Q&A: Rep. Linda Ichiyama on women’s health care and ongoing pandemic response

Rep. Linda Ichiyama (D – Moanalua Valley) is the Chair of the Hawaii House Pandemic and Disaster Preparedness Committee. She is also a co-convener of the bipartisan Women’s Legislative Caucus (WLC).

In this Q&A, Ichiyama discusses her committee’s key developments this past session, goals for next year, and legislation to address women’s health.

 

Get the latest state-specific policy intelligence for the health care sector delivered to your inbox.

 

State of Reform: What were some of your committee’s key priorities this last session? What went well for you, and what would you like to see improve next session?

Rep. Linda Ichiyama: “For the pandemic committee this past session, we had a number of different bills that we’re working on, and we’re very fortunate this year to get a number of them passed … We passed a bill to do a one-time enhanced payment to skilled nursing facilities, expanded arches and community foster care homes, to help them cover some of the unexpected, increased costs due to the pandemic staffing and PPE shortages. It’s going to be equivalent to a 15% payment, and the total amount that we appropriated was $80 million. 

Another bill we worked on was SB 3089, and that was to help increase transparency and accountability in our state emergency powers chapter. HRS Chapter 127A is our chapter that gives the governor or mayor authority to declare a state of emergency, issue proclamations, suspend laws, and basically take the actions necessary to address the emergency. This was building on our work from last year. In the pandemic, we realized that our emergency statute only allowed for misdemeanor offenses, which is pretty severe—up to one year in prison and a substantial fine. It just wasn’t the right fit for people who were violating the mask mandate or sizes of social gatherings in a park. Instead, you’d expect more than something like a parking ticket—a citation. We gave the governor and the mayor the authority to create violations, so it’d be more like a parking ticket, with a lower fine amount, no jail time.

We updated our emergency powers chapter to say that the governor or the mayor, when they’re suspending any laws, they have to narrowly tailor the suspension to the emergency and there has to be a written justification in the proclamation as to why this is relevant to a particular emergency. A good example is at the beginning of the pandemic, our governor suspended our Uniform Information Practices Act. Essentially, he suspended the whole chapter, which also suspended our Office of Information Practices, which was never intended … inadvertently, he suspended the office that administers all of our Sunshine Law and open records laws. [We’re] trying to avoid situations like that for suspensions that are overly broad and not necessarily directly related to the emergency.”

SOR: In January the WLC put together its bill package. What were the most important women’s health issues you focused on?

LI: “This year, our package covers a broad variety of issues, from Title IX, gender equity and education, to women who are incarcerated, to trying to improve health care [through] coverage for mammography and specialized types of mammography. 

Another bill is extending postpartum coverage for Medicaid recipients, right. So the federal government allowed states to extend up to 12 months postpartum coverage. If you’re pregnant, you have a higher income threshold to qualify for Medicaid because we want to cover pregnant people, but coverage terminates 60 days after you give birth. Unfortunately, a lot of moms are dealing with postpartum depression, gestational diabetes, and heart problems that continue way past 60 days after delivery. So, we were able to get that into the budget to extend postpartum coverage up to 12 months, to give us $5.8 million. 

This wasn’t part of the Women’s Caucus package, but something we have worked on in the past was menstrual equity. In the budget, they appropriated funds to provide free menstrual products in our public schools, because no one should ever have to be ashamed or embarrassed or not have access to a pad. 

There were a couple of things that did not pass that we want to come back and work on again next year. One is creating more data collection and reporting on the commercial sexual exploitation of children, or CSEC. That’s an issue that we’ve become more aware of in Hawaii. And we want to make sure that we’re tracking the trends and patterns and making sure we’re putting resources where they’re most needed. We did in the budget, created an Office of Human Trafficking in our Department of Attorney General, and hopefully provide some of the staffing and resources that will help address this issue.”

SOR: Hawaii’s supplemental budget recently came through, with notably less pandemic-related federal funding. What is the legislature’s plan for funding future pandemic response measures in Hawaii?

LI: “We had to do a couple of emergency appropriations in general funds to the Department of Health for vaccine deployment and testing. We’re hoping though, to get federal reimbursement through FEMA, for those through the Stafford Act, grants, public assistance grants.

In general, the approach our state is taking as we move into less of a pandemic crisis and more endemic, long term issue of how address COVID-19, is that we’re starting to move away from the state being the provider of testing and vaccines and trying to have more of our community groups and private sector to fill the traditional role that they have always filled in health care. We’re relying a lot on our [federally qualified health centers] and some of those real grassroots organizations. We’ve been trying to also promote the use of home testing kits versus community mass testing sites, because [mass testing sites] take a lot of manpower and resources. We’ve been trying to push people to apply for the free test kits that you can get from the federal government, and I actually ordered it myself and it came really fast and I was very pleased.”

SOR: With the ongoing staffing shortage, there seems to be a need for other testing and vaccination options, especially in the case of new variants.

LI: “We’re all anxiously awaiting the under 5 vaccine. That will present its own challenges because our pharmacists cannot vaccinate those under 3. We’re looking a lot at our pediatricians, and most families go to their pediatricians for their vaccines anyway, but because of the nature of the vaccine and having to use the doses once you open the vial, it just creates a lot of logistical challenges.”

SOR: What other policy moves should health care experts keep an eye one moving forward? 

LI: “Something for me personally, that I’m paying close attention to is the decision on Roe v. Wade, and how that will protect or not protect women’s access to reproductive health in Hawaii. We’re very fortunate Hawaii was the first state to legalize abortion back in 1970, which was 3 years before Roe v Wade, but we want to make sure that we still fell under the umbrella of protection of Roe v. Wade and Casey v. Planned Parenthood. If those precedents go away, do we still have the same level of protection for women in Hawaii? Last year, we passed a bill to allow APRNs to perform aspiration abortions. Following up on that, making sure APRNs are getting trained, because access [to abortion] on the neighbor islands is very, very difficult. Some neighbor islands have no providers at all, and so that’s why including APRNs was so important. So that’s another thing I’m looking at right now and then for the next session.”

This interview was edited for clarity and length.