HONOLULU – Ideas offered by Maui citizens on improving health care took shape in legislation introduced in the 2008 Legislature by three state senators from Maui County.
Inspired by a 140-page report from the Maui Health Initiative Task Force, the state Senate delegation offered seven bills for consideration in the session that opened on Jan. 16.
They include proposals on limiting physician liability, health insurance premium caps and a pilot project on fluoridation to address dental health in Maui County.
The legislative package was put together by Sens. Roz Baker of West and South Maui, Shan Tsutsui of Central Maui, and J. Kalani English, who represents East and Upcountry Maui, Molokai, Lanai and Kahoolawe. The bills were filed on Wednesday, the deadline for introduction of legislation for the 2008 session.
“The only way the recommendations can be considered is if we got them introduced,” Baker explained, noting that the seven proposals will be among 1,000-plus bills in the legislative mix.
Typically 60 percent of each year’s legislative proposals go
nowhere and that could happen with any of the Maui initiatives.
The Maui Health Care Initiative Task Force was established during the 2007 session in response to criticism of the health care system and calls to repeal the State Health Planning and Development Agency.
The 2007 Legislature kept intact the SHPDA law that mandates a state certificate of need for new health care services and facilities – a review process that blocked plans for the Malulani Health and Medical Center in Kihei.
State senators agreed with the task force that action should be taken to streamline the certificate of need process this year.
Senate Bill 2418 calls for eliminating the Certificate of Need Review Panel and the Statewide Health Coordinating Council – two Oahu-based review bodies – and designating the subarea health planning councils as regional health planning councils with final authority for medical services in their regions.
The regional councils would advise the State Health Planning and Development Agency administrator, who ultimately approves new health care services and facilities in each area.
Baker said she does not necessarily support all of the task force’s recommendations. In fact, the senator said she has told task force members that some of their ideas are “a stretch.”
But still, the three senators wanted to “honor” the task force’s work and formulate legislation as suggested, she said.
“We asked them to do something. Whether we agree with them or not is irrelevant,” she said.
“We appreciate all the hard work of the task force to accomplish its legislative mandate in such a compressed time frame,” English said. “The Maui senators are committed to achieving the best quality health care possible for all of our citizens. The efforts of the task force help us to achieve this goal.”
“We are all working together to accomplish our goals, and we are united in our desire to improve Maui’s health care with the best combination of approaches,” Tsutsui said.
Task force members said they were happy to see senators responding.
“It’s a positive move forward,” said task force Chairwoman Rita Barreras. “That’s encouraging.”
Barreras said she was disappointed that the state Senate bills did not address the need to support home- and community-based services for Maui’s elderly and disabled. The task force recommendations include increasing the supply of long-term care beds and funding additional community facilities and residential options in Maui County. There was also a suggestion that legislation for tax incentives and funding for the private sector to build long-term care beds.
Barreras said she understands the report contained a lot of initiatives, and that senators did not have much time to review the report and draft legislation.
“There’s no doubt we were recommending a lot,” Barreras said.
Dr. Guy Hirayama, a pediatrician and task force member, was encouraged by the senators’ bills.
“I think it’s good. It’s promising. We don’t know if any of it will actually pass but at least it’s out there,” Hirayama said.
A former president for Maui Medical Group, Hirayama wrote much of the proposed legislation in the task force report.
“The bottom line is we can come up with all these nice ideas but with no real reimbursements, nothing will be realized,” he said.
Senate Bill 2413 allows for health insurance companies to determine rates.
At Hirayama’s suggestion, the task force recommended that the state insurance commissioner not be authorized to set caps on health care insurance premiums.
Hirayama said he understands that businesses and consumers don’t want to pay higher premiums, but that affects the levels of reimbursement provided by the insurance companies – which correspondingly affects pay and recruitment for physicians and health care workers, and ultimately quality of care.
“The consumer has been for too long hiding behind the insurance companies. If they don’t want to pay for higher premiums, that’s fine. They’ll get what they pay for,” he said.
The task force suggests no caps on insurance premiums and recommends the state re-examine laws requiring employers to provide health care insurance. The Legislature would also need to review state-sponsored health insurance programs, especially for those unable to afford insurance, according to the task force report.
Although she is a member of the state Senate Health Committee, Baker said she cannot promise a hearing on any of the legislation drafted out of the task force report.
Under legislative rules, committee chairs determine what bills are heard for action.
Barreras said she plans to resubmit a request by the task force that it be given the $100,000 appropriation that was attached to its legislative mandate. The task force was denied the funding last year. Barreras said task force members could use funds to travel to the State Capitol to lobby for their health care proposals.