The Hawaii Legislature closed its 2023 session on May 4, after a roller-coaster few months. With 18 new members in the House and six in the Senate, including new chairs of major committees, and a new governor with a new Cabinet, this was not unexpected. But as the Star-Advertiser observed (“Surplus allows aid for working poor,” Our View, May 7), “the substance of what lawmakers did this past session has to earn fairly respectable grades.” We agree.
Focusing on health care, we see significant and measurable progress. Right at the top, the Legislature increased Medicaid reimbursements to 100% of Medicare levels by budgeting $30 million in each of the next two years, leveraging $43 million in federal funds each year, to bring increased access to health care to many of the most vulnerable members in our community. This is an excellent example of a triple bottom-line benefit: Medicaid recipients receive increased access to care, health care providers receive higher reimbursements which help them stay in business, and the state uses its funds wisely to leverage available federal funds. As the House Finance chairman, Rep. Kyle Yamashita, noted in his floor speech in support of the budget bill, Hawaii will be one of the top five states in reimbursement levels for Medicaid, up from 42nd in the country.
Another victory is the passage of the Medical Licensure Act (Senate Bill 674), long supported by many physician advocates including the American Medical Association and the Hawaii Medical Association (HMA). This bill adopts the Interstate Medical Licensure Compact, creating an expedited pathway for currently licensed physicians to become licensed in multiple states.
As HMA noted in its testimony, this measure “will improve access to care by encouraging physicians to practice in Hawaii, both in-person and through telehealth services.” Since its final form in 2014, 37 states (plus Washington, D.C., and Guam), have adopted the compact.
Another significant commitment in the state budget is the addition of $10 million in fiscal year 2024 and $20 million in fiscal 2025 for the Hawaii State Loan Repayment Program for Healthcare Professionals. This loan repayment program seeks to address the tremendous shortage of health-care professionals in our most underserved areas by providing loan repayment to those who commit to work in federally-designated health professional shortage areas. Those professionals eligible include physicians, nurse practition- ers, physician assistants and psychologists, as well as social workers, marriage and family therapists, and registered nurses. Hawaii will be the first state to offer such broad support for needed health-care professionals.
There were other very positive legislative actions including those impacting telehealth (House Bill 907), provider protections and reproductive care (SB 1), $50 million in funding for capital improvements at the Hilo Medical Center, and the taxation of electronic smoking devices (SB 975). This last bill was down to the wire, as the tobacco and vaping industry have major resources that have opposed such measures for years. But due to the tenacity and thoughtfulness of advocates, this bill finally made it over the finish line.
One final observation: In each of these efforts, there was broad support from many organizations and individuals who don’t always agree with each other. As those who have navigated the Legislature know, we may be allies on one bill, and then in the next hearing, find ourselves on opposite sides. It does happen that people of good will have different positions on bills and issues; this is part of the democratic process, listening and learning from each other. It’s what Hawaii does when we’re at our best.
Angela M. Pratt, M.D., is president of the Hawaii Medical Association (HMA); Elizabeth A. Ignacio, M.D., is HMA’s president-elect; Thomas S. Kosasa, M.D., is HMA secretary.
