Q&A: Sen. Roz Baker on the 2019 session and what’s next in Hawaii’s health policy conversation

Senator Roz Baker is the Chair of the Senate Commerce, Consumer Protection, and Heath Committee in the Hawaii State Legislature. Sen. Baker represents Senate District 6 in South and West Maui and has over 25 years of experience serving as a Maui legislator.

We caught up with Senator Baker a week after the 2019 session ended to discuss key health bills passed this year, bills that failed, health care challenges in Maui, and where the conversation is headed next in Hawaii health policy.


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Emily Boerger: Looking back, how do you think session shaped up this year for health policy?

Roz Baker: “We passed a lot of really good bills. We left a few either in conference or committee, but I think overall, we accomplished what we needed to get accomplished. We got funding for some of our hospitals and health centers, added some additional regulation on the books for e-cigarettes, and we got funding for our cancer research center.”

EB: Outside of those pieces of legislation, are there any bills passed this year that you want to highlight or that you are excited about?

RB: “Two other things in health care I should highlight: We have a high incidence of youth suicide and so we made sure that we had funding in each of the counties for suicide prevention and working with the schools on that.

The other had to do with Assisted Community Treatment (ACT)… We improved our ACT laws and we streamlined the process for getting commitments to treatment. I think that’s going to give our providers and families some additional tools.

The other thing that we did was, we’ve had telehealth on the books as a way to get services to more of the remote areas, but we were finding that it wasn’t being adopted as widely as we had wanted. So, we put together a working group of providers, insurers – because there have been some issues about if it was going to be a covered service – to really come up with some ideas, and report back to the legislature on what the gaps are in any of our statutes that we need to address. You know, can we adopt best practices or a set of standards that all providers need to be trained on and adhere to? I’m looking forward to getting a report from them before the beginning of the 2020 session. If we do need some other legislation, or some training money for some of these areas, then we can tackle that next year.”

EB: What about bills that you were pushing for that didn’t make it into law?

RB: “We were trying to get some language in our labor laws for employee protection in the work place if they’re medical cannabis users. That proved to be a little more complicated than anticipated. But, I think we finally found some legislation from Arizona that seems to be the closest to what we were trying to push, so I’m going to reintroduce that next year.

The other two areas that I was most disappointed in: we couldn’t get a flavored e-liquid sale ban to minors. And we couldn’t get them included in the tobacco products tax so that we could tax them greater than just the general excise tax.

We did get one important bill though — it waived liability for teachers and enabled them to confiscate any e-cigarettes, Juuls and those sorts of devices, and any of the paraphernalia that goes with it, both to seize it and dispose of it.”

EB: Is youth tobacco use a big issue in Hawaii?

RB: “Yes… The companies are targeting kids with the flavors and telling them it’s cool, it’s a tech-y device, and so we’re having a lot of them at schools. Our age to smoke in Hawaii is 21, and that includes e-cigarettes. We’re seeing it in middle schools and a lot of high schools. So, we want there to be real consequences for having them on campus.

The best we could think of – there’s a fine because they’re under 21 — but also, they get them taken away and they don’t get them back. Since e-liquids are considered hazardous waste, we’re having to get the Department of Health involved so that when they collect these devices at schools, we have an appropriate method of disposal.”

EB: Shifting gears a little bit, I wanted to talk about your district specifically. Any big wins this year for Maui County? Also, what are some the challenges that still remain?

RB: “Well, our public hospital went private a couple of years ago, so they still need some subsidies. We were able to get them $22.5 million to help with their services.

We have adopted a community paramedicine program, and of course we think that that’s really going to be helpful for the neighbor islands which Maui is one of. So, I was particularly pleased with that.

We also just got a new medevac helicopter for Maui that’s a public-private partnership with our ambulance service over there. I was thrilled that that happened. That wasn’t necessarily a result of the legislative session, but it’s important for my community.”

EB: What about health care challenges that still exist for Maui?

RB: “Attracting providers. We have the medical school here and so we provide some loan repayment as an incentive to get the docs to stay here and practice. We also have the school of nursing. So, we want to keep them here. Helping to pay for their education is a great incentive because if they take our money, then they have to stay.

But also working with the Federally Qualified Healthcare Centers (FQHCs), we’re finding that they need providers as well. And since APRNs are considered primary care providers in our state, that’s helped to fill a provider shortage. We’ve also empowered physician assistants to do a little more within the scope of their practice. We’re trying to find ways that we can have different professionals, sometimes paraprofessionals, work in collaboration with a primary care provider and extend their reach.

Doing those things with licensing as well as telehealth, we’re hoping that we’re going to get better reach on Hawaii Island, which is really challenged along with some of the other islands outside of Honolulu. But we have, like any place else, a shortage of providers. So, we’re trying to grow our own and do our best to recruit and steal others.”

EB: Looking to the future, what else is going to be on the docket for health care in Hawaii? And, what will you be working on during the interim?

RB: “Well, [we’ll be working on] really fleshing out our paramedicine program and utilizing our first responders in a more holistic way. I think that’s going to be a big help.

We’re still going to be working on homelessness and we’re still going to be working on some of the mental health issues.

One of the things I’m going to work on next year, is we have a couple of — I’m going to call them hospitals because that’s what they used to be… I’d like to have those be public residential treatment centers for folks with mental illness. Right now, with our state hospital, the only way to get into the state hospital is if you commit a crime and are judged guilty by reason of insanity and you get sent up there. We have no other kinds of patients at that hospital. And we have homeless people that we know are probably dually-diagnosed with substance abuse and mental health issues, and we have people that are sitting in some of the jails that probably don’t belong there but they can’t just be out on the streets. So that’s one of the things I want to work on next year.

I’ll also want to follow up with the Department of Education to see how they’re working in the various communities and the non-profits that are working on suicide prevention.

The other area, particularly if Trump follows through and tries to reinstate a gag order or cuts funding for our Planned Parenthood, is reproductive health, which will continue to be an issue that we’re going to have to watch… We’ve put some of the provisions of the Affordable Care Act into our statutes. We have some provisions regarding reproductive health in our statute as well, just trying to be proactive. But we like to pull down as much federal money as we can. I think those [issues] are more watching and trying to see if we can get ahead of the curve of anything that may be coming down from the federal side.”