doctor who is super open to ensuring that behavioral health needs in the state of Hawaii—which have long been forgotten—that we’re going to start looking at it anew and seeing possibilities of where we can increase these behavioral health therapies and treatments and the like. So I’m super excited about that.
I’m super excited that we passed … the Office of Wellness and Resiliency [last year]. One of the things I am doing that hasn’t actually passed this session, but I’m hoping that the House health chair would be more open to it next session … is to see it as a resource, because the DOH is super understaffed.
Even pre-COVID they had a 40% shortage of personnel—that’s huge. After the pandemic they’ve had to handle a number of retirements and resignations because they were just burnt out with the pandemic. We should use the Office of Wellness and Resiliency for the kinds of studies that we normally rely on the DOH to do. So, one of those was to look at emerging psychotropic drugs as a possibility. Psilocybin. They’re using it in the military, at least as a pilot for [PTSD].
So I wanted to put the study of the psilocybin use, as well as other emerging treatments, into [the] Office of Wellness and Resiliency because they’re new; they have the resources and the new manpower to be able to make these studies and research far more robust than the very understaffed DOH. And then of course use whatever recommendations that come out of these studies, and of course, have the DOH look at those recommendations before we get them out to the general public.”
SOR: Is there anything else you would like to say?
JSB: “One of the things I was super excited [about] that passed, but it was in the housing committee and not in my committee, was that we put in $100 million for supportive housing. If you look at the continuum, you have the emergency which is the ER, you’ve got the stabilization beds which were underfunded but hopefully with the new kauhale that Gov. Green just opened up, hopefully that will generate more stabilization beds—temporary beds, which is only up to 10 days.
Then you have the supportive housing, which is super lacking but hopefully with $100 million from Health and Human Services, we can entice developers to develop more supportive housing. That doesn’t have an end date but hopefully we can have those who have mental health disabilities—and that doesn’t include only those who are mentally ill but ….people suffering from various illnesses that may not arise to severe mental illness so that they have supportive housing, so we don’t see them on the streets and that they will be able to have a community who will help them throughout their lives.”
This interview was edited for clarity and length.