Q&A: Rep. Della Au Belatti on the 2019 legislative session

Rep. Della Au Belatti represents House District 24 and is a member of both the House Health Committee and the Human Services and Homelessness Committee. She also serves on leadership as House Majority Leader.

With the 2019 legislative session at an end, we caught up with Rep. Belatti to discuss how session shaped up in terms of health care, new policies that she is excited about, and where Hawaii’s health policy conversation is headed next.


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Emily Boerger: In general, how do you think this session went in terms of health care legislation? Was this a consequential year for health care bills?

Della Au Belatti: “It was. It was a very good year for Hawaii. We passed some significant bills that continue to lead in the nation, I think, on making sure that we are improving our health care system and making sure that access to care is strong.”

EB: Are there any specific bills that passed this year that you are particularly proud of or excited about?

DB: “Yes, there are actually two bills in particular.

The first one is our community paramedicine bill, HB 1453… The idea is that, right now with emergency services, typically you have to send the person to the emergency room. But then, if they don’t go to the emergency room, then there actually is no payment that is executed. So, it’s a question of: How can we make sure that we can bill for those services that people might receive from our EMT services?

And then, it’s also a question of how to transport them to the most appropriate place. We know that our emergency rooms are being overcrowded, and sometimes we think [patients] don’t necessarily need emergency room treatment. So, community paramedicine will empower the paramedics on the scene to make the call, or consider whether or not that person maybe really should go to urgent care or some other clinic that does not have the high cost of the emergency room.

Of course, if a person needs emergency care, they will go to an acute care hospital. But, this really is about making sure that our system, as a whole, is functioning well. So, I’m very excited about that.

And, then we also have a bill where we make improvements for our Kupuna Caregiver Program.

Hawaii was first in the nation for creating a Kupuna Caregiver — elderly caregiver — program, where we supplement the services performed by caregivers in the home.

We know that caregivers are often stressed, and we know that caregivers are sometimes elderly themselves. The Kupuna Caregiver program supplements much of the Older Americans Act monies, so that we can ensure that people can age in place.

What that program is actually building upon, and what’s very interesting to me, is that Medicare… has changed its rules to enable some of these kinds of aging-in-place support services to be paid for. So, the state’s program — which is the first and, I think, the only one in the nation that provides monetary supports for things like transportation, meals, adult daycare so that the caregiver can have respite — Hawaii’s first-in-the-nation program is actually something that our national programs like Medicare are looking to fund.

I think it’s a really nice compliment. So, I’m very excited about those two bills.”

EB: What about bills related to addressing homelessness in Hawaii?

DB: “Let me say that both of those bills that I just mentioned are actually related to homelessness.

With the community paramedicine: If you think about it, oftentimes paramedics get called out for a homeless person who may not be suffering an emergency, but might have a wound that needs to be cared for. So, rather than go to the emergency room where it’s super expensive, they can now go to an urgent care clinic.

And then the Kupuna Caregiver bill: We know that we have many elderly people out on the streets who are homeless. So, to the degree that folks can get more supports as Kupuna — as the elderly — that also, I think, addresses the homelessness problem.

But, the other thing that we did was we funded many of the homeless services that we initiated last year.

In particular, some of the pilot programs we had funded include a medical respite pilot program. This is funding for a continued extension of the pilot program for those types of patients who might be in acute care hospitals and are having problems getting placement in the community. It’s a partnership to develop placements for them in the community… between the acute care hospitals and the community service providers who work with the homeless population.

Another pilot program that we extended this year was our emergency assessment department pilot program. And again…we know that homeless people often cycle in and out of the emergency room. They are the high utilizers.

So, what we want to do is assess what’s happening in the ERs, and then see if there’s better placement. So, [the pilot program is] working with social service providers on whether or not we can place the high utilizers into proper placement, so they can get the housing-first supports that they need, they can get the social services that they might need, and they can get civil legal services that they might need. That was a third, very important bill that we passed that addresses homelessness and the intersection between medical care and homelessness.”

EB: Any bills that didn’t pass, that you wish had?

DB: “You know, there was a lot of bills related to benefits for workers that didn’t pass, and we’ll have to revisit those again.

Also, I will say that people continue to talk about how can we have universal health care or single payer health care. You know, we struggle with that in Hawaii, where we have probably the best-in-the-nation insured rate. So, our insured population is pretty high, but now we have to talk about how…we cover everybody and whether a government-paid model is the model to go after.

I think we’re going to continue to have discussions about that. You know: What is Medicare for all? What is Medicaid for all? What is the role of the state? What is the role of the state in paying for retiree benefits and current employees’ benefits?

So there’s definitely conversations happening, but we did not pass any legislation in that particular area this year.”

EB: Any other issues or important bills that passed this year that you want to mention?

DB: “One of the things that I wanted to tell you about — because, again, it was such a great year — [is that] we funded pilot programs for palliative care, which I think is also a very big deal, because a lot of states are looking at that. And Hawaii, I think, might actually have one of the best rates of using palliative care, but it’s still low.

We also funded our telehealth pilot program, to connect service providers across the state. So those two interesting pilot programs, I’m hopeful, are going to yield a lot of good benefits moving into the future.”