Hearings

House Standing Committee on Finance

February 21, 2025
  • Kyle Yamashita

    Legislator

    Morning. We're convening the Committee on Finance for 3—4—agendas today. Our first agenda—first bill up is House Bill 640, HD 2. Vice Chair.

  • Jenna Takenouchi

    Legislator

    First, we have the Office of the Ombudsman, with comments.

  • Robin Matsunaga

    Person

    Hello, Chair, Vice Chair, Members. Robin Matsunaga, State Ombudsman. I'll stand on my written testimony and I'm available for any questions you may have.

  • Jenna Takenouchi

    Legislator

    Thank you. Next, we have the Department of Human Services on Zoom, with comments.

  • Kerry Moea'I

    Person

    Morning, Chair, Committee Members. My name is Kerry Moea'i from the Director's Office. On behalf of Doctor—Director Ryan Yamane—we stand on our testimony. Thank you.

  • Jenna Takenouchi

    Legislator

    Members, we also received one—Hawaii Coalition for Child Protective Reform in opposition and one individual with comments who indicate they would not be here. Is there anyone else in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Any questions, Members? Okay, thank you. We'll move on to the next Bill, House Bill 619, HD 1. Vice Chair.

  • Jenna Takenouchi

    Legislator

    We have Danson Honda in support.

  • Danson Honda

    Person

    Aloha, Members of the Finance Committee. My name is Danson Honda, and I am testifying in strong support of HB 619. I am passionate about this Bill because I've experienced firsthand the power of financial literacy. Growing up in a single income family of four, my family could only afford a small one-bedroom apartment.

  • Danson Honda

    Person

    So, I slept on a fold up mattress on the living room floor for the first 20 years of my life. As a child, I believed that getting good grades and going to college was the key to success. I worked hard and was a straight A student. But towards the end of high school, I started questioning this path.

  • Danson Honda

    Person

    I wondered, if this was really the key to success, why do so many still struggle in life, despite doing everything right? Disillusioned from our education system, my grades slipped, and I didn't even walk out of high school graduation. According to the system, I was a failure. After getting into college, I soon found myself in financial trouble.

  • Danson Honda

    Person

    It's quite troubling that students right out of high school can easily take out loans and open credit cards, despite having never learned about finances. I realized that my schooling had left me ill equipped for the real-life challenges. And because of the mistakes I made, I began teaching myself about budgeting, saving, and investing—lessons I learned not from school or even business classes in college.

  • Danson Honda

    Person

    I had to learn it on my own on YouTube. This knowledge transformed my approach to life. And I realized that working smart to somewhere mattered more than working hard to nowhere. The most valuable lesson that financial literacy taught me was resilience.

  • Danson Honda

    Person

    Instead of dwelling on setbacks and feeling sorry for myself, I learned to spot opportunities where most people only saw obstacles. It also changed the way I saw work itself. Society often defines a good job as one with a salary and requires a degree, while viewing anything outside of that as lesser.

  • Danson Honda

    Person

    But financial literacy taught me that success isn't just about job titles. It's about how effectively you can manage your resources and opportunities. It showed me that any job, no matter the label, can be a steppingstone toward financial freedom, if you know how to leverage it.

  • Danson Honda

    Person

    I graduated and began job hunting, but the Pandemic derailed those plans. I applied everywhere I could, but hiring freezes meant that no one was calling back. So, I became a food delivery driver and applied my newly learned financial skills to make the most of what I learned.

  • Danson Honda

    Person

    Two—just two years later, at 24 years old, I achieved my wildest dream and purchased a single-family home in Pearl City. Despite starting the Pandemic jobless, broke, and in debt. While we worked hard to achieve this, I'm so grateful to have had a chance to learn from my mistakes.

  • Danson Honda

    Person

    Many people don't have that luxury, and we should not be forcing people to learn about finances through their mistakes when we can equip them with this knowledge ahead of time. The Finance Committee is no stranger to the financial struggles people in Hawaii face.

  • Danson Honda

    Person

    Every session, you hear countless bills designed to improve lives, each one very well intended, but they also are accompanied by a very steep price tag. And you see firsthand how financial hardship drives more and more people to rely on government assistance. But we can't just keep spending more.

  • Danson Honda

    Person

    We must also help people break free from this cycle of dependency in the first place. Instead of continuously expanding safety nets, we also need to be giving the people the tools to climb out of them. This binder here is filled with all the financial literacy legislation that's been introduced over the years.

  • Danson Honda

    Person

    Some of these proposals date back to 2003. I was just a couple years old. To me, these aren't just sheets of paper. They represent the voices of so many of us over time, advocating for a more resilient Hawaii.

  • Danson Honda

    Person

    I sincerely hope that by the time my kids are in school and for all of our future generations that they will have the opportunity to receive the education that I wish I had growing up. So, let's not delay any longer, and please vote in support of this vote. Let's make this happen. Mahalo.

  • Jenna Takenouchi

    Legislator

    Thank you. We also received testimony with comments from the Hawaii State Board of Education, three organizations in support, and two other individuals also in support. Anybody else in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Members, questions? Only one person to question. You did a good job. Very good. Okay, thank you. We'll move on to the next Bill, House Bill 1169, HD 1. Vice Chair.

  • Jenna Takenouchi

    Legislator

    We have the University of Hawaii system in support.

  • Kalbert Young

    Person

    Good morning, Mr. Chair. Madam Vice Chair, Members, Calbert Young with the University of Hawaii System. University has submitted testimony in support of this measure.

  • Kalbert Young

    Person

    We can stand on the testimony, but I would like to point out we consider this measure simply a housekeeping measure because the statute currently already has two separate provisions for conference center funds at the University. So this Bill would simply consolidate them into one single fund. Thank you.

  • Jenna Takenouchi

    Legislator

    That's all the testimony we've received on this measure. Is there anyone else in the room wishing to testify? Anybody on zoom?

  • Kyle Yamashita

    Legislator

    Okay, questions, Members, thank you. We'll move on to House Bill 548 HD1.

  • Jenna Takenouchi

    Legislator

    First up, University of Hawaii system in support.

  • Kalbert Young

    Person

    Thank you. Madam Vice Chair. University stands on its testimony. We are supportive of this measure. However, I'd like to point out two things. First of all, the St. Francis property is currently owned by a private. A private landowner. I do not believe and have not heard that the property is actually for sale or available for sale.

  • Kalbert Young

    Person

    We are supportive of this measure as a preemptive measure that should it ever become available for sale, the University would be interest. Interested in acquiring it. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. We also have seven individuals in support who did not indicate that they would be joining us. Is there anyone else in the room wishing to testify? Anybody on zoom?

  • Kyle Yamashita

    Legislator

    Okay, Members, questions? Okay, you have Representative Kusch.

  • Matthias Kusch

    Legislator

    Thank you. Do you. Do you know what the sale Price was in 2024 when it was sold to Avalon?

  • Kalbert Young

    Person

    I believe it was in the neighborhood of 24 million. Thank you.

  • Kyle Yamashita

    Legislator

    Yeah, while you're up there. So this is not new. This is something that we have talked about in the past and I know you've done an appraisal in the past.

  • Kalbert Young

    Person

    The original appraisal. Yes. In 2018. Ish. Around there, the University, as part of anticipation of submitting an offer, when the property was listed for sale with the previous owners, the University did contract for a private appraisal. That appraisal was for six. Came out to be 16,1 6 million.

  • Kyle Yamashita

    Legislator

    Okay. And then, you know, because of the uniqueness of this property and. Right. The access road in the back is very limited. And then the only other access would be through University property. You know, when we first talked about it, I thought it had a huge potential to be part of the University system or Manoa.

  • Kyle Yamashita

    Legislator

    And I think I was thinking that in large Part because I didn't think anybody else could make it work. Yeah. So if somebody did come in to make it work, I would think that because of the limited access to the back road, they would have to come and talk to you about access to the campus.

  • Kyle Yamashita

    Legislator

    What is the University's position?

  • Kalbert Young

    Person

    Well, the access to this property is not through the University of Hawaii.

  • Kyle Yamashita

    Legislator

    Right. There is.

  • Kalbert Young

    Person

    There's an emergency fire lane that is present that connects it, but it's only a fire lane. It is not a roadway. It couldn't serve as a roadway because it flows through another lot, a lot on the University property. So it's not a roadway. There is an official and formal access to this property.

  • Kalbert Young

    Person

    It is in Manoa Valley on Pomoa Road. That is the recorded and official entryway. And any development at their. The University has previously examined and evaluated any development would have to primarily utilize their formal entry access, not through the University because of the location of that fire lane.

  • Kalbert Young

    Person

    That is not a service roadway that could adequately service that property. Yeah.

  • Kyle Yamashita

    Legislator

    If you had that property, what, what could you use it for?

  • Kalbert Young

    Person

    Well, when the University was originally interested in it with the former landowner, the University desired to acquire it to construct faculty housing as a, as a project there. And for that we actually would have closed the. The Pomoa Road entrance or utilize that as an emergency egress from the property.

  • Kalbert Young

    Person

    But that's because it would make sense since it's faculty housing. You know, you have faculty on campus already, essentially. It wouldn't be as much vehicular traffic. You know, the day to day that was back in 2018. Ish. So it's been a while.

  • Kalbert Young

    Person

    The University would probably revisit what would make sense depending on how the University was to acquire it. If it were for sale. To be clear, it is not offered for sale. Yeah, but I do think something like faculty housing is still an opportunity, but that would have to be explored.

  • Kalbert Young

    Person

    The economics have dramatically changed for housing development today versus 2018. Are there limits to what you can do on that property? There are limits. I believe the current landowner is going through, you know, working through the entitlement process with the city. The zoning, the subdivision of parcel. This is actually only one large parcel.

  • Kalbert Young

    Person

    It's residential zoned in Manoa. You know, it's bordered on two sides by the University, one side by Manoa Stream and then the access roadway.

  • Kalbert Young

    Person

    So, you know, all of those things, depending on the type of development that you would build there or that the current landowner plans to build there, there are a number of things that would have to be addressed entitlement wise.

  • Kyle Yamashita

    Legislator

    Okay. So it probably has, like, height limitations and part of. Is it historic there?

  • Kalbert Young

    Person

    There are some historic structures on there. I'm not sure if they would be considered historical meaning in the sense that they're on some register. But there are. You know, this property has been utilized, you know, for talking decades. Right. So there's a church, there's a Catholic denomination church there. It's not the University. It's a private.

  • Kalbert Young

    Person

    I mean, it's a Catholic church and residences for priests there. And there are some buildings that have heights that are beyond what is zoned for residential. So there could be some grandfathering opportunities there.

  • Kyle Yamashita

    Legislator

    All right, thank you. Further questions, Members. Okay, thank you. We'll move on to the next Bill. House Bill 542 HD1. Vice Chairman.

  • Jenna Takenouchi

    Legislator

    First up, we have the University of Hawaii system on zoom. In support, Deborah Halbert or Faram. Sorry, in person. Sorry, in person.

  • Debora Halbert

    Person

    Thank you. Aloha, everyone. Chair. Vice Chair, Deborah Halbert, Vice President for Academic Strategy for the University of Hawaii System. We stand on our written testimony in support. I'm happy to answer questions. We do believe that extending the Hawaii promise to the four years offers important opportunities for our most vulnerable students. And so we hope that we can get this through. Thank you so much.

  • Jenna Takenouchi

    Legislator

    Thank you. We also have the University of Hawaii Professional Assembly UPA in support. We also received testimony and support from the University of Hawaii Student Caucus. That's all the people I have on the list. Is anyone else in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Okay, questions, Members. Okay, moving on to House Bill 1345 HD1.

  • Jenna Takenouchi

    Legislator

    First up, we have the Department of Education in support.

  • Sean Bacon

    Person

    Good morning, Chair. Vice Chair. Members of the Committee, Sean Bacon, Assistant Superintendent from the Department of Education. We stand on our written testimony in. Support and available for any questions. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. And we have the University of Hawaii system with comments.

  • Debora Halbert

    Person

    Good morning, Chair. Vice Chair Deborah Halbert. Again, we stand on our written testimony with comments. We would like to note that if we are waiving tuition for the semester in which students are doing their teaching apprenticeships or whatnot, there would be a cost involved.

  • Debora Halbert

    Person

    And we've tried to do some estimates on that, but that's our 1.0 that we. Otherwise, we certainly agree with anything that can help us solve the teacher shortage in the state. Thanks.

  • Jenna Takenouchi

    Legislator

    Thank you. We also received testimony and support from the Office of Hawaiian Affairs and the Hawaii State Teachers Association. Is there anyone else in the room wishing to testify? Anybody on Zoom questions, Members?

  • Kyle Yamashita

    Legislator

    House Bill 11. We'll move on House Bill 11. 70 HD1.

  • Jenna Takenouchi

    Legislator

    First up, a University of Hawaii system in support.

  • Debora Halbert

    Person

    Good morning again, Chair, Vice Chair, Members of the Committee, we stand on our written testimony and support. And we do believe that this is an opportunity to bring students who may have traveled outside the state for assorted reasons home and provide them with the best opportunity for education here. So thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. Next up, we have the Department of Education and support.

  • Teri Ushijima

    Person

    Aloha. Chair Yamashita, Vice Chair Takenouchi and Members of the Committee. Teri Ushijima, Assistant Superintendent for the Department of Education, testifying in support of this measure. Thank you for the opportunity to testify.

  • Jenna Takenouchi

    Legislator

    Thank you. We also received testimony support from two other organizations. Anybody else in the room wishing to testify? Anybody on zoom?

  • Kyle Yamashita

    Legislator

    Okay. Questions? Representative. Thank you. Go ahead.

  • Susan Lokelani Keohokapu-Lee Loy

    Legislator

    Thank you. Chair for University. You know, in support of this, but I also understand that the University have a. Has a program for seniors that if they wanted to enroll in classes, they also have a tuition waiver.

  • Susan Lokelani Keohokapu-Lee Loy

    Legislator

    And I just want to understand how these two complement each other because I know of so many classmates who started school and then life happened and so they had to put down their education to start working and caring for kids. And now they're at 55 or older and wanting to go back.

  • Susan Lokelani Keohokapu-Lee Loy

    Legislator

    And I just want to understand how this actually complements some of that that's already available at the University.

  • Debora Halbert

    Person

    You're right. There are a lot of different programs for different students. This particular Bill for the Hawaii resident tuition fee is for students or former students from Hawaii high schools who may have left the state and now are residents in other states for any number of reasons and want to return.

  • Debora Halbert

    Person

    If they had graduated from a Hawaii high school, then they would be understood as a resident. Now, in this particular version of the Bill, much of the debate has been over how many years can you have left the state.

  • Debora Halbert

    Person

    And there's been, over the course of us working on this particular piece with the Legislature, some differences of opinion between the House and the Senate on what that should be. We've used four years because we thought that mapped to a more traditional student. You're right.

  • Debora Halbert

    Person

    If there were students who were outside the state for longer, it would not be covered in this particular piece of legislation. However, as you mentioned, we do have programs. Manoa used to have one called the Come Back to Manoa.

  • Debora Halbert

    Person

    There's the adult learning programs through Leeward Community College, which is trying to get people to come back, and that is certainly one of our key efforts. Many of those students are already in the state. So you're pointing to an interesting policy issue that isn't directly addressed by this piece of legislation.

  • Susan Lokelani Keohokapu-Lee Loy

    Legislator

    Yeah. And I want to understand that a little bit better, because my understanding is if you are 55 or older, you would have that. But the class is only available if the seats are not at capacity. So if there's 25 and the class is full, they can't enroll in that.

  • Susan Lokelani Keohokapu-Lee Loy

    Legislator

    And I'm just trying to figure out a way how we can somehow tweak. Yes, we want our kids to come back. Yes, we want them. But there's so many others who made incredible sacrifices, and they actually stayed. They stayed. They stayed to take care of their kids.

  • Susan Lokelani Keohokapu-Lee Loy

    Legislator

    They stayed to take care of their parents, and now they want an opportunity to get their bachelor's. But because the policy requires that if the class is not full, they would be ineligible. And I'm just trying to find a way to kind of complement this with our baby boomers, I think, who want to return to.

  • Debora Halbert

    Person

    I'm not exactly sure which program you're talking about, because Leeward was running the Returning Adults program. It may be that one with the five week consecutive courses. And you're right, that was a limited pilot. But maybe we can talk after this meeting about ways in which we can help facilitate returning adults, because it is on our radar.

  • Debora Halbert

    Person

    We do know there's many, many students or former students in the state who have not completed their credentials, and we would like to help them do so.

  • Susan Lokelani Keohokapu-Lee Loy

    Legislator

    Yeah. And they're missing just one or. Yeah. 12 credits. You know, something really. That would really kind of. All right, thank you. Thank you. Chair, if I may.

  • Debora Halbert

    Person

    Oh, yes, this is Associate Vice President Farrah Gomes. She's Associate Affairs.

  • Kyle Yamashita

    Legislator

    Yeah, we're in questions and we're done with testifying.

  • Debora Halbert

    Person

    Well, she's. She can provide additional detail on this particular question.

  • Kyle Yamashita

    Legislator

    Okay, thank you.

  • Farrah-Marie Gomes

    Person

    Aloha, Vice Chair, thank you for the opportunity to provide additional information to that question. We appreciate the question. I believe the program that is being mentioned is called the Senior Visitors Program. We do have additional information that we'd be happy to share.

  • Farrah-Marie Gomes

    Person

    I can see that that program was established through legislative action, and we can share that information with you as well. At this time, not all 10 campuses are offering the program, but for the campuses that do, I'd be happy to put together information and provide that.

  • Susan Lokelani Keohokapu-Lee Loy

    Legislator

    Great. Thanks. Dr. Gong, good to see you. Thank you.

  • Kyle Yamashita

    Legislator

    Okay, thank you. In general, I am not a big fan of Zoom in General. And this is one of the reasons where people jump in. In the middle. Okay, moving on. Representative Kush.

  • Matthias Kusch

    Legislator

    Thank you, Chair. oh, uh, don't go away yet. Sorry, sorry. This applies to undergrad or is it both undergrad and graduate studies?

  • Debora Halbert

    Person

    It could be either. It applies to the student, not the program. Got you.

  • Matthias Kusch

    Legislator

    And you said that the Senate version has a four year cap on it now.

  • Debora Halbert

    Person

    That was what was introduced in past years. I think both versions have a four year cap at this point. In past years there have been different permutations. Let's just say that from no cap to two years, four years, et cetera. Okay.

  • Matthias Kusch

    Legislator

    And do you have a specific carve out for like people who deploy military or you know.

  • Debora Halbert

    Person

    So in Executive policy, we do have different ways of treating military students in a variety of different capacities in our EP for the purposes of tuition. And again, we have Associate Vice President Gomes online who's a student affairs, so she can help fill in the details. Details.

  • Matthias Kusch

    Legislator

    Okay. Well, that's all I needed to know. Thank you so much. Appreciate it.

  • Kyle Yamashita

    Legislator

    Okay, thank you. Okay.

  • Jenna Takenouchi

    Legislator

    Vice Chair, quick question for you. Yes.

  • Jenna Takenouchi

    Legislator

    Have you run initial understanding that this is probably going to be more of an incentive program, especially after Covid, like you mentioned, but have you run any initial numbers on, you know, current students who would have been impacted and you know, who are within this gap year who would have qualified because you have the graduation information. Right.

  • Debora Halbert

    Person

    These are always really challenging counterfactuals. We'll be, I mean in terms of all the different proposals for what ifs, what if we do this kind of thing? Farrah, I'm not sure if you're current.

  • Jenna Takenouchi

    Legislator

    Have you run the numbers on current students? Current students left and then did not qualify for residency but did graduate from a local high school who would have benefited from this program? Are there any current numbers?

  • Farrah-Marie Gomes

    Person

    So we do have current numbers. And we did just run this for. If we looked backwards for four years from today. Number is actually 66 students. 48 of those students would have entered back to a community college and 18 of those to a four year institution.

  • Farrah-Marie Gomes

    Person

    So the numbers are relatively small in terms of what we're talking about.

  • Jenna Takenouchi

    Legislator

    Thank you. Understood. They're small because this is going to hopefully be the carrot to get all our kids home. Thank you.

  • Kyle Yamashita

    Legislator

    Thank you for the questions, Members. Okay, thank you. Moving on to the next Bill House Bill 442 HD1.

  • Jenna Takenouchi

    Legislator

    First up, we have the University of Hawaii system.

  • Clementina Sery Ulep

    Person

    Good morning, Chair Yamashita, Vice Chair Takei, Members of the Committee, my name is Clementina Sery Ulep, Dean of the University of Hawaii at Manoa School of Nursing and Dental Hygiene.

  • Clementina Sery Ulep

    Person

    So this testimony is presented on behalf of the University of Hawaii system, in particular the University of Hawaii School of Nursing and Dental Hygiene at Manoa, uh West Oahu and uh Hilo. So I'll give further details for uh Manoa. And Rebecca Rumine will provide testimony for uh Wasiwahu and Jeanette Ayers Kawakami for uh Hilo.

  • Clementina Sery Ulep

    Person

    So for uh Manoa, we're asking for funding for the phase three of the uh Manoa and uh Wesawahu collaboration for four faculty and one online rn, two BS Faculty. Thank you.

  • Rebecca Romine

    Person

    Good morning. Chair, Vice Chair, Members of the Committee. I'm Dr. Rebecca Romine. I'm an associate Professor and the current faculty Director of our uh West Oahu's Pre Nursing Pathway Program. We're working in collaboration with MNOA and I'm here in support of our testimony. Um, we're currently asking for in the funding for funding for two faculty.

  • Rebecca Romine

    Person

    We're currently asking for in the funding for funding for two faculty. An educationalist, an education specialist and an academic advisor. And I'm here for any questions you guys may have.

  • Jenna Takenouchi

    Legislator

    Okay. Thank you. We also have Aloha Care on Zoom in support.

  • Jenna Takenouchi

    Legislator

    Maybe not. Okay, that's. We also have testimony and support from six other organizations and one individual. Yeah, all in support. Is there anyone else in the room wishing to testify? Anyone on Zoom?

  • Kyle Yamashita

    Legislator

    Okay, questions Members?

  • Rachele Lamosao

    Legislator

    I have a question Chair.

  • Kyle Yamashita

    Legislator

    Representative Lamosao.

  • Rachele Lamosao

    Legislator

    This is for Dean Clementine Nursing and then also for UH West Oahu. You mentioned that there was going to be a Hilo representative. Jeanette.

  • Unidentified Speaker

    Person

    What happened to Jeanette? She's supposed to do it via Zoom.

  • Rachele Lamosao

    Legislator

    Okay, no worries. I just wanted to double check because you both mentioned how many faculty this would involve. So let's go with Manoa for the 444,000...between West Oahu and uh, what is the current enrollment at West Oahu.

  • Unidentified Speaker

    Person

    For the Pre Nursing Pathway Program? Currently we have two groups of students at different levels within the pathway program. And total it's a little bit under 100 students combined.

  • Rachele Lamosao

    Legislator

    And for Manoa?

  • Unidentified Speaker

    Person

    We have. So the first cohort was admitted in spring 2024. Then the second cohort was admitted recently spring 2025. So we have at this time who qualified and eligible for our program is 39 current enrollment.

  • Rachele Lamosao

    Legislator

    And then for the faculty, you said four. That's I assuming in-person and then one online. Why do you need an online?

  • Unidentified Speaker

    Person

    Oh, so the one for the four is for the, uh, Manoa and uh, West Oahu Collaboration Phase Three. It's a three year program. So. So the funding for the four faculty is for the year 34 instructors for that. The online RNTBS request, we do have a Hawaii Statewide Nursing Consortium.

  • Unidentified Speaker

    Person

    So upon completion of their associate degrees, those who is in collaboration with us from Maui College, Kauai and Kapiolani College seamlessly transitioned to Manoa to get their BS in nursing because they only have an associate degree. And the preferred degree by our clinical organizations at this point is baccalaureate because of the complexity of care.

  • Unidentified Speaker

    Person

    And so for that one faculty we're asking for, for the online, it's going to be for students in Kauai, because we actually go to Kauai or hire someone in Kauai to administer the program or course so that they don't have to come to Oahu.

  • Rachele Lamosao

    Legislator

    And then if you can, also for West Oahu, the positions you asked for were two faculty, one educational advisor, and there was one more.

  • Unidentified Speaker

    Person

    There was an academic advisor. So like we call them a student success advisor. And their role is to guide the student through application, GPA requirements, changing classes and whatnot, all of the stuff associated with student affairs.

  • Rachele Lamosao

    Legislator

    Do all the colleges in West Oahu have a person like this?

  • Unidentified Speaker

    Person

    So we have a different kind of hierarchy. We don't have colleges, we just have divisions.

  • Rachele Lamosao

    Legislator

    And so all the divisions have similar. Because I feel like some of this work can be done by in collaboration with other divisions. Yeah.

  • Unidentified Speaker

    Person

    So we have a student success advisor for each program or degree program. And currently there are a few that double up and cover more than one degree program. And so this ask is to help separate.

  • Rachele Lamosao

    Legislator

    Could you do away with no funding for that position?

  • Unidentified Speaker

    Person

    Well, we're asking for it because it would really help the success of the program.

  • Rachele Lamosao

    Legislator

    A growing need from the high schools that want to go to West Oahu for this particular program. And then if you have a number already of participants.

  • Unidentified Speaker

    Person

    Yeah, that's a great question. So we do tend to serve high schools that are west side or central Oahu. And over the past several years, the first group of students, we had about 11 initial direct entry from high school. And then as the semester went on, it increased to 20.

  • Unidentified Speaker

    Person

    And so we took some students in our spring semester. And then once we were able to adequately kind of advertise our program, we had double, triple the amount of applicants that applied to our pre nursing pathway program, Especially a lot from Waianae, Nanakuli, Waipahu. And they're strong students right now.

  • Unidentified Speaker

    Person

    So the way our cycle is we accept students into our fall entry program. And they are applying now, most of our demographic students tend not to apply until like February, March, April. And we have a March 1 priority deadline and then a July 1 deadline. Right now we have about 40 students in queue.

  • Unidentified Speaker

    Person

    The way that we have the application process that they have to come to an information meeting, they meet with us, then we go through their application to make sure that they understand the process of what pre-nursing is. And there are a set number of courses they have to take in a specific order.

  • Unidentified Speaker

    Person

    And then we admit them if they meet the UH West Oahu admission criteria. Right now we're at about 40. Last year at this time, we're about 20. And so we are definitely increasing and I usually the increased number of student applicants comes between April, May and June. So we're anticipating well over 100 applicants this year.

  • Rachele Lamosao

    Legislator

    I'd love to hear more about that. That and your collaboration with the. Ah, thank you. And then. Too bad Janette isn't here. Yes. So I wanted to. She's online. Oh, okay. I'm sorry, I'm here. Yeah. So we can talk about the amount that will or the faculty that will be funded for the months that you are requesting.

  • Jeanette Ayers-Kawakami

    Person

    Yes. Aloha. I'm Jeanette Ayers-Kawakami, Director here at the School of Nursing UH Hilo. We're requesting for five additional faculty positions.

  • Jeanette Ayers-Kawakami

    Person

    This will to assist in increasing our enrollment in each of our cohorts, both of our junior and seniors from a current number of 30 students up to 50 students will increase. It will increase our size by 67%.

  • Rachele Lamosao

    Legislator

    So those are all professors as well?

  • Jeanette Ayers-Kawakami

    Person

    Yes, some may be instructors or professors.

  • Kyle Yamashita

    Legislator

    Thank you for the question, Members. Okay, thank you. Okay, I'm going to make a brief comment and this is, you know, I, on decorum. Right. So normally the chair needs to recognize whoever is going to speak.

  • Kyle Yamashita

    Legislator

    If you want one of your colleagues to speak on a certain issue, that you would have to ask for that person to speak. If the Member wants somebody else to speak, that's fine. The proper decorum is that they're supposed to ask the chair that they can recognize that person.

  • Kyle Yamashita

    Legislator

    The reason why I'm making a big deal out of this is because I expected, you know, educators and people to understand decorum. And I'm more concerned about the fourth agenda today, that we're going to have to hold some level of decorum.

  • Kyle Yamashita

    Legislator

    And so I just don't want to say that I allowed something to happen in an earlier hearing and then I didn't allow it to happen in the fourth hearing. So understand that going forward, you need to be recognized before we allow you to speak. Okay, thank you. We're going to be moving on to the next one.

  • Kyle Yamashita

    Legislator

    House Bill 718 HD1. Vice Chair.

  • Jenna Takenouchi

    Legislator

    First up, we have University of Hawaii system in support.

  • Lee Buenconsejo-Lum

    Person

    Aloha Chair, Vice Chair, Committee Members. I'm Dr. Lee Buenconsejo-Lum from the John A. Burns School of Medicine. I'm the Associate Dean for Academic Affairs. We stand on our testimony and I would like to point out that we really hope that you're able to support us.

  • Lee Buenconsejo-Lum

    Person

    Especially in light of the concerning potential budget cuts in our indirect costs from the National Institutes of Health. So we're very concerned about our ability to higher faculty and actually continue the research that helps make Hawaii healthier. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. We have the University of Hawaii Professional Assembly in support. We also received testimony and support from the Hawaii Primary Care Association. That's all the testimony, written testimony we've received. Anybody in the room wishing to testify? Anybody on zoom?

  • Kyle Yamashita

    Legislator

    Okay, questions? Members? Okay, thank you. We'll move on to the next Bill. House Bill 1320 HD1.

  • Jenna Takenouchi

    Legislator

    First, we have the University of Hawaii system in support.

  • Debora Halbert

    Person

    Good morning, Chair. Vice Chair. Debora Halbert, Vice President, Academic Strategy. We stand on our written testimony. I will note that you can see links to some of our existing postgraduate outcomes in the testimony that we submitted. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. That's all the written testimony we've received. Anybody else in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Okay, questions Members? Okay, moving on to the next Bill. House Bill 1171 HD1.

  • Jenna Takenouchi

    Legislator

    University of Hawaii System in support.

  • Debora Halbert

    Person

    Good morning again, Chair, Vice Chair, Members of the Committee. I would also stand on our written testimony here. I would also acknowledge, and I apologize deeply for not doing this before, that Associate Vice President Farrah-Marie Gomes is on the on Zoom for technical questions related to the relief funding Bill.

  • Jenna Takenouchi

    Legislator

    Okay. Oh, thank you. We also received one piece of testimony from the University of Hawaii Student Caucus in support. That's all the written testimony received. Anybody else in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Okay, thank you. Questions, Members, Moving on to the next Bill. House Bill 546, HD1.

  • Jenna Takenouchi

    Legislator

    University of Hawaii System in support.

  • Vassilis Syrmos

    Person

    Good morning Chair, Vice Chair. Vassilis Syrmos, the Vice President for Research and Innovation at UH System. We're standing on our testimony in strong support. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. University of Hawaii Professional Assembly in support. Thank you. And we received testimony support from one individual. Anybody else in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Okay, thank you. Questions, Members? Thank you. Moving on to the next Bill. House Bill 989, HD1.

  • Jenna Takenouchi

    Legislator

    First up, we have the Department of Accounting and General Services in support.

  • Meyer Cummins

    Person

    Morning Chair, Vice Chair, Members of the Committee. My name is Meyer Cummins. I work for the Land Survey Division under DAGS. I'm here to testify on behalf of Comptroller Regan in strong support of this Bill. And we stand on our written testimony and I'm here to answer any questions you might have.

  • Meyer Cummins

    Person

    Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you.

  • Jenna Takenouchi

    Legislator

    That's all the testimony we've received on this measure. Anybody else in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Okay, questions, Members? Thank you. Moving on to the next Bill. House Bill 477 HD1.

  • Jenna Takenouchi

    Legislator

    First, we have the Department of Labor and Industrial Relations in support.

  • David Rodriguez

    Person

    Hello. Chairman Yamashita, Vice Chair Takenouchi, Members of the Committee. David Rodriguez with the Department of Labor Industrial Relations. We do apologize, Director Butay had to step out for another meeting.

  • David Rodriguez

    Person

    But yes, we support this measure and the modernization of the UI system while also improving services, and would respectfully request amendments to clarify the intentions of the Bill. Again, thank you for hearing this Bill. And Anne Perreira-Eustaquio, the Administrator of UI, is available to answer any questions you may have. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. Also received one other testimony in support from one organization. Anybody else in the room wishing to testify? Anybody on Zoom? Questions, Members?

  • Kyle Yamashita

    Legislator

    Moving on to the next Bill. House Bill 202, HD1.

  • Jenna Takenouchi

    Legislator

    First, we have DLIR in support.

  • David Rodriguez

    Person

    Hello again, Chair, Vice Chair David Rodriguez, the Department of Labor Industrial Relations. We stand on our testimony of support in strong support as it safeguards the health and long term stability of the Unemployment Compensation Trust Fund. We're available to answer any questions. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. We also have Tax foundation of Hawaii on Zoom. Okay, that's not present. That's all the testimony we received and, oh yeah, Tax Foundation with comments. Anybody else in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Okay, questions, Members. Okay, moving on to the next Bill. House Bill 430, HD1.

  • Jenna Takenouchi

    Legislator

    First up of DLIR in support.

  • David Rodriguez

    Person

    Chair, Vice Chair, Members. David Rodriguez from the Department of Labor Industrial Relations. We stand in our testimony in support so long it does not affect the governor's biennium budget. On Department notes, there exists some uncertainty pertaining to federal funding currently available for similar purposes.

  • David Rodriguez

    Person

    The DLR supports the HD1 amendments which the Department believes will allow us to operate the program in a much appropriate fashion. And we are available to answer any questions you may have. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. Next we have the University of Hawaii system in support.

  • Debora Halbert

    Person

    Good morning again Chair, Vice Chair, Members of the Committee. We stand on our written testimony in support. I will note as we do in our testimony, that internships are one of the positively correlated post-success student success initiatives that lead to better postgraduate outcomes.

  • Jenna Takenouchi

    Legislator

    Thank you. Next we have the State Council on Developmental Disabilities in support.

  • Samaya Gorham

    Person

    Good morning, Chair, Vice Chair. My name is Samaya Gorham. I am an intern at the Hawaii State Council on Developmental Disabilities. We are here to stand in our strong support of this testimony, this Bill. Yeah, I'm an intern. This is a great program.

  • Samaya Gorham

    Person

    I'm with the Hele Imua program and it's really broadened my perspective on a lot of different things and show me what I can do, you know, with my life and with my future. So I think these kind of internship programs are really important to personal development and for like also your career development for the future. So thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. We have Department of Education in support.

  • Keith Hayashi

    Person

    Hello Chair Yamashita, Vice Chair Takenouchi, Members of the Committee. Keith Hayashi, Superintendent, testifying on behalf of the Department of Education. We stand on our written testimony in strong support of this measure. Thank you for the opportunity.

  • Jenna Takenouchi

    Legislator

    Thank you. We also have the Hawaii Food Industry Association in support on Zoom. Not present. Members, we also received about a dozen other pieces of testimony from various organizations, all in support. Is there anyone else in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Questions, Members? Moving on to the next Bill. House Bill 864 HD1.

  • Jenna Takenouchi

    Legislator

    First, we have the Department of Education in support.

  • Keith Hayashi

    Person

    Hello, Chair, Vice Chair, Members of the Committee, Keith Hayashi, Superintendent, testifying on behalf of the Department of Education. We stand in support of this measure. Thank you for the opportunity to testify.

  • Jenna Takenouchi

    Legislator

    Thank you. We also have testimony support from one from the Maui Chamber of Commerce and one individual. Anybody else in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Okay. Thank you. Questions, Members? Superintendent. So if we added to the measure some reporting requirements, that's fine, right?

  • Keith Hayashi

    Person

    Yes, Chair. What type of reporting requirements?

  • Kyle Yamashita

    Legislator

    Yeah. Thank you. Thank you. Thank you very much. Okay, further questions. Okay. Moving on to the next Bill. House Bill 480, HD1.

  • Jenna Takenouchi

    Legislator

    First up, we have Department of Labor Industrial Relations in support.

  • David Rodriguez

    Person

    Hello Chair, Vice Chair, Members of the Committee, David Rodriguez with the Department of Labor Industrial Relations. The DLIR supports this measure and stands on its testimony which encourages the timely and accurate assessments of injured workers physical abilities. I have JoAnn Vidinhar available on Zoom if you have any questions. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. We also received testimony support from DHRD and three other organizations. Anybody else in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Okay, thank you. Questions, Members? Okay, thank you. Moving on to the next Bill. House Bill 1152 HD1.

  • Jenna Takenouchi

    Legislator

    First up, we have Department of Taxation in support.

  • Kristen Sakamoto

    Person

    Good morning. Kristen Sakamoto, Deputy Director of Taxation. The Department supports this measure which would allow us to exempt three specific positions from civil service. These are very specialized positions that require specific knowledge and expertise that go beyond the current civil service regime.

  • Kristen Sakamoto

    Person

    Just very briefly, the first one is a data privacy officer which comes about from an IRS requirement that we hire a senior official in charge of data privacy requirements. The second one attacks business analysts which would allow us to take on large projects such as Direct File or other tax law changes that come about every year.

  • Kristen Sakamoto

    Person

    This position is very specialized with tax knowledge and knowledge between the business side as well as the IT side of our operations and finally the supervising software developer. We currently have an exemption for software developers which are high level software developers that go beyond the current civil service regime.

  • Kristen Sakamoto

    Person

    So we just need a supervisor to that is also exempt to supervise this position. I'm available if you have any questions. Thank you very much.

  • Jenna Takenouchi

    Legislator

    Thank you. We also have Tax foundation of Hawaii with comments on Zoom. No, not present. That's all the testimony we've received on this measure. Anybody else in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Okay, question by Representative Kusch.

  • Matthias Kusch

    Legislator

    Thank you Chair. Deputy Director of Taxation please. Thank you. I won't pretend to remember those three descriptions. But the second one, there's been a lot of testimony that we've heard about the inability to collect get and tat taxes off of short term vacation rentals throughout the state. And will that second position sound like it was a business? It help the data troll for that?

  • Kristen Sakamoto

    Person

    No. So this position would be more aligned with if major system changes need to take place as a result of like taking on direct file from the IRS or if the Legislature imposes any new category of tax or bigger exemptions, they would be helping with making the systems to our changes in order to comply with the new laws or the new project.

  • Matthias Kusch

    Legislator

    Okay, so none of these high level positions especially in the data sets are kind of focused on that.

  • Kristen Sakamoto

    Person

    Right. I think with regard to compliance with get or tat, we do have existing positions in our special enforcement section and they take on compliance issues such as that.

  • Kyle Yamashita

    Legislator

    Okay, thank you.

  • Kristen Sakamoto

    Person

    Thank you.

  • Kyle Yamashita

    Legislator

    Ok, thank you for the question. Okay, thank you. Moving on to 159 HD1.

  • Jenna Takenouchi

    Legislator

    First up we have UPW in support.

  • Kamakana Kaimuloa

    Person

    Aloha Chair, Vice Chair, Members of the Committee, Kamakana Kaimuloa, United Public Workers. You have our written testimony and strong support of this Bill. Due to the staffing shortages across the state, we're finding that employers across all jurisdictions are leaning heavily on these contracts.

  • Kamakana Kaimuloa

    Person

    And so what this Bill does is actually provides clarifying language that it should be the cap would apply to in aggregate rather than on a per contract basis. We feel this is necessary as, as we move forward because of the reliance on these contracts. Happy to answer any questions you may have. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. We also have HGA in support.

  • Kauanui Sabas

    Person

    Good morning Chair, Vice Chair, Members. Nui Sabas with HGEA. We'll stand on a written testimony in strong support of this measure. Mahalo.

  • Jenna Takenouchi

    Legislator

    Thank you. We also received testimony support from Hawaii State AFL-CIO. That's all the written testimony received. Is there anyone in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Okay, Members, questions? Representative Lamosao.

  • Rachele Lamosao

    Legislator

    This is for UPW. Can you explain some of the instances this is kind of being, I guess if the, if the counties are taking advantage of this and in what ways?

  • Kamakana Kaimuloa

    Person

    Sure. Thanks for the question Rep. Actually in our testimony we point specifically to Maui County, in particular DPR, Department of Parks and Recreation. So what they're actually doing is they're carving up the contracts.

  • Kamakana Kaimuloa

    Person

    Rather than one master contract for all of the Department, they're carving it up by district so that in the aggregate it's actually around $1.8 million rather than if they carve it up, it would fall below the threshold. That's the biggest what we would call abuse of the interpretation.

  • Kyle Yamashita

    Legislator

    Further questions. Moving on to the next Bill, House Bill 164 HD1.

  • Jenna Takenouchi

    Legislator

    First up, we have the Department of Accounting and General Services with comments.

  • Ladea Nash

    Person

    Morning, Chair, Vice Chair, Members of the Committee. My name is Ladea Nash. I'm the Accounting Administrator for the Accounting Division at the Department of Accounting and General Services. I'm here to testify on behalf of Keith Regan, Comptroller. And we stand on our written testimony and are here for any questions you might have. Thank you.

  • Jenna Takenouchi

    Legislator

    Next up, we have UPW in support.

  • Kamakana Kaimuloa

    Person

    Chair, Vice Chair, Members again, Kamakana Kaimuloa, United Public Workers. You have a written testimony and strong support of this Bill. We feel that this is more in step with the rising costs of living in Hawaii. Our biggest issue is actually in current statute, the $1000 swipe.

  • Kamakana Kaimuloa

    Person

    So if the debt is less than $1,000, it can take it to one pay period. We know that there may be policies that run contrary to that, but in practice, that's what we're seeing from some of our. With some of our Members happy to answer any questions you may have.

  • Jenna Takenouchi

    Legislator

    Thank you. We have HGEA in support.

  • Kauanui Sabas

    Person

    Good morning, Chair, Vice Chair, Members, Nui Sabas here with HGEA. We'll stand on our testimony in strong support of this measure. I do want to emphasize that this Bill is really intended for employees on. The lower end of the salary schedule. Specifically for folks that make less than $3,000 per pay period, or effectively $72,000 a year. Thank you. Happy to answer any questions.

  • Jenna Takenouchi

    Legislator

    Thank you. We also received comments from the Hawaii State Public Library System. That's all the written testimony we received. Anybody else in the room wishing to testify? Anybody on Zoom? Questions?

  • Kyle Yamashita

    Legislator

    Members, thank you. We'll move on to the next Bill. House Bill 1424 HD1.

  • Jenna Takenouchi

    Legislator

    First off, we have Department of Budget and Finance in opposition.

  • Luis Oliveira

    Person

    Good morning, Chair, Vice Chair, Members. Luis Oliveira, Director of Finance for the State of Hawaii. You have our testimony. We'll stand on our position of opposition on this particular Bill. We do appreciate the intent on what this Bill is trying to accomplish, but what we would like to express is that we are currently.

  • Luis Oliveira

    Person

    The State of Hawaii is going through a process of modernizing our existing budget process and our budget system. And we believe that transparency and accountability with regards to the expenditure of legislatively appropriated funds is appropriate.

  • Luis Oliveira

    Person

    But we would like to go through the process of actually implementing that system forward. Given our current processes and the tools that we have right now, something like this and the inability for a Department to have some degree of flexibility between payroll and OCA could cost, could result in some significant difficulties for the Department.

  • Luis Oliveira

    Person

    And I'll be happy to answer any questions if you may have Chair. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. We have the Department of Accounting and General Services with comments.

  • Miyoke Ng

    Person

    Morning Chair. Co-Chair, Members of the Committee. My name is Miyoke Ng from the Department of Accounting General Services testifying on behalf of Comptroller Keith Regan. And DAGS stands on our written testimony with comments. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. We have the Department of Hawaiian Homelands with comments. Thank you. We have the Department of Corrections and Rehabilitation in opposition. We also received comments from the Department of Human Services, Department of Agriculture and the Department of Labor Industrial Relations, opposition from Department of Defense and support from the Grassroots Institute of Hawaii.

  • Jenna Takenouchi

    Legislator

    Is there anyone else in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Okay, questions members. Okay, Representative Lamosao, I mean Lee Loy. Sorry.

  • Susan Lokelani Keohokapu-Lee Loy

    Legislator

    Thank you. Chair. Let's see. Sorry, yes, it's Mr. Oliveira you mentioned. Thank you for being here, by the way.

  • Luis Oliveira

    Person

    I wouldn't miss it. Wouldn't miss it.

  • Susan Lokelani Keohokapu-Lee Loy

    Legislator

    Absolutely understand the intent of the Bill. But it sounds like you guys are kind of moving forward with a modernization and basically accounting system that would actually kind of capture some of these internal transfers within the Department so that they can be kind of trigger ready. And I understand that. What is the timeline on that modernization?

  • Luis Oliveira

    Person

    So we are currently actually we have issued the RFP. The bids for that RFP are expected within the next week. We would like to have a vendor on board by the end of March, early April. And our expectation is that we would start using it. And so just for clarification, representatives.

  • Luis Oliveira

    Person

    So there are two efforts that are going on. This is the budget management system, but there's also very large enterprise financial system that's going effort that's going on and that RFP is forthcoming very, very soon too as well.

  • Luis Oliveira

    Person

    So, you know, I think where we are in the process is that we would like to start on our budget execution and as well as start our budget prep processes probably starting in the next biennium.

  • Luis Oliveira

    Person

    And so, you know, we'll probably try to start implementing some of the smaller aspects of the new system, the new budget management system earlier if we can, in conjunction and working with the awarded vendor and solution providers.

  • Luis Oliveira

    Person

    So the real secret and what we're trying to get to right here or this secret sauce really is a combination of both the budget management system and the enterprise financial system, because what we want to do Is we want to be able to basically run variance reports around what you guys appropriate and what departments are actually expending.

  • Luis Oliveira

    Person

    And what we would like to do, as with any like, you know, good organization, is we would like to actually close the books on a monthly basis. Right now the state closes the books once a year.

  • Luis Oliveira

    Person

    And so by being able to provide with that information, I mean, we would departmentally and as an Administration, you know, we would have so much more nimbleness when it comes to actually being able to manage the state finances when that, when both of those systems are in place.

  • Susan Lokelani Keohokapu-Lee Loy

    Legislator

    Speaking to that piece of nimbleness, you know, we're getting a lot of signals from the Federal Government. Does that program, that modernization help you guys track that information much quicker and to the point you're closing books every year?

  • Susan Lokelani Keohokapu-Lee Loy

    Legislator

    And ideally, I think we're all trying to get to the same secret sauce, which is where are we, how much money is there and how much money do we need or are we still on track to meet the goals set out by the Legislature?

  • Luis Oliveira

    Person

    Yes, I mean, it would definitely, you know, more transparency, more real time information in regards to how departments are, especially when it comes to the receipt of federal funds. You know, the state operates on a lot of these funds on a reimbursement basis.

  • Luis Oliveira

    Person

    So we many times have to front it with state funds in anticipation of reimbursement by the feds on it. So cash flow becomes an issue. You know, budget is one thing, Cash flow is another thing too as well that we have to manage.

  • Luis Oliveira

    Person

    So again, yes, it would allow us to be a lot more nimble, a lot more transparent, and it would actually drive accountability all the way down to the expendituring departmental level, the various departments.

  • Susan Lokelani Keohokapu-Lee Loy

    Legislator

    And then this system, ideally, it's kind of like a dashboard. Is that going to be something that's going to be available to legislators or the public?

  • Luis Oliveira

    Person

    That is the intention, I think. You know, dashboards will be, I think, a byproduct. You know, right now our process is a, is a system of spreadsheets and word documents and it's not really a system.

  • Luis Oliveira

    Person

    This will allow for again, you know, data to start collecting longitudinal data to start happening, trending, to be able to start pulling all of that information together. So yeah, so I mean, I'm really excited about pushing forward on this effort.

  • Susan Lokelani Keohokapu-Lee Loy

    Legislator

    Great, thank you. Thank you, Chair.

  • Kyle Yamashita

    Legislator

    Thank you for the questions. Okay Director, you know, part of what this Bill is trying to accomplish is that, you know, they, some of these transactions and tracking of them are currently being done by subdivisions of the State. Okay. And I think what we need to...

  • Kyle Yamashita

    Legislator

    ...what would help this Committee understand this is the complexity of the difference between what you have to deal with and, say, a subdivision?

  • Luis Oliveira

    Person

    So, I mean, for us, because the Budget and Finance looks at everything on such a macro level, right? And when we ask departments to put together at the beginning of the year operational expenditure plans, which essentially breaks out by quarter and by category. So 10 and 20 is the difference.

  • Luis Oliveira

    Person

    10 is payroll, 20 is OCE, other current expenses. We asked departments to put together an operational expenditure plan for the year by quarter. And, you know, we're constantly having to basically look at it at this macro level, but we don't have the visibility down into the Department level in terms of tracking.

  • Luis Oliveira

    Person

    Okay, well, where are you on the payroll at any given point in time of the year? Does it look like you're going to be short or are you going to have a significant amount of savings, like, say, for example, vacancy savings?

  • Luis Oliveira

    Person

    And what we do once those operational expenditure plans are set up, that gets set up in the accounting system. And the accounting system is essentially the check and balance, right? The operational expenditure plans provide you with the amount that the accounting system will allow a Department to expend up until. And so you're looking at it by quarter.

  • Luis Oliveira

    Person

    Sometimes you have to move money from one quarter. Like say, for example, oh, a big expense happened in the first quarter, you might have to move money from the second into the first. Or sometimes a big expense happened in OCE. Oh, you might have to move some money into that.

  • Luis Oliveira

    Person

    So providing some degree of flexibility and the challenges and the complexities.

  • Luis Oliveira

    Person

    I think the departments, at the end of the day, what they're trying to do is just operate and what budget and finance is trying to do is basically kind of keep track of all of those expenditures and to provide you and with some degree of comfort that the budget will execute based upon what you guys appropriate.

  • Luis Oliveira

    Person

    So it's, we need a system chair. And essentially the complexities that we have with the, you know, very archaic systems is challenging.

  • Kyle Yamashita

    Legislator

    Okay, so right now, you know, I understand. I mean, the, you know, FEMA system and what the EGS has in it is communicating between the systems is part of the problem and things like that.

  • Kyle Yamashita

    Legislator

    But going forward, right. My assumption is the enterprise system and your budgeting system will work in concert. Yes, Right. Okay. Is part of that concert with the Legislature.

  • Luis Oliveira

    Person

    So, you know, I know there's separation of powers and, you know, and stuff like that, but yes, our intention really, you know, what I would love to see is one system that the Executive branch would have and the Executive branch would have, with the appropriate firewalls, of course, you know, but to provide some degree of transparency and accountability between both, especially for the Legislature.

  • Luis Oliveira

    Person

    Because as the appropriators, as the funders of us, I mean, we would want to be able to provide you with information on a real time basis. Right. Basically to show you how we're executing and we can be evaluated based upon our performance. So I would love to have a, you know, we're doing it first.

  • Luis Oliveira

    Person

    Hopefully, you know, you guys really like what we're doing and then you guys decide to, like, jump on and tag onto our system.

  • Kyle Yamashita

    Legislator

    Yeah, yeah, I think, I think that's kind of a key too, because there's a lot of, you know, as far as extra work that goes on at this level also that can be streamlined. Right.

  • Luis Oliveira

    Person

    Even from the budget development process. Right. I mean, we have, if we're able to use the system to prepare that, I mean, we could basically give you the file.

  • Kyle Yamashita

    Legislator

    Right. Because if we were to do that, then, right, we could actually develop our own budget without seeing your budget, if you so choose.

  • Luis Oliveira

    Person

    Yes, Chair.

  • Kyle Yamashita

    Legislator

    Yeah, yes. But anyway, okay, thank you very much. I appreciate it. Okay, further questions, Members? Okay, we're going to, you know what we're going to do?

  • Kyle Yamashita

    Legislator

    We're going to break and come back in about an hour and then we'll have decision making at that time and then move into the next agenda. Okay, thank you. We're in recess.

  • Kyle Yamashita

    Legislator

    Okay, we're going to reconvene the Committee on Finance for our first agenda. First up is House Bill 640 HD2 recommendation is that we pass it out with amendments, adding a Defective date of 7/1/3000 and Tech. Any discussion? Question for the vote.

  • Jenna Takenouchi

    Legislator

    Voting on HB 640HD2 recommendations to pass with amendments. Chair and Vice Chair vote. Aye. Representative Grandinetti, Representative Holt.

  • Jenna Takenouchi

    Legislator

    Representative Hussey.

  • Daniel Holt

    Legislator

    Aye.

  • Ikaika Hussey

    Legislator

    Aye.

  • Jenna Takenouchi

    Legislator

    Representative Keohoku Liloi. Representative Kisagawa. Aye. Representative Kush. Aye. Representative Lama Sau. Representative Lee is excused. Representative Miyake. Aye. Representative Morikawa is excused. Representative Templo. Aye. Representative Alcos is excused. Representative Reyes-Oda. Aye. And Representative Ward is excused. Chair. Recommendations adopted.

  • Jenna Takenouchi

    Legislator

    Okay, thank you. Moving on to House Bill 619 HD1 as is discussion. Vice Chair.

  • Jenna Takenouchi

    Legislator

    Voting on HB 619 recommendation is to pass as is. Noting the excused absences of Representatives Lee, Morikawa, Elkos and Ward, who will remain marked as excused for the rest of this agenda unless otherwise noted. Are there any Members voting with reservations? Any Members voting? No. Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay, thank you. Moving on to House Bill 1169. HD1 as is discussion.

  • Jenna Takenouchi

    Legislator

    Going on. HB 1169 HD1 recommendations to pass, unamended. Any reservations? Any NOS recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay, thank you. Moving on to the next Bill. House Bill 548 HD1 as is discussion. Representative Reyes Oda.

  • Julie Reyes Oda

    Legislator

    Okay, thank you. I'm not fond of state agencies coming to the Legislature for money to buy properties that are not willingly for sale. HB 548 is preemptive and testimony submitted in the previous Committee in opposition by Avalon Development provides reasonable doubt that they will be open to negotiations concerning the possibility of, uh, acquiring the property.

  • Julie Reyes Oda

    Legislator

    Um, I'll be voting with reservation so that the conversation for this or potentially the sale or agreement by Avalon can continue. Okay, thank you very much. Any further discussion?

  • Kyle Yamashita

    Legislator

    Okay, Vice Chair going on.

  • Jenna Takenouchi

    Legislator

    HB 548 HD1 recommendations to pass unamended. Noting the reservations for Representative Reyes oda. Any other reservations? Any no's? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay, thank you. House Bill 542. HD1 as is discussion. Vice Chair.

  • Jenna Takenouchi

    Legislator

    HB 542 HD1 recommendations to pass unamended. Any reservations? Any noes? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay, thank you. Moving on to House Bill 1345 HD1 as is discussion. Vice Chair.

  • Jenna Takenouchi

    Legislator

    HB 1345 HD1 recommendations to pass, unamended. Any reservations? Any no's? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay, thank you. Moving on to House Bill 1170 HD1 as is discussion, Vice Chair.

  • Jenna Takenouchi

    Legislator

    HB 1170, HD1 recommendation to pass, unamended. Any reservations, any no's? Recommendations adopted. Okay.

  • Kyle Yamashita

    Legislator

    Going on HB. 442, HD1 recommendations to pass, unamended. Any reservations? Any no's? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    House Bill 442, House District One as is discussion, Vice Chair.

  • Kyle Yamashita

    Legislator

    Okay, thank you. Moving on to House Bill 718, HD1 as is discussion, Vice Chair.

  • Jenna Takenouchi

    Legislator

    Going on HB 718, HD1 recommendations to pass, unamended. Any reservations, any no's? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay, moving on to House Bill 1320, HD1 as is discussion, Vice Chair.

  • Jenna Takenouchi

    Legislator

    HB 1320, HD1 recommendation is to pass, unamended. Any reservations, Any no's? Recommendations adopted.

  • Jenna Takenouchi

    Legislator

    HD2HB 1171, HD1 Recommendations to pass with amendments. Any reservations? Any noes? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay, thank you. Moving on to House Bill 1171, HD1. Okay. Recommendation is that we're going to be blanking out the new cap and technical amendments. Any Discussion? Vice Chair,

  • Jenna Takenouchi

    Legislator

    Okay, thank you. Moving on to House Bill 546, HD1.

  • Jenna Takenouchi

    Legislator

    As is discussion, Vice Chair, HB 546, HD1 recommendations to pass, unamended. Any reservations, Any noes? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    It will be on House Bill 989. HD1 as is discussion, Vice Chair.

  • Jenna Takenouchi

    Legislator

    HB 989, HD1 recommendations to pass, unamended. Any reservations, any no's? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Moving on to House Bill 477, HD1 as is discussion.

  • Jenna Takenouchi

    Legislator

    On HB 477 HD1 recommendations to pass, unamended. Any reservations, any no's? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay. Moving on to House Bill 202, HD1 as is discussion, Vice Chair.

  • Jenna Takenouchi

    Legislator

    Going on HB 202, HD1 recommendation is to pass unamended. Any reservations, any no's recommendations adopted.

  • Kyle Yamashita

    Legislator

    Thank you. Moving on to House Bill 430, HD1. Okay, we're going to be moving this out. We're going to be amending and blanking out the amounts and technical amendments. HD2. Any discussion?

  • Jenna Takenouchi

    Legislator

    Vice Chair going on HB 430, HD1 recommendations to pass with amendments. Any reservations, any no's? recommendations adopted.

  • Kyle Yamashita

    Legislator

    Thank you very much. Moving on to the next bill. House Bill 846, HD1 moving in and out with amendments. Okay, this is what going to be moving out with prior concurrence, adding the reporting requirements that I talked to the Superintendent about and it will be on page three, line six, and it should read as follows.

  • Kyle Yamashita

    Legislator

    The Department shall submit an annual report to the Legislature no later than 20 days prior to the convening of each legislative session that shall include one. The number of students participating in the school approved work work based learning program sponsored by the Department or the University of Hawaii.

  • Kyle Yamashita

    Legislator

    Two, the number of workers compensation claims filed pursuant to this section and number three, the number of students who continue to participate in the school approved work based learning program sponsored by the Department or the University of Hawaii after graduating from high school. Any discussion and technical amendments? Any discussion? Okay, Vice Chair for the vote. I'm sorry.

  • Kyle Yamashita

    Legislator

    Oh, sorry. Okay, just to be clear, we're voting on House Bill 864 HD1 with amendments. Okay, Vice Chair for the vote.

  • Jenna Takenouchi

    Legislator

    Going on HB 864 HD1, recommendations to pass, with amendments. Any reservations? Any no's recommendations adopted?

  • Kyle Yamashita

    Legislator

    Okay, thank you. Moving on to House Bill 480 HD1 as is discussion. Vice Chair.

  • Jenna Takenouchi

    Legislator

    HB 480 HD1, recommendations to pass, unamended. Any reservations? Any no's? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay, Moving on to 1152 HD1 as is discussion. Vice Chair going on.

  • Jenna Takenouchi

    Legislator

    HB 1152 HD1, recommendations to pass, unamended. Any reservations? Any no's? recommendations adopted?

  • Kyle Yamashita

    Legislator

    Okay, moving on to House Bill 159. House D1 as is discussion, Vice Chair?

  • Jenna Takenouchi

    Legislator

    Voting on HB 159 HD1, recommendations to pass, unamended. Any reservations? Any no's? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay, moving on to House Bill 164 HD1 as is discussion, Vice Chair following on.

  • Jenna Takenouchi

    Legislator

    HB 164 HD1, recommendations to pass, unamended. Any reservations? Any no's? Adopted.

  • Kyle Yamashita

    Legislator

    And last bill on the agenda, House- Sorry. Thank you. The last Bill, 1424 HD1 as is discussion.

  • Jenna Takenouchi

    Legislator

    HB 1424 HD1, recommendations to pass, unamended. Any reservations? Any no's? recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay, thank you very much. We are adjourned. Okay, we're gonna do our second agenda first up. Okay, we're going to recess. Hold on.

  • Kyle Yamashita

    Legislator

    Here we're going to reconvene the second agenda. First up is House Bill 1167, HD1. Vice Chair.

  • Jenna Takenouchi

    Legislator

    First up, we have the Department of Transportation in support on Zoom.

  • Ed Sniffin

    Person

    Hello, Chair, Vice Chair, Members. Ed sniffin with hawaii.stand in support.

  • Jenna Takenouchi

    Legislator

    Thank you. We also have. We also received testimony and support from Hawaii Transportation Association. That's all the written testimony we received. Anyone else in the room wishing to testify? Anybody? On Zoom?

  • Kyle Yamashita

    Legislator

    Okay, Members, any questions? Okay, thank you very much. Moving on to the next Bill. House Bill 1164, HD1.

  • Jenna Takenouchi

    Legislator

    First up, Department of Transportation in support on Zoom.

  • Ed Sniffin

    Person

    Chair, Vice Chair Members. Ed Sniffin in support. Thanks.

  • Jenna Takenouchi

    Legislator

    That's all the written testimony we received. Anybody else in the room wishing to testify? Anybody? On Zoom?

  • Kyle Yamashita

    Legislator

    Okay, thank you very much. And we're moving on. Any questions, Members? Okay, thank you. We're going to move on to the next Bill. Going too fast. House Bill 1156, HD1.

  • Jenna Takenouchi

    Legislator

    Vice Chairman, Department of Transportation in support on Zoom.

  • Ed Sniffin

    Person

    Thank you. Department stands in support.

  • Jenna Takenouchi

    Legislator

    Thank you. Also testimony and support from Akahi Energy and Hawaii Harbors users group, both in support. Anybody else in the room wishing to testify? Anybody? On Zoom?

  • Kyle Yamashita

    Legislator

    Okay, questions, Members? Okay, thank you. Moving on to the next Bill. House Bill 667 HD one question.

  • Jenna Takenouchi

    Legislator

    Department of Transportation in support on Zoom.

  • Ed Sniffin

    Person

    Thank you. The Department stands in support.

  • Jenna Takenouchi

    Legislator

    And then we also received testimony and support from four individuals. Is there anybody else in the room wishing to testify? Anybody? On Zoom?

  • Kyle Yamashita

    Legislator

    Any questions, Members? Moving on to the next bill. House Bill 177 HD1.

  • Jenna Takenouchi

    Legislator

    First up, we have the Department of the Attorney General with comments on Zoom. In person. Sorry.

  • Rachel Jordan

    Person

    Good afternoon, Chair, Vice Chair and Members of the Committee. My name is Rachel Jordan, Deputy Attorney General with the Department of the Attorney General. We already provided our written comments and are available for any questions. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. Also Department of Transportation in opposition on Zoom.

  • Ed Sniffin

    Person

    Yes, the Department stands in opposition. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. We also have testimony from Ty Tuli to fight in support.

  • Matthias Kusch

    Legislator

    Good afternoon, Chair, Vice Chair, Members of Committee. I wish Department of Transportation would have supported it like the last four measures, but it's okay. But I'm rise here as a private citizen urging with support. State IDs have become a basic necessity in life. You need it everywhere you go to enter here. For me to testify.

  • Matthias Kusch

    Legislator

    I need a state ID. And so this, this is measured. This bill is aimed for those who are poor and we forget about those left in the gaps.

  • Matthias Kusch

    Legislator

    And so this bill, I've seen the testimonies that's been supported that have been submitted to support that it benefits a lot of people and, you know, it's a minor drop in the bucket as far as finances, but it'll make an immediate impact in the lives of the people we serve in every community.

  • Matthias Kusch

    Legislator

    So I urge passage of this measure. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. We also received testimony in opposition from the County of Honolulu Department of Customer Services, testimony and support from Waianae Coast Comprehensive Health center, and testimony and support from eight individuals. Is there anybody else in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Okay, thank you very much. Members, questions? Okay Representative Kusch.

  • Matthias Kusch

    Legislator

    Thank you Chair. For Department of Transportation, Mr. Sniffin, do you have any data on, like, how many people or the origins of people who get ID cards?

  • Matthias Kusch

    Legislator

    What I'm trying to suss out is, you know, obviously there's a big need for the houseless population, and I know this is a recurring issue for them and they probably go maybe multiple times during an episode.

  • Matthias Kusch

    Legislator

    But do you have any data to support who is just getting an ID card because they're not driving and who is getting these? Just for basic. Is there any programs out there to help fund these for them?

  • Ed Sniffin

    Person

    We can. Representative Kush, thanks for the question. We can get data on the breakdowns of those who use the state ID programs and the reasons that we see for them. I don't have it with me, but I can send it to the Committee if you'd like.

  • Ed Sniffin

    Person

    For us, the reason for the opposition is it's 1.2 million that we're going to have to make up someplace. That's the only thing.

  • Matthias Kusch

    Legislator

    Yeah, no, I understand that. And that's what I'm wondering is if it's 10% to help this body of people who are in need, then maybe there's another route other than changing the whole law to accommodate a minority situation, which I'm loathe to do. But anyway, that would be great.

  • Matthias Kusch

    Legislator

    If that information, if that's something you can get quickly, that would be great. Thank you.

  • Ed Sniffin

    Person

    Absolutely. We can get that over by Monday morning at the latest. Okay, thank you, sir.

  • Kyle Yamashita

    Legislator

    Thank you very much. Any further questions, Members? Okay, thank you. We're going to move on to the next Bill. House Bill 228 HD1.

  • Jenna Takenouchi

    Legislator

    Department of Transportation in support on Zoom.

  • Ed Sniffin

    Person

    Zero, sorry. Department Standards and Support. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. We also received testimony with comments from the County of Honolulu. Yeah, Department of Customer Services and the Hawaii Transportation Association. One individual in opposition and three individuals in support. Is there anybody else in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Okay, Members, questions? Thank you. We're going to move on to House Bill 1161 HT2.

  • Jenna Takenouchi

    Legislator

    Upper step. Department of Transportation in support. On zoom.

  • Ed Sniffin

    Person

    Thank you. The Department stands in support.

  • Jenna Takenouchi

    Legislator

    Thank you. We have the Hawaii State Energy Office in support.

  • Unidentified Speaker

    Person

    Chair, Vice Chair, Members of the Committee. The Hawaii State Energy Office stands on its testimony and support and they're available for questions. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. We have the alliance for Automotive Innovation with comments.

  • Tiffany Ajima

    Person

    Our Vice Chair, Members of the Committee. Tiffany Ajima on behalf of the alliance for Automotive Innovation. We submitted comments in support and asked for hybrids to be removed from the Bill. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. We have Avis Budget Group with comments.

  • Lori Lum

    Person

    Afternoon Chair, Vice Chair, Committee Members, Lori Lum on behalf of Avis Budget Group. We are requesting an amendment to allow rental cars to pay a flat fee rather than the miles traveled formula, which would be very difficult for us to process. Thank you for your consideration of this amendment.

  • Jenna Takenouchi

    Legislator

    Thank you. Ulupono initiative in support. Okay. Stand in support. Thank you. Enterprise Mobility with comments. Thank you. Also testimony and support from Council Member Bullasan from Kauai County, Council Member Kimball from Hawaii county, the Honolulu County Department of Customer Services, Mayor Bisson's Office, County of Maui, the office of the Mayor County of Kauai, ompo.

  • Jenna Takenouchi

    Legislator

    And then with comments, we also have Hawaii Electric Vehicle Association, Cervical Pacific. zero, I'm sorry. Tax foundation of Hawaii on zoom with comments if they're available. Sorry about that.

  • Dave McMillan

    Person

    No problem. Good afternoon, Members of the Committee. This is Dave Mcmillan on behalf of Tom Yamachika for the Tax Foundation of Hawaii. We've submitted some comments on the measure. Just noting that there have been some inconsistencies regarding policies regarding electric vehicles and the rate that they're being charged for use. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. Also Council Member Sugimura from Maui County in support. One other individual in support and one with comments. Is there anybody else in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Okay, Members, questions? No question. Okay. Representative. I mean, Liloy. Sorry.

  • Susan Lokelani Keohokapu-Lee Loy

    Legislator

    I'm hoping Director Sniffin is still online. Director Sniffin, real quick. I know it's a mileage road usage charge that actually goes back to the Department, but I just want to be clear that it's not only for resurfacing, but any other safety measures such as striping reflectors, vertical delineators.

  • Susan Lokelani Keohokapu-Lee Loy

    Legislator

    Would this Fund be available to use those types of other traffic measures under this Bill?

  • Ed Sniffin

    Person

    Hello, Rep. Ed Sniffin with HOY Dot. Yes, this. This is a replacement of the gas tax. So anything that comes into this Fund will go directly into the highway Fund and it's be used for all of those purposes that's correct.

  • Susan Lokelani Keohokapu-Lee Loy

    Legislator

    Thank you. Thank you. Chair.

  • Kyle Yamashita

    Legislator

    Okay. Thank you for the question. Okay, thank you. We're going to move on to the next Bill. House Bill 1166 HD1.

  • Jenna Takenouchi

    Legislator

    Department of Transportation in support on Zoom.

  • Ed Sniffin

    Person

    Thank you. The Department stands in support.

  • Jenna Takenouchi

    Legislator

    Thank you. We also received testimony from the Judiciary with comments and AMPO in support. Is there anybody else in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Okay, Members, questions. Thank you. We're going to move on to House Bill 697 HD2.

  • Jenna Takenouchi

    Legislator

    Department of Transportation in support on Zoom.

  • Ed Sniffin

    Person

    Thank you. Department stands in support.

  • Jenna Takenouchi

    Legislator

    Thank you. We also received testimony and support from AMPO and three individuals in opposition. Is there anybody else in the room wishing to testify? Anybody on Zoom questions?

  • Kyle Yamashita

    Legislator

    Members, thank you. Moving on to the next bill. You have a question? Vice Chair.

  • Jenna Takenouchi

    Legislator

    All right, Director, a couple quick clarifying questions about the program. So are the employees who are going to be approved to do this work, are they just doing that review section, or are they also somehow issuing the tickets? I was, when I was reading the statute, I was a little unclear.

  • Ed Sniffin

    Person

    So the request is for, for our group of either people working for the DOT or for law enforcement to be able to review and be. And they're going to be supervised by law enforcement. So the whole intent is to make sure we can expand the program without overtaxing police at this time.

  • Ed Sniffin

    Person

    For the 10 intersections that we have, we have two police officers doing the thousand to 2000 citations per month. When we start opening up speed just based on the numbers we see, it could be 10 times that.

  • Ed Sniffin

    Person

    Until such time that the public adjusts to reduce the citations, we don't have 20 officers that we could put out there or put under this program to review the tickets and the citations before they go out.

  • Ed Sniffin

    Person

    So we'd like to build up a force of individuals that are employed by the DOT or by DL that can be managed to put out the citations.

  • Jenna Takenouchi

    Legislator

    Okay. So they're just doing the review part, though. And then the supervising officer would be actually doing the citation part of the program. Okay. And then I think you touched on this second part a little bit. So these are all going to be new employees.

  • Jenna Takenouchi

    Legislator

    They're not identified existing employees who, who would be starting to do this work. We'd be having to hire up in either of DOT or D for this initiative.

  • Kyle Yamashita

    Legislator

    That's correct.

  • Jenna Takenouchi

    Legislator

    Okay, thank you.

  • Kyle Yamashita

    Legislator

    Thank you. Thank you. Further questions, Members, moving on to House Bill 1231 HD1.

  • Jenna Takenouchi

    Legislator

    First up, Department of Transportation in support on zoom.

  • Ed Sniffin

    Person

    Thank you, Chair. Vice Chair. The Department of Supports the intent.

  • Ed Sniffin

    Person

    We definitely want to make sure we focus on in areas where there's, there's high crash incidents, people running red lights, and in those types of situations, when we start prioritizing the system, we would need to just prioritize based on a zone, but based on the data that's necessary to consider the program successful.

  • Ed Sniffin

    Person

    And second, considering removal of funding from the program that should be going into a red light and speed enforcement program will make it difficult to expand the program into other areas. Thank you very much.

  • Jenna Takenouchi

    Legislator

    Thank you. We have Ulupono Initiative in support.

  • Mariah Yoshizu

    Person

    Thank you. Chair, Vice Chair, Members of the Committee, Mariah Yoshizu on behalf of Ulupono Initiative, we are supportive of this measure. In particular the part relating to safe Routes to school, the special Fund.

  • Mariah Yoshizu

    Person

    There is an analysis of Hawaii EMS calls found that pedestrian and bicycling injuries to children are most likely to occur when they're traveling to and from school.

  • Mariah Yoshizu

    Person

    So we think that building out correct, proper infrastructure so that they can do that safely will help reduce those risks and have parents not have to worry when they send their kids to school.

  • Mariah Yoshizu

    Person

    And we also believe that it will provide for healthier students who's able to do those more physical activities moving to and from school, reduced absences and tardies and less congestion on the roads as well. So thank you so much for consideration of this measure.

  • Jenna Takenouchi

    Legislator

    Thank you. We have the Hawaii Bicycling League in support.

  • Eduardo Hernandez

    Person

    Chair, Vice Chair, Members of the Committee, Eduardo Hernandez on behalf of the Hawaii Bicycling League, we stand on in support of our written testimony. In support on our written testimony, particularly want to highlight the Safe Routes to School component.

  • Eduardo Hernandez

    Person

    HBL has worked really closely since the Safe Routes to School Committee was enacted and they've been doing a fantastic job and we really want to identify funding streams that will allow them to continue their work. So thank you very much for this opportunity to testify.

  • Jenna Takenouchi

    Legislator

    Thank you.

  • Jenna Takenouchi

    Legislator

    We also received testimony with comments from the judiciary as well as testimony in support from, from ampo, Hawaii Appleseed Center for Law and Economic justice and four individuals. Is there anybody else in the room wishing to testify? Anybody on zoom?

  • Kyle Yamashita

    Legislator

    Okay. Questions, Members?

  • Tina Grandinetti

    Legislator

    Question for Director Sniffin. Hello.

  • Tina Grandinetti

    Legislator

    I was wondering if you think that it's possible to strike a balance between, you know, the percentage, percentage of fines collected and the need to expand the system with the need to expand the Safe Routes to School system, find dedicated funding as you know, another pedestrian safety and vehicular accident like prevention measure or if.

  • Tina Grandinetti

    Legislator

    And if not, where. What's your preferred sort of source of funding for that program? Because I see both of them as really important. And I know you do too.

  • Ed Sniffin

    Person

    Absolutely. The difficulty that I'm having right now is, and this is coming from the Members, there's a lot of interest in expanding this red light and safety camera program to a lot of different districts.

  • Ed Sniffin

    Person

    And we're working through issues with police and courts and prosecutors to ensure that we can fund some of their positions to ensure that we don't bog up the entire system and that that's going to be costing a lot of money.

  • Ed Sniffin

    Person

    Very difficult for me to see that we can expand this without the dedicated source of funding that we have there. Now. That being said, the Legislature in the past two years had dedicated 10 million in our highway Fund directly to safe Router School for those. For those past two years, that funding was significant.

  • Ed Sniffin

    Person

    That came out of the DOT to go into those safer out of school programs. And I'll just say this, I think it's really important those types of projects move forward. I cannot see an agency that moves forward faster than we do.

  • Ed Sniffin

    Person

    So it's very difficult for me to support moving money out of the.who's delivering on these safety issues for the communities rather than finding other sources that are not. They're not moving at this time, if that makes sense.

  • Tina Grandinetti

    Legislator

    Thank you so much.

  • Kyle Yamashita

    Legislator

    Thank you for the questions. Okay, Director, Many years ago when I first took a look at St. Frost's School, it was primarily federally funded. Right. And then over the years we General funded some and then now we're kind of using the Special Fund as well. So. Right. It's evolving and it's moving and things like that.

  • Kyle Yamashita

    Legislator

    But at the same time, I think in light of what's happening at the federal level, it's unclear will the federal money ever return. Is there any talk at that level?

  • Ed Sniffin

    Person

    Yeah. For state Rossi School, there's two sources of funding. There's one federal source and there's one state source. The federal source has always been a source of funding that communities had used for pilots to start a pilot. There's so many strings attached to that program. It's very difficult for community groups to use that federal funding source.

  • Ed Sniffin

    Person

    They don't Fund long term initiatives as well. It's just a startup and they expect the state or the county or locality to take over the program from there.

  • Ed Sniffin

    Person

    On the state side, there's another safe route to school program that was under the DOT previously that used to take citations in or funding from citations to put into the Fund. It's a smaller Fund. I think the last time I checked several years ago, the Fund had amount about 700,000.

  • Ed Sniffin

    Person

    The difficulty with that Fund is when we put it out, the DOT was not able to use that funding. It had to be used by counties or by community groups. But the difficulty was when the counties partnered with community groups, that wasn't their priority. Their priority was the larger projects.

  • Ed Sniffin

    Person

    Those funds, when they were committed to different projects, were very difficult to move. There are a lot of cancellations of projects and the like. The, the Legislature had taken it over, I want to say, four or five years ago. I don't remember exactly when. And we haven't seen the, the funding coming out of that, that fund since.

  • Kyle Yamashita

    Legislator

    Okay. All right. Thank you. Okay. Thank you very much. We'll, we'll move on to the next measure. House Bill 235 HD1.

  • Jenna Takenouchi

    Legislator

    First up, Department of Transportation in support on zoom.

  • Ed Sniffin

    Person

    Thank you. The Department stands supporting the, supporting the intent. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. We also received comments from the judiciary and support from ompo. Anybody else in the room wishing to testify? Anybody on zoom?

  • Kyle Yamashita

    Legislator

    Okay. Thank you. Questions, Members? Okay, thank you. Moving on to 12. House Bill 1260 HD1.

  • Jenna Takenouchi

    Legislator

    Department of Transportation in support on Zoom.

  • Ed Sniffin

    Person

    Thank you. The department stands in support.

  • Jenna Takenouchi

    Legislator

    Thank you. We have the Department of Health in support. Thank you. Hawaii Bicycling League in support.

  • Unidentified Speaker

    Person

    Yes. Aloha, chair, vice chair. The Hawaii Bicycling League stands in support of this measure, particularly the- the economic impact of it. There have been 50 years of this type of project happening across the world in more than 400 jurisdictions. And the- in my testimony, you'll find a link to an economic impact study in New York City.

  • Unidentified Speaker

    Person

    It's clear, given obligations under the Navajine settlement, that we need to do more to get people to choose to walk and ride safely. One of the things that we've seen over 50 years at HBL is that people are afraid to ride their bike because they don't feel safe.

  • Unidentified Speaker

    Person

    Having a few hours out of the year that are dedicated for open streets would allow people to experience what it's like. And, and this would be an important benefit for socioeconomic and health reasons. Thank you very much for the opportunity to testify. Here for any questions.

  • Jenna Takenouchi

    Legislator

    Thank you. We have Jonathan Lott in support. Please come forward.

  • Jonathan Lott

    Person

    Good afternoon. I'm generally in support, but I do not support restricting it to the smaller size counties it should be statewide. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you.

  • Jenna Takenouchi

    Legislator

    We also have testimony from three other organizations in support, as well as three individuals in support and one other person with comments. Is there anybody else in the room wishing to testify? Anybody on zoom?

  • Kyle Yamashita

    Legislator

    Okay. Thank you. Question, members.

  • Matthias Kusch

    Legislator

    I guess this would be for you, Director Sniffin. Do you- Do you know. I'm familiar with this bill and I think it's great. Do you know why Oahu was cut out?

  • Ed Sniffin

    Person

    I don't. Sorry.

  • Matthias Kusch

    Legislator

    Okay. Thank you.

  • Ed Sniffin

    Person

    Thank you.

  • Kyle Yamashita

    Legislator

    Okay. Thank you very much for the questions. Thank you. We'll move on to the next bill. House Bill 958, HD2.

  • Jenna Takenouchi

    Legislator

    Department of Transportation in support. On Zoom.

  • Ed Sniffin

    Person

    Thank you. The department stands in support.

  • Jenna Takenouchi

    Legislator

    Thank you. We have the Honolulu Police Department in support, on Zoom. Not present. We have Ulupono Initiative in support. Thank you. And we have the Hawaii Bicycling League in support.

  • Unidentified Speaker

    Person

    Thank you. We stand in support.

  • Jenna Takenouchi

    Legislator

    Thank you.

  • Unidentified Speaker

    Person

    With comments as noted.

  • Jenna Takenouchi

    Legislator

    With comments. Okay. Okay. We also received testimony in support from the Honolulu County Department of Transportation Services, two other organizations and four individuals. Is there anybody else in the room wishing to testify? Oh, sorry. Okay. Stand this support. Thank you. Anybody else in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Okay. Thank you. Questions, members? Okay. Thank you very much. We'll move on to the next bill. House Bill 1055, HD1.

  • Jenna Takenouchi

    Legislator

    First up, we have the Public Utilities Commission in support. Thank you. We also received testimony in support from Hawaiian Electric. Is there anybody else in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Okay. Questions? Moving on to the next bill. House Bill 1052, HD1.

  • Jenna Takenouchi

    Legislator

    First up, we have DCCA Division of Consumer Advocacy in support.

  • Kyle Yamashita

    Legislator

    Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. We also have the Public Utilities Commission in support. Thank- Thank you. We have the National Federation of the Blind of Hawaii in support.

  • James Gashell

    Person

    Yeah. Good afternoon. Chair, Vice Chair, Members of the Committee, my name is James Gashell speaking for the National Federation of the Blind of Hawaii. You know, it just strikes me that looking at the title of this Bill, it looks like kind of a bureaucratic or governmental Bill.

  • James Gashell

    Person

    There are real people that are behind this Bill and benefit from the program that's operated under this Bill. That program is described in our written testimony and it came about as a result of Act 247 passed in 2023.

  • James Gashell

    Person

    This Bill proposes to extend that program on out into the future with implementing the Public Utilities Commission's universal service program. Mahalo for their efforts in regard to this and we support this Bill. Thank you very much.

  • Jenna Takenouchi

    Legislator

    Thank you. We also received testimony and support from the State Council on Developmental Disabilities and the Department of Human Services. Is there anybody else in the room wishing to testify?

  • Unidentified Speaker

    Person

    Anybody on Zoom questions, Members? Okay, thank you. Moving on to the next Bill, House Bill 108 HD2.

  • Jenna Takenouchi

    Legislator

    First up we have Maui Brewing Company on Zoom in support, Garrett Marrero.

  • Garrett Marrero

    Person

    Aloha Chair Yamashita, vice chair, members of the committee, thank you for the opportunity to testify. You know, going to stand on my testimony. There's a lot of great facts in there about the consumer sentiment. Over 82% of drinkers do support updating the laws for direct to consumer.

  • Garrett Marrero

    Person

    I'd like to focus a little bit on the fear mongering that the Wholesalers Association and others put out there. First, it's just not possible that minors are going to get this easy access to alcohol.

  • Garrett Marrero

    Person

    First and foremost, what we're talking about shipping here are not beers that you're going to, you normally would run to ABC and pick up. We're not going to put in our case say bikini blonde lager in the mail to ship to another island.

  • Garrett Marrero

    Person

    These are going to be beers that the wholesalers who are opposing this specifically refuse to carry. And what I mean by that are these very esoteric small batch beers that frankly there's just not enough money in them for the wholesalers to sell.

  • Garrett Marrero

    Person

    The very same arguments the wholesalers used 20 years ago when wine sought the opportunity to sell direct to consumer are the exact same arguments that are being used today. It's minors are going to be drinking alcohol. That's not the case.

  • Garrett Marrero

    Person

    You figure if you did buy a six pack through the mail, it's going to be at least a $36 pack.

  • Garrett Marrero

    Person

    And I don't know about you, but when I was a minor I was not spending anything like that to get any- anything elicit. Beyond that common carrier reporting is- is done every day by the common carriers who are allowed to ship. This is for wine. And there's a perfectly auditable process that happens regularly.

  • Garrett Marrero

    Person

    I'd also point to Mr. Takase's supporting testimony from the County of Hawaii Liquor Control that the system works very well and he supports the right of brewers and distillers producing local products to be able to have the same rights that- that wine does. The wholesalers will also contend that there'll be this massive loss of jobs.

  • Garrett Marrero

    Person

    Wholesalers in our country have declined by over half in numbers over the last, say, 20 years. This is not a result of direct to consumer shipping, it's consolidation. So while the number has decreased, they're just owned by fewer and fewer, meaning they want less and less to do with small producers.

  • Garrett Marrero

    Person

    So if it doesn't hit a certain volume, a certain velocity, they don't even want to carry these beers. So I challenge the wholesalers to come and testify that they will agree to carry 100% of any beers produced by our local brewers and distribute them across the state.

  • Garrett Marrero

    Person

    And if they can do that, maybe there's a conversation to be had. But these are beers that they refuse to carry. They just don't want to share the world with the small producers. Now, I work very closely with several wholesalers, 26 wholesalers at least. We have great relationships. We of course are opposing ideas around this issue.

  • Garrett Marrero

    Person

    However, the three tier system is not as old as they may contend. It does work well and we support the three tier system. However, direct to consumer is modernizing our laws to fit right in where wine does

  • Garrett Marrero

    Person

    currently. I'm sure many of you have traveled to Napa and other wine producing regions of the world, fall in love with a winery, a specific wine and say, just send that to my house. And they say, no problem.

  • Garrett Marrero

    Person

    But if you go to Lanikai Brewing, if you go to Maui Brewing, if you go to Ola Brewing, if you go to any of our local breweries and fall in love with a beer and you're visiting from the mainland, we have to say no, I'm sorry, our laws don't allow us to do that. And why?

  • Garrett Marrero

    Person

    With beer being the beverage of moderation, low ABV compared to even wine, are we denied that right? This is about expanding the economy and expanding access to market for our smallest producers. And I'll be available for questions. Thank you so much.

  • Jenna Takenouchi

    Legislator

    Thank you. We have testimony from the Brewers Association in support on Zoom. Sam DeWitt.

  • Sam DeWitt

    Person

    Aloha. Mr. Chair, members of the committee, my name is Sam DeWitt, State Government Affairs Director for the Brewers Association or the 501c6 National Trade Organization dedicated to promoting and protecting America's small and independent craft brewers.

  • Sam DeWitt

    Person

    I'm thrilled to join you today to enthusiastically support moving House Bill 108 forward as this legislation will make a tangible difference for brewers in the Islands, bringing them to parity with the winemakers in the state and helping to expand the customer base for great Hawaiian beer. I have submitted written testimony and will lean on that.

  • Sam DeWitt

    Person

    But a couple items I wanted to point out for your consideration. First, the beers, as Garrett said, that we are trying to ship are not available through the three tier system. That's an important point as you're going to hear that this will cost wholesaler jobs. It will not. Beer available currently through normal distribution channels will remain available.

  • Sam DeWitt

    Person

    Routes served by wholesaler trucks will continue to run those routes as currently scheduled. The beers shipped will be to consumers who are otherwise unable to get these short run and specialty products. Second, according to the National Beer Wholesalers Association, or NBWA, which puts out an annual Beer Purchasers Index, wholesalers are scaling back on their craft beer purchases.

  • Sam DeWitt

    Person

    There's limited space on those trucks and competition for that space builds almost daily from non alcoholic brands to beyond beer products like canned cocktails and seltzers. As wholesalers carry fewer craft brands, those brewers will be forced to find other routes to market. House Bill 108 opens up one of those routes.

  • Sam DeWitt

    Person

    Finally, long term direct to consumer shipping of craft beer builds opportunity for wholesalers by seeding new markets. Without that wholesale partner, craft brewers are able to build a reputation in those markets, build buzz in those markets and build those products up to be something wholesalers actually want to carry.

  • Sam DeWitt

    Person

    The Brewers Association enthusiastically supports this and all direct to consumer legislation as a way for our members to survive and thrive during a complicated er- era for this segment of beverage alcohol. HB 108 is a good bill and we urge a yes vote to the house floor. Thank you for your time and consideration.

  • Sam DeWitt

    Person

    I am happy to stand for any questions.

  • Jenna Takenouchi

    Legislator

    Thank you. We have Lanikai Brewing Company in support.

  • Steve Haumschild

    Person

    Hi, chair, vice chair, members of the committee, I'm Steve Haumschild, the founder of Lanikai Brewing Company. I stand on my testimony. I just want to take this opportunity to do what Mr. Marrero and Mr. DeWitt did already and just kind of highlight some of the opposition real quickly. You know, direct shipment of alcohol is not groundbreaking,

  • Steve Haumschild

    Person

    as they've mentioned. This isn't something new that we're creating out of nowhere, it's already existing. So the purpose of this bill is simply to put parity with wine, with other alcohols that are already out there.

  • Steve Haumschild

    Person

    For a small producer like myself, it gives me the opportunity to explore new markets to get our product into hands that other people might not normally be able to have because many of the wholesalers, as mentioned before, refuse to carry some of the products that we have already.

  • Steve Haumschild

    Person

    So it's a way for us local manufacturers to continue to expand, continue to grow and continue to support made in Hawaii products. You know, the argument against the three tier system is kind of false. Again, you know, again, wine has been shipped already. It's already.

  • Steve Haumschild

    Person

    It's proven that wine shipping doesn't violate the three tiered system any more than shipping of a beer or a spirit would as well. Finally, I'll just kind of close down. Everybody loves to throw the term around of like supporting local manufacturing, supporting local jobs, local agriculture, and a vote for this bill does exactly that.

  • Steve Haumschild

    Person

    It's supporting families like mine, the employees that we have that are out there, and 18 to, you know, 25 different breweries that are here within the state. Whereas a vote in opposition to this mostly supports the large wholesalers and the conglomerates that are out there. So we continue to.

  • Steve Haumschild

    Person

    I'm here for any questions you might have and I urge you to support this bill. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. We have testimony from the Hawaii Food Industry Association in opposition on Zoom. Lauren Zerbel, not present. We have testimony from the Hawaii Liquor Wholesalers Association in opposition.

  • Kenneth Hoo

    Person

    Chair, vice chair, I'm Kenneth Hoo for the Hawaii Liquor Wholesalers Association. Stand on our testimony in opposition and I'm prepared to answer any questions that you may have. Back to the remarks that.

  • Kyle Yamashita

    Legislator

    Take questions at the end.

  • Jenna Takenouchi

    Legislator

    Thank you. We have testimony from Ola Brew in support.

  • Naehalani Breeland

    Person

    Aloha chair, vice chair and members of the committee. My name is Naehalani Breeland. I'm the president and co founder of Ola Brew and we are a community and employee owned brewery. We have over 4,200 shareholders and we're super proud that Hawaii truly owns Ola. Our mission is to support the growth of Hawaii's agricultural economy.

  • Naehalani Breeland

    Person

    And we do that by sourcing local ingredients here in Hawaii, adding them into our beverages. And that creates a more circular economy here in Hawaii, supporting our local farmers. We've also recently begun resurrecting our Monarch era distilled spirit Okolehau and have won over 60 international awards.

  • Naehalani Breeland

    Person

    And we're thrilled that finally we're able to make something that's 100% Hawaii grown and made. I'd like to address some of the concerns outlined by the Hawaii Liquor Wholesalers Association, and I believe they're a bit misleading. In my written testimony, I responded to each of their concerns. But here today I'll just focus on a couple.

  • Naehalani Breeland

    Person

    The first is that direct to consumer shipping could get product into the hands of minors. And I think it's always a concern for all liquor license holders that that doesn't happen. With the exponential rise of E commerce in every other industry, though, it only makes sense that this industry does it as well.

  • Naehalani Breeland

    Person

    Of course, regulations and compliance standards to shipping alcohol are of the utmost importance and those outlined in this bill have been successful with wine manufacturers right here in Hawaii as well as other states throughout the US that allowed direct to consumer of all alcoholic beverages.

  • Naehalani Breeland

    Person

    Another argument is that allowing consumer direct to consumer shipping will create the possibilities of monopolies within the beer and spirits industry.

  • Naehalani Breeland

    Person

    This bill is not presented as a replacement for the three tier system, but rather an opportunity for small Hawaii producers to sell specialty items that our distributors will not pick up due to the volume potentials that they see or do not see.

  • Naehalani Breeland

    Person

    So a question to our wholesalers would be, are you willing to distribute every single item that we produce? The answer that many of our Hawaii producers have heard is a resounding no. And it actually makes sense, right, because the wholesalers are looking for volume.

  • Naehalani Breeland

    Person

    This is where direct to consumer shipping comes in and saves the day for not only businesses, but for consumers as well.

  • Naehalani Breeland

    Person

    In fact, it would help- it would actually help us vet new products to introduce to our distributor partners here in Hawaii and through- and throughout the continental US. Direct to consumer shipping would not only bring additional tax revenue to the state, but it would allow for much needed vetting of new regions.

  • Naehalani Breeland

    Person

    So again, this is not a way doing away with the three tier system. It's working together to test products so that we can eventually drive more business to our distributor partners.

  • Naehalani Breeland

    Person

    And lastly, allowing direct to consumer shipping of alcohol would not affect the livelihoods of our wholesalers or their employees in Hawaii because the products that we're trying to sell direct to consumer aren't in their catalogs and with and it really is just creating more visibility for Hawaii producers in general to thrive.

  • Naehalani Breeland

    Person

    I really appreciate all of you hearing my testimony today and I'm available for questions.

  • Jenna Takenouchi

    Legislator

    Thank you.

  • Jenna Takenouchi

    Legislator

    We also have testimony from the County of Hawaii Liquor Department in support as well as testimony and support from another 13 or about a dozen organizations and one individual. Is there anybody else in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Questions, members?

  • Kyle Yamashita

    Legislator

    Okay, I'm going to move on the next bill. House Bill 939 HD1.

  • Jenna Takenouchi

    Legislator

    First up, we have Department of Taxation with comments. Thank you. We have Maui Brewing Company in support on Zoom. Garrett Marrero.

  • Garrett Marrero

    Person

    Chair, Vice Chair. Thanks for having me back. I feel like the theme for our testimony as brewers today is really, I think, really just highlighting the protectionist attitudes on some of these, those that are opposing both of these bills. 939 effectively expands what we already have in 244D under the cooler beverage category.

  • Garrett Marrero

    Person

    So addressing, for example, the Wine Association, the Wine Institute's testimony, I think they failed to mention that they already enjoy the same benefit that we're looking for in this new category of low ABV beverages.

  • Garrett Marrero

    Person

    So you have a relatively high wine tax, but if you dilute that wine with mixers and package it, now, it enjoys the cooler beverage tax, which is only 85 cents a gallon, which is still high in the country. But we won't get into that.

  • Garrett Marrero

    Person

    So we're just asking on the distillery side that we're able to dilute those spirits and not tax a vodka soda or a whiskey soda, as if that is 12 ounces of alcohol, when in reality it might be 1 ounce of alcohol and 11 ounces of water or mixer.

  • Garrett Marrero

    Person

    I think there was some testimony also from another large beer producer that talked about creating a whole new tax category, which again, is incorrect. We already have this in 244D. My testimony is to support, with amendments that lines it up with 244D that it's a 7% instead of 5%.

  • Garrett Marrero

    Person

    This also makes it easier for compliance because all cooler beverages are then 7% and 85 cents a gallon. It just creates a homogenized category with reference to the large brewer that testified against it.

  • Garrett Marrero

    Person

    They failed to mention that they own a large cocktail producing company that puts these beverages in cans, however, would not qualify for this legislation, for this, this new cooler beverage category, because all of their cocktails are 10 to 12% alcohol.

  • Garrett Marrero

    Person

    So I think it's really important that we highlight the facts here and not just drive the conversation in any one direction. We do have a lot of in the industry, brewers, distillers, all the local producers. There are no local producers of scale in this category.

  • Garrett Marrero

    Person

    And I think the reason for that is we cannot compete with these big producers from the mainland. High Noon, for example, is owned by Gallo Wine, one of the largest beverage alcohol companies in the world. We can't compete, and that's why there are no real local players.

  • Garrett Marrero

    Person

    And I Think this creates a better playing field for local producers to create a market.

  • Garrett Marrero

    Person

    And we believe that when a visitor comes to Hawaii and even our people in Hawaii, if they see an opportunity to have a locally produced version of something they might have had elsewhere, they're almost always going to choose that price being the same.

  • Garrett Marrero

    Person

    Now, when ours are so much higher than these products that are shipped in from the mainland, we are left with a, well, I'd like to try it, but it's too expensive and you end up not having a market. As Hawaii's largest brewer, I totally understand the arguments of the Beer Institute. Brian Cross offered is a good friend.

  • Garrett Marrero

    Person

    However, again, it is a bit protectionist. The beer market has completely changed in our country. Things like seltzer, ready to drink cocktails, canned wine. It's really changed how the beverage, any consumers of alcohol are drinking these days. And so we see the need to evolve and to be able to compete in this marketplace.

  • Garrett Marrero

    Person

    I'd add that although we're the largest Hawaiian craft brewer, that still makes us extremely small on the national scale. But we do see a potential for the local industry to flourish with beverages of these types.

  • Garrett Marrero

    Person

    If we are allowed this cooler beverage category again, that already exists in 244D for wine and malt based beverages, to just create that for spirits based. I'll be available for questions. Thank you for your time. Aloha.

  • Jenna Takenouchi

    Legislator

    Thank you. We have the Tax foundation of Hawaii with comments on Zoom.

  • Jade McMillan

    Person

    Yes, good afternoon, this is Jane McMillan. I'm at the Tax foundation of Hawaii. Our comment state that we believe that the lower tax rate would be appropriate given that the beverages will have a lower alcoholic content.

  • Jenna Takenouchi

    Legislator

    Thank you. We have the Wine Institute in opposition.

  • Mihoko Ito

    Person

    Good afternoon, Chair. Vice Chair, Members of the Committee. Mihoko Ito, on behalf of the Wine Institute, we are respectfully opposed to this measure. And the reason is this. This bill actually creates a discrepancy in the tax code. Currently, alcohol products are taxed as a gallonage tax.

  • Mihoko Ito

    Person

    And this, which is a certain formula, is applied to create those categories. And this actually creates a tax discrepancy by creating a new category just solely based on alcohol by volume. We also think that this Committee should be concerned about the resulting revenue loss, as pointed out in other testimony.

  • Mihoko Ito

    Person

    Happy to answer any questions, but thank you for the opportunity to testify.

  • Jenna Takenouchi

    Legislator

    Thank you. We have Anheuser Busch in opposition.

  • Mike Yosula

    Person

    Thank you Chair, Vice Chair. Mike Yosula, on behalf of Anheuser-Busch, echo the comments of the Wine Institute. I think it's important to recall that there are a lot of different types of beverages now available, which is different than what the tax category is.

  • Mike Yosula

    Person

    So if we're going to do a amendment and give a tax break, there should be an overhaul of the whole system instead of just trying to do it piecemeal. Thank you, Chair.

  • Jenna Takenouchi

    Legislator

    Thank you. We have Lanikai Brewing Company.

  • Unidentified Speaker

    Person

    Hi, Members. Good to see you guys again. Thanks for the opportunity again. 939 is very similar to my testimony that I had before, for 108. We're trying to put our.

  • Jenna Takenouchi

    Legislator

    You're in support?

  • Unidentified Speaker

    Person

    I'm in support. It's very clearly in support. So we're just kind of similar to 108. The goal here is just to put everything on parity. I mean, alcohol is alcohol, and as you dilute it down to a lower percentages, you know, it should be taxed at lower rates. It's just logical when it goes down that route.

  • Unidentified Speaker

    Person

    So, you know, the purpose of 939 is really for local distillers like myself, we're Brewery Distillery to be more competitive. You know, we can't be competitive to these large brands that are shipping into the State of Hawaii.

  • Unidentified Speaker

    Person

    So we're just trying to find ways that local producers can produce more and serve our community, hire more jobs and, you know, proudly create more local products. So, again, I'm in support. Thank you so much.

  • Jenna Takenouchi

    Legislator

    Thank you. We also have Ola Brew.

  • Unidentified Speaker

    Person

    Aloha Chair, Vice Chair, Members of the Committee, thank you so much for. For hearing our testimonies today. And I just stand on, actually, Garrett and Steve's testimony as well. And if you have any questions, I'm happy to answer. Right. In support. In support.

  • Jenna Takenouchi

    Legislator

    Thank you. We also received written testimony in support from other four organizations and one organization in opposition. Is there anybody else in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Okay. Questions. Okay. Representative Lee Loy.

  • Susan Lokelani Keohokapu-Lee Loy

    Legislator

    Thank you. Tax. I guess it was Tax Foundation. They had comments. Yes. Hi. Thanks for being here. Through the testimony, they mentioned some of the loss of revenue. But I was wondering, our prior Bill, House Bill 108, kind of allows for small breweries to kind of expand their abilities.

  • Susan Lokelani Keohokapu-Lee Loy

    Legislator

    And I was just wondering if there was an analysis done. We can see the revenue loss with the current system, but I actually see these two bills kind of working together where there might be more potential revenue gain if these small breweries are able to kind of grow their capacity and the ability to generate tax revenue.

  • Susan Lokelani Keohokapu-Lee Loy

    Legislator

    Was there any analysis done on that?

  • Jade McMillan

    Person

    Thank you for your question. Our comments are mainly directed towards the fairness of the application of taxes. We have not done any analysis on the revenue impact. We do not generally review the revenue impact specifically for measures such as this. In our experience, perhaps the Department of Taxation would be better suited to give you those particular numbers.

  • Jade McMillan

    Person

    However, I can do some research and we can get back to you with that.

  • Susan Lokelani Keohokapu-Lee Loy

    Legislator

    Great. Yeah, I'd be really curious or somebody else maybe here in the audience chair, if that's okay.

  • Gary Suganuma

    Person

    Good afternoon, Gary Sugunuma from the Department of Taxation. So your question pertains to the revenue impact for this.

  • Susan Lokelani Keohokapu-Lee Loy

    Legislator

    Yeah. So in your testimony on Bill, House Bill 939, House Draft 1, you know, you gave the analysis of potential revenue loss, but I was just really curious if there was an analysis done for House Bill 108, House Draft 2, because I actually see these two bills kind of offsetting one another.

  • Gary Suganuma

    Person

    Yeah. I don't have. So just to let you know, the revenue impact for this particular Bill takes this Bill in isolation and does the analysis offhand, I don't know what the revenue impact is for 108, but I can check.

  • Gary Suganuma

    Person

    And then I guess then you could compare the two to see if the gain in one more than offsets the loss.

  • Susan Lokelani Keohokapu-Lee Loy

    Legislator

    Yeah, I think we're really good at identifying the loss. I think I would love to see how there was probably a potential revenue gain.

  • Gary Suganuma

    Person

    Yeah, we do revenue impacts on all the bills. Some of them do end up with a gain. Right. So in this particular one, though, where.

  • Susan Lokelani Keohokapu-Lee Loy

    Legislator

    Yeah. And I just know that Gerald Takasi, our liquor Director of Hawaii County, he runs a very tight ship. And for him to support some of these bills tells me a lot that there's potential for him to collect more money. And so if there's more money to liquor office back in Hawaii County, there's potential here, too. So.

  • Susan Lokelani Keohokapu-Lee Loy

    Legislator

    Thank you. Thank you, Chair. Yield.

  • Kyle Yamashita

    Legislator

    Okay. For the questions.

  • Tyson Miyake

    Legislator

    Sorry, Director. Question for DOE tax, Director. Thank you, Director. Does this bill create a discrepancy in the tax treatment from previous testimony says gallonage tax to alcohol by volume?

  • Gary Suganuma

    Person

    I don't know that our testimony is limited to whether or not we can implement the tax change being proposed. And. Yes, we can. All we're asking is that the change go into effect on January 1, 2026 in terms of. I mean, it does create a new category. Right. Low alcohol by volume spirits. And so.

  • Gary Suganuma

    Person

    And it is taxed at a different gallonage rate, and we can implement it. And that's the extent of what I'm comfortable testifying to right now.

  • Tyson Miyake

    Legislator

    Okay.

  • Gary Suganuma

    Person

    There might be differing opinions as to whether or not it's unfair. Fair. Unfair. That's not for me.

  • Tyson Miyake

    Legislator

    Okay. Well, I mean, I do see a sunset date of 2028 too, so. Okay. Thank you, Director. Thank you, Chair.

  • Kyle Yamashita

    Legislator

    Thank you. Any further questions, Members? Yeah, you follow up. Go ahead, please.

  • Susan Lokelani Keohokapu-Lee Loy

    Legislator

    Yeah, if you don't mind coming back up because I want to understand the low volume alcohol spirits, because I see the threshold if we're going down, but I was wondering if there's a maximum because we see spirits and wines with higher alcohol content.

  • Susan Lokelani Keohokapu-Lee Loy

    Legislator

    If we're setting a threshold as it goes down, do we set a threshold as it goes off?

  • Gary Suganuma

    Person

    What's the question?

  • Susan Lokelani Keohokapu-Lee Loy

    Legislator

    I understand how this bill works to set a low alcohol volume, but I was just wondering if we adjust the ceiling, like they can just keep going up or do we tear it as it goes up?

  • Gary Suganuma

    Person

    This ask for you guys to figure out. I mean, I didn't set the rate. This is not our bill. We're not proposing it. We're just saying that we can implement it if this is what you guys want. Perfect. Good to know. Thank you.

  • Kyle Yamashita

    Legislator

    Yeah. Every once in a while we go through a relook at all these things and at some point in time, I think it's always been the my position that it's a comprehensive look. So at some point we'll do that. Okay, thank you very much. Any further questions, Members? Okay, moving on to House Bill 807 HD1.

  • Jenna Takenouchi

    Legislator

    We have the Hawaii Green Infrastructure Authority in support. Thank you. We have the Hawaii Bankers Association in support.

  • Unidentified Speaker

    Person

    We stand on our testimony.

  • Jenna Takenouchi

    Legislator

    We also received testimony from Department of Budget and Finance with comments as well as three other individuals all in support. Is there anybody else in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Okay, thank you. Question, members? Okay. Okay, we're gonna. Let's see. What time is it? Okay, we're gonna recess till 2 o'clock is our next agenda. We're gonna come back at one minute to two. No, I'm kidding. We'll come back for decision making about 2:00 and then we'll go right into our next agenda. Okay, thank you, we're in recess.

  • Kyle Yamashita

    Legislator

    We're going to reconvene Committee on finance for a second agenda. First up is House Bill 1167, HD1 as is discussion. Vice Chair going on.

  • Jenna Takenouchi

    Legislator

    HB 1167, HD1 recommendations to pass unamended chair and Vice Chair vote. I represent Grandinetti. Representative Holt.

  • Unidentified Speaker

    Person

    Aye.

  • Jenna Takenouchi

    Legislator

    Representative Hussey.

  • Jenna Takenouchi

    Legislator

    Representative Keohokapu Leloi. Aye. Representative Kitagawa.

  • Unidentified Speaker

    Person

    Aye.

  • Jenna Takenouchi

    Legislator

    Representative Kush.

  • Unidentified Speaker

    Person

    Aye.

  • Unidentified Speaker

    Person

    Aye.

  • Jenna Takenouchi

    Legislator

    Representative Lamasao. Representative Lee is excused. Representative Miyake. Aye. Representative Morikawa, Representative Templo. Aye. Representative Akos is excused. Representative Reyes, oda. Aye. Representative Ford is excused. Chair recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay, moving on. Thank you. Members. Moving on to House Bill 1164, HD1 as is discussion. Vice Chair going on.

  • Jenna Takenouchi

    Legislator

    HB 1164, HD1 recommendation is to pass, unamended, noting the excused absences of Representatives Lee, Alkos and Ward, who will remain marked as excused for the remainder of this agenda unless otherwise noted. Are there any Members voting with reservations? Any NOS recommendations adopted? Okay.

  • Kyle Yamashita

    Legislator

    House Bill 1154, HD1 as is discussion question. Zero, 56. I'm sorry.

  • Jenna Takenouchi

    Legislator

    1156.

  • Kyle Yamashita

    Legislator

    1156. H2 as is discussion. Vice Chair going on.

  • Jenna Takenouchi

    Legislator

    HB 1156, HD1 recommendations to pass, unamended. Any reservations? Any NOS recommendations adopted?

  • Kyle Yamashita

    Legislator

    Okay, moving on. House Bill 667, HD1 as is discussion. Vice Chair.

  • Jenna Takenouchi

    Legislator

    HB667HD1 recommendations to pass, unamended. Any reservations? Any NOS recommendations adopted?

  • Kyle Yamashita

    Legislator

    Okay, moving on to House Bill 177, HD1 as is discussion. Vice Chair going on.

  • Jenna Takenouchi

    Legislator

    HB177HD1 recommendation is to pass unamended. Any reservations? Any noes? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay, thank you. Moving on to House Bill 228, House D1, as is discussion. Vice Chair going on.

  • Jenna Takenouchi

    Legislator

    HB228HD1 recommendations to pass, unamended. Any reservations? Any noes? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay, moving on to House Bill 1161, HD2 as is discussion question. Hold on. Any discussion? Okay. Register for the vote. zero, you have something. Go ahead.

  • Unidentified Speaker

    Person

    Sorry. Go ahead. Okay, Due to the disadvantage of commuters. On the west side or anybody who has to drive far into traffic, I'm going to be voting with reservations. Thank you. Any further discussion? Okay, Vice Chair for the vote, voting.

  • Jenna Takenouchi

    Legislator

    On HB 1161, HD2 recommendations to pass, unamended, noting the reservations of Representatives Reyes, oda. Any other reservations? Any NOS recommendations adopted?

  • Kyle Yamashita

    Legislator

    Okay, moving on to House Bill 1166, HD1 as is discussion. Vice Chair going on.

  • Jenna Takenouchi

    Legislator

    HB 1166, HD1 recommendations to pass, unamended. Any reservations? Any NOS recommendations adopted?

  • Kyle Yamashita

    Legislator

    Moving on to House Bill 697, HD2 as is discussion. Vice Chair.

  • Jenna Takenouchi

    Legislator

    Voying. HB 697, House D2 recommendations to pass, unamended. Any reservations, Any noes? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Thank you, Members. Moving on to House Bill 1231, HD1 as is discussion. Vice Chair.

  • Jenna Takenouchi

    Legislator

    Going on. HB 1231, recommendations to pass, unamended. Any reservations? Any nos? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay, thank you. Moving on to House Bill 235, HD1 as is discussion. Vice Chair.

  • Jenna Takenouchi

    Legislator

    HB 235. HD1 recommendations to pass, unamended. Any reservations? Any no's? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Thank you. Moving on to House Bill 1260, HD1 as is discussion. Vice Chair.

  • Jenna Takenouchi

    Legislator

    HB 1260, HD1 recommendations to pass, unamended. Any reservations? Any nos? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay, thank you. Moving on to House Bill 958. HD2 as is discussion. Vice Chair.

  • Jenna Takenouchi

    Legislator

    HB958HD2 recommendations to pass, unamended. Any reservations? Any noes? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay, thank you. Moving on to House Bill 1055, HD1 as is discussion. Vice Chair.

  • Jenna Takenouchi

    Legislator

    HB1055HD1 recommendations to pass, unamended. Any reservations? Any noes? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Moving on to House Bill 1052, HD1 as is discussion. Vice Chair.

  • Jenna Takenouchi

    Legislator

    HB1052HD1 recommendations to pass, unamended. Any reservations? Any noes? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay. Moving on to House Bill 100. I'm sorry. 108 HD2 as is discussion. Vice Chair.

  • Jenna Takenouchi

    Legislator

    Going on. HB 108 HD2 recommendations to pass, unamended. Any reservations? Any nos. Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay, thank you. Moving on to House Bill 939, HD1 recommendations pass as is discussion. Vice Chair.

  • Jenna Takenouchi

    Legislator

    HB939HD1 recommendations to pass, unamended. Any reservations, Any noes? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Final Bill on the agenda. Moving on to House Bill 807, HD1 as is discussion. zero, I'm sorry. zero, yeah, I'm sorry. Okay. I'm sorry. Moving on to House Bill 807, HD1. We're going to be defecting the effective date and putting technical, nonsensive amendments in there. Any discussion? Okay. Vice Chair for the vote.

  • Jenna Takenouchi

    Legislator

    HB807HD One recommendation is to pass with amendments. Any reservations? Any nos? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay, thank you very much, Members. We are adjourned.

  • Unidentified Speaker

    Person

    It.

  • Kyle Yamashita

    Legislator

    Going to convene the Committee on Finance for our third agenda. First up is House Bill 1427, HD1, vice chair.

  • Jenna Takenouchi

    Legislator

    First up, we have the Department of Health in support.

  • Nathan Tan

    Person

    Hi, honorable chair and vice chair and members of the House Finance Committee. My name is Nathan Tan and I'm the deputy at the Disease Outbreak Control Division with the Department of Health. We stand by our testimony as written and stand by for questions.

  • Jenna Takenouchi

    Legislator

    Thank you. We have the Hawaii Food Industry Association in support, on Zoom. Sorry. Oh, we have the State Health Planning and Development Agency in support.

  • Jack Lewin

    Person

    Aloha chair, vice chair, members, we stand on our testimony and thank you for your support of this legislation. Jack Lewin here.

  • Jenna Takenouchi

    Legislator

    Thank you. We also have testimony and support from DLNR and the Department of Agriculture, two organizations and two other individuals. Everything in support. Is there anyone else in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Members questions on this measure? Okay, moving on to the next Bill. House Bill 1389, HD1 Vice Chair.

  • Jenna Takenouchi

    Legislator

    I have nobody checked in, but I do have the Department of Health, dlnr, Department of Agriculture and Honolulu County Department of Customer Service in support, as well as Hawaii Farm Bureau, Animal Rights Hawaii and zero, White Farm Bureau in support. Animal Rights Hawaii in opposition and one individual in support.

  • Jenna Takenouchi

    Legislator

    If anybody is in the room and wishing to testify or anyone else in the audience wishing to testify. Anybody on zoom. zero, please, you can come up and identify yourself. Sorry.

  • Jennifer Grimm

    Person

    Aloha Chair, Vice Chair and Members of the Finance Committee. I am Jennifer Grimm from the Division of Forestry and Wildlife and we are standing on our supportive testimony to Fund this work.

  • Jenna Takenouchi

    Legislator

    Thank you.

  • Kyle Yamashita

    Legislator

    Okay, Members will move on to questions. Any questions, Members? Okay, thank you very much. Moving on to the next Bill. House Bill 237 HD1.

  • Jenna Takenouchi

    Legislator

    First up, we have the Department of Health in support. Thank you. We have Family Hui Hawaii in support. Sherrilyn Shionoki.

  • Sherrilyn Shionoki

    Person

    Good afternoon Members of the House Finance Committee. Thank you for allowing us to speak in testimony of our of the Bill. We stand by our written testimony, but I also wanted to highlight one section of it which is really that. The.

  • Sherrilyn Shionoki

    Person

    Bill is really a smart investment and opportunity in order for us to really partner with the community to advocate for themselves. So in peer to peer supports, there's no other way to build strong relationships, no better or faster way to build strong relationships than peer to peer. Because there's nobody who understands you like a peer.

  • Sherrilyn Shionoki

    Person

    And when these organizations bring peers together and share those meaningful lived experiences, they can help each other and they bond together. And then after they get out of their formal programs, they are able to still connect outside of the community.

  • Sherrilyn Shionoki

    Person

    So your support to do peer to peer supports to set those opportunities up for our community Members allows them to take the next step and support each other in the future in their own communities and keep building that way. Thank you for allowing us to testify today.

  • Jenna Takenouchi

    Legislator

    Thank you. We have testimony from Aloha Care in support on Zoom not present. We have testimony from Lena Ala Henriques in support.

  • Leina Henriques

    Person

    Aloha. My name is Lena Ala Henriques of Kona, Hawaii. Mahalo to the Chair, Vice Chair and honored Members of the Committee on Finance for hearing HB237. I'm in strong support of this Bill because it would help families, many of whom may fall through the cracks of other types of programming.

  • Leina Henriques

    Person

    I was born and raised in Hawaii and I'm a proud parent of two children who I'm raising in Koda. I have suffered from postpartum depression and what saved my life was a small group of parents.

  • Leina Henriques

    Person

    This experience, along with raising my children in an underserved rural community, I know firsthand how hard it is for parents to find help, support and basic services. I've worked with families in Kona in the nonprofit human services field since the early 2000s in different capacities. Because of my personal hardships. This work is close to my heart.

  • Leina Henriques

    Person

    In my other roles, I would connect families to the limited resources available to them as best I could, but I would frequently worry about them when their time with my program would come to an end. Alternatively, in my current work, I help parents to connect with each other.

  • Leina Henriques

    Person

    I see and hear about the joy, comfort and peace of mind parents get by forming meaningful connections, finding a support system and creating that village which we all know is vital to parents mental health and subsequently children's well being.

  • Leina Henriques

    Person

    Every time I get to witness that connection, it's special and I strongly believe our island communities would be healthier and safer if more parents had access to peer support. Mahalo for your time and consideration. Take care.

  • Jenna Takenouchi

    Legislator

    Thank you. We have Leilani Novak in support.

  • Leilani Novak

    Person

    Aloha, Honorable Chair, Vice Chair, Members of the Committee, thank you for the opportunity to speak today in strong support of this Bill. Throughout my work and time in the community, I've truly been able to see the benefits that peer to peer support has for our parents and for our families.

  • Leilani Novak

    Person

    Really as a critical lifeline to those who are experiencing and navigating complex challenges and through this, able to receive emotional support, shared knowledge, as well as practical guidance that only those with lived experience can really offer to others.

  • Leilani Novak

    Person

    Research consistently shows that families who engage in peer support experience lower stress levels improved coping mechanisms and better long term outcomes, not only for the parents, but for the Keiki as well. And furthermore, these programs often prevent crises, reducing the need for more costly interventions and alleviating the burden on other public services.

  • Leilani Novak

    Person

    The financial investment in peer to peer support programs yields substantial returns both short term and long term. And by facilitating early intervention and providing accessible support, these programs reduce the reliance on crisis services, improve educational outcomes for children, and strengthen family stability. And this proactive approach leads to cost savings across Healthcare, social services and the judicial system.

  • Leilani Novak

    Person

    I urge the Committee to prioritize sustained funding for peer to peer support programs. This continued investment ensures that families facing hardships have access to resources and communities to help them thrive. And by supporting these programs, we're not only aiding individual families, but we're also fostering healthier and more resilient communities for future generations.

  • Leilani Novak

    Person

    And as someone who looks forward to having these programs when I start a family of my own, I just urge the Committee to support this Bill. Thank you so much.

  • Jenna Takenouchi

    Legislator

    Thank you. We have testimony from Shayna Au in support on zoom.

  • Shaina Au

    Person

    Hi, Good afternoon. Chair Yamashita, Vice Chair Takenuchi and Committee Members. My name is Shaina Au and I am a Bachelor's of Social Work student at the UH Manoa Thompson School of Social Work and I am testifying in favor of House Bill 237.

  • Shaina Au

    Person

    I support this Bill because peer support groups have shown to be helpful for parents and children, learning, sharing resources and building self confidence. It is also an instant and cost effective safety net. This Bill addresses the issue of child abuse and neglect in Hawaii.

  • Shaina Au

    Person

    The Bill mentions that there are about 600 cases of child abuse and neglect in Hawaii each year. If peer support groups are an instant safety net as mentioned, this will tremendously help the children and parents that are at risk of being separated from each other. It will also limit the trauma from families being separated.

  • Shaina Au

    Person

    As someone that eventually wants to work in child and family social work, I think it is important for children to stay with their families and to educate parents instead of separating families. These support programs will help families with similar issues, support one another and lessen the strain on intervention methods.

  • Shaina Au

    Person

    The Parents Anonymous organization has helped combat child abuse and neglect through the use of peer support. The National Clearinghouse of Foster Care Prevention Programs ranked Parents Anonymous as promising, which is the second highest rank on a 4.0 scale.

  • Shaina Au

    Person

    Evaluating its evidence base, the California Statewide Clearinghouse also rated the support groups as promising in effectively preventing child abuse and neglect. Also, more than four and a half million parents, caregivers and children nationwide have Participated since going virtual after the pandemic.

  • Shaina Au

    Person

    In closing, I support this Bill and hope that peer to peer support programs will continue to help families and children in the future. Thank you for your time.

  • Jenna Takenouchi

    Legislator

    Thank you. Next we have Kiana Kove on Zoom in support. Not present. That's everyone. I have checked in. We also received testimony support from the Department of Human Services, comments from the Executive office on early learning for other organizations. All in support. And 16 individuals all in support. Is there anybody else in the room wishing to testify?

  • Jenna Takenouchi

    Legislator

    zero, please come forward and yeah, first. And then second, please just come up, state your name for the record and then you can proceed.

  • Heidi Alencaster

    Person

    For letting me testify. So my name is Heidi Alencaster. Okay. Okay. Thank you. Thank you for the opportunity to testify. So I wanted to strongly support this Bill. Raising children can often feel overwhelming and isolating.

  • Heidi Alencaster

    Person

    Peer to peer support programs offer parents the opportunity to connect with others, providing a sense of support and reassurance that they are not alone. Building these social connections is especially crucial for parents facing additional challenges such as economic instability, family violence or parenting alone.

  • Heidi Alencaster

    Person

    Without these programs, many parents would carry the emotional weight of raising their children without knowing if others were facing the same struggles or triumphs. By supporting peer to peer programs, you prioritize the mental health and well being of parents which has a direct positive impact on their children.

  • Heidi Alencaster

    Person

    From personal experience, I can say that when I feel emotionally supported, I can show up better as a parent in my household. So please support other families by supporting this Bill. Thank you. Thank you.

  • Jenna Takenouchi

    Legislator

    Next testifier you come up and just state your name for the record so we can track.

  • Christina Simmons

    Person

    Hello, chair, Vice Chair and Committee Members. I'm Christina Simmons. I work for Early Childhood Action Strategy and I can't say it any better than these folks that have done this already. It is peer counseling or peer to peer support is really a money saving device as well as a quality device in programs.

  • Christina Simmons

    Person

    So one of the things I wanted to point out after all of their great testimony is that it can really save money and improve quality. It also meets the goals of the Infant and Early Childhood Behavioral Health plan for the state and the Malama Ohana working group recommendations.

  • Christina Simmons

    Person

    Also the Trauma Informed Task force also is in support of this. So I want to thank you for the opportunity to testify.

  • Jenna Takenouchi

    Legislator

    Thank you. Sorry, we do have your testimony, I just didn't have you checked in, but thank you for sure. Anybody else in the room wishing to testify and anybody on Zoom.

  • Kyle Yamashita

    Legislator

    Okay, thank you. Members questions? Okay, thank you. We'll move on to the next Bill. House Bill 72 HD2.

  • Jenna Takenouchi

    Legislator

    First up, we have Walgreens.

  • Unidentified Speaker

    Person

    Testimony in support.

  • Jenna Takenouchi

    Legislator

    Thank you. We have Molokai Drugs incorporated on Zoom.

  • Unidentified Speaker

    Person

    Aloha. As a rural health care provider, access to comprehensive, high quality health care services is our mission at Molokai Drugs. On behalf of our employees and patients, I am testifying in favor of House Bill 72, draft 2, which will create necessary regulations for pharmacy technicians in our state.

  • Unidentified Speaker

    Person

    At Molokai Drugs, our pharmacy technicians are essential in workflow management. From data entry to managing inventory, to contacting on island and off island doctors, to product dispensing, to giving the prescription to the verifying pharmacist and then delivering the patient's drug to the point of sale cash- cashier.

  • Unidentified Speaker

    Person

    Hawaii is the only state in the United States without an active managed list of practicing pharmacy technicians. Beyond enhancing our Molokai patient safety, this measure will lay the foundation for pharmacy technicians in Hawaii to expand their scope of practice in the future.

  • Unidentified Speaker

    Person

    Across the country, pharmacy technicians are taking on advanced roles such as administering immunizations and assisting with medication management. As of today, our pharmacy technicians administer over 50% of our immunizations, including Covid, flu, pneumonia, RSB and shingles.

  • Unidentified Speaker

    Person

    Without regulation, Hawaii risks falling behind in providing the best possible care to our communities, especially rural communities like Molokai with very limited medical resources. With only one airline which was shut down for six months last month, and no ferry, our sick and or elderly residents have even more challenges traveling off island for medical procedures and services.

  • Unidentified Speaker

    Person

    This measure comes at a reasonable price tag and even small pharmacies such as Molokai Drugs are willing to pay for these regulations. On behalf of our 7,000 full time residents, we ask that you support this bill and help Hawaii become the 50th state out of 50 to finally align our pharmacy technicians with national standards.

  • Unidentified Speaker

    Person

    Our Molokai based pharmacy technicians live full time on our island and know our people. They work hand in hand with our licensed pharmacists. Our pharmacy technicians are essential healthcare employees and they help keep Molokai healthy and thriving. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you.

  • Jenna Takenouchi

    Legislator

    We have testimony from Corey Sanders in support. Thank you. Testimony from Dylan Soliday in support. And I have Heidi Alencaster in support. I think they put her on the wrong bill. Okay. We also received testimony in support from the University of Hawaii system, comments from the Board of Pharmacy and about 12 individuals all in support.

  • Jenna Takenouchi

    Legislator

    Is there anybody else in the room wishing to testify? Anybody on Zoom?

  • James Skizewski

    Person

    Hi, Chair, this is James Skizewski of the Board of Pharmacy and of DCCA. Just letting you know that I am here for any questions and stand on our written testimony. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you.

  • Kyle Yamashita

    Legislator

    Any questions, members? Thank you very much. We'll move on to the next Bill. House Bill 714 HD1.

  • Jenna Takenouchi

    Legislator

    First, we have DBEDT on Zoom. In person. In person. Good to see you.

  • Dennis Ling

    Person

    Aloha chair, vice chair, committee members. Dennis Ling for on behalf of DBEDT. DBEDT stands in its written testimony in support of this bill. Thank you very much.

  • Jenna Takenouchi

    Legislator

    Thank you. We have the State Council on Developmental Disabilities, in support. We have the University of Hawaii system in support. Do we have the Healthcare Association of Hawaii on Zoom in support?

  • Unidentified Speaker

    Person

    Thank you. Chair, vice chair, members of the committee for the opportunity to testify in strong support of this measure. This measure will provide state funding for two years to continue and expand proven healthcare workforce development programs for high school students and current nurses.

  • Unidentified Speaker

    Person

    The number of openings in healthcare in Hawaii has been very well documented and we have a growing need for entry level positions like CNAs, Certified Nurse Assistants. The programs supported by this measure are having material impacts on addressing our workforce pipeline.

  • Unidentified Speaker

    Person

    Last year, 2024, we were able to serve more than 100 public high school students across 14 schools achieving a 98% completion rate and a 74% employment rate. We're also able to support 34 CNAs in the Glide Path program. And this year we have 50 over 50 individuals registered in that program.

  • Unidentified Speaker

    Person

    We plan with this funding to continue these successful programs. We have requested an amendment to remove a reference to capital expenditures because this request is for programmatic expenses only. Thank you again for your time and I'm available for any questions.

  • Jenna Takenouchi

    Legislator

    Thank you. We have HMSA in support. Thank you. Okay, that's everybody. I have checked in. We also have testimony and support from the Department of Education, OHA, State Health Planning and Development Agency, HHSC, about 11 organizations and one individual all in support. Would anybody in the room like to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Okay, questions, members? No questions. Okay, thank you. We're going to move on to House Bill 213 HD1.

  • Jenna Takenouchi

    Legislator

    First up, we have the Department of Health and Support. Thank you. Next, we have the Hawaii Association of Health Plans in support. Thank you. Do we have Aloha Care on Zoom and support.

  • James Skizewski

    Person

    This is Mike Wynn with the Aloha. Care, happy to stand on her written testimony. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. That's everybody. I have checked in all testimony and support. We also have the Office of the Governor, University of Hawaii Systems, HHCS, a number of organizations and multiple individuals all in support. Anybody in the room who would like to testify or expand on their testimony.

  • Unidentified Speaker

    Person

    Chair, this is JC Mikinglight from the Queen's Health System. Just wanted to stand on our testimony. And very strong support as well. Mahalo. Thank you.

  • Kelly Withey

    Person

    Go ahead. Just state your name for the record, please. University of Hawaii, Dr. Kelly Withey. And I'll stand on our seat. Strong support, but I can answer any. Questions you have about the program.

  • Jenna Takenouchi

    Legislator

    Queensland support.

  • Jenna Takenouchi

    Legislator

    Okay, sorry. Also, I guess if Hawaii State Center for Nursing would like to add to anything. Thank you. Anybody else in the room or on Zoom?

  • Jack Lewin

    Person

    I think Chair, Vice Chair, Members, I think we submitted written testimony, maybe didn't come through.

  • Jenna Takenouchi

    Legislator

    We strongly. Yes, we have your testimony in support. I just don't have anybody else checked in. So if you'd like to expand on your testimony, Dr. Lewin, you can feel free to come to the mic.

  • Jack Lewin

    Person

    I just want to stand on our testimony. Thank you very much.

  • Jenna Takenouchi

    Legislator

    Anybody else?

  • Kyle Yamashita

    Legislator

    Okay, thank you very much. Questions, Members, Questions. Okay, thank you. We're going to move on to the next bill. House Bill 303, HD 2.

  • Jenna Takenouchi

    Legislator

    Offers up Department of Health in support. We have the Department of Taxation with comments. Thank you. Hawaii State Center for Nursing in support. Thank you. Hawaii Academy of Pas in support.

  • Leo Conlon

    Person

    This is for House Bill 303, Leo Kadiak Conlon, standing on our testimony for support, but would like to expand on it with one of our student representatives.

  • Ikaiku Clayton

    Person

    Aloha. My name is Ikaiku Clayton. I'm a student representative of the Hawaii Academy of Pas and I'm here today to stand on our written testimony and support.

  • Ikaiku Clayton

    Person

    And I want to emphasis as a PA student the importance of this legislation to provide equitable opportunities for clinical education for PA students in Hawaii and to help support the availability of clinical sites for the PA students. This can allow us to stay at home in Hawaii during our clinical year.

  • Ikaiku Clayton

    Person

    This can also increase the chances that we will find health care jobs and be able to stay in Hawaii after graduation to serve our communities. Mahalo.

  • Jenna Takenouchi

    Legislator

    Thank you. We have the Tax foundation of Hawaii with comments on zoom.

  • Tom Yamachika

    Person

    Thank you. Chair, Vice Chair, Members of the Committee, Tom Yamachika from Tax foundation of Hawaii. We will stand our written testimony and be available for questions.

  • Jenna Takenouchi

    Legislator

    Thank you and apologies. The University of Hawaii System in support. Thank you. Hawaii Pharmacists Association in support. Okay. Members also numerous other agencies with support and in comments. Lots of individuals in support and one with comments. Anybody who's here in the audience wishing to expand on their testimony or anyone else wishing to testify. Anybody on zoom.

  • Kyle Yamashita

    Legislator

    Okay, members, questions? Okay, thank you very much. We'll move on to the next bill. House Bill 474, HD1.

  • Jenna Takenouchi

    Legislator

    First up, Department of Health with comments.

  • Dennis Ling

    Person

    DoH stands by its written testimony.

  • Jenna Takenouchi

    Legislator

    Thank you. Next we have the Executive Office on Aging on Zoom.

  • Cristina Valenzuela

    Person

    Aloha, chair, vice chair, members of the committee, this is Christina Valenzuela with the Executive Office on Aging. I'm testifying on behalf of Caroline Cadirao, our Director. We stand on our written testimony in support.

  • Jenna Takenouchi

    Legislator

    Thank you. Next we have AARP Hawaii on zoom.

  • Audrey Suga-Nakagawa

    Person

    Good afternoon, chair, members of the committee. I'm Audrey Suga-Nakagawa, Advocacy Director for AARP Hawaii. And we stand our testimony in support. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. Also received testimony in support from American Medical Response and one individual. Is there anybody else in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Okay. Thank you. Questions, Members? Okay, we're going to move on to the next Bill. House Bill 700 HD 1 first step.

  • Jenna Takenouchi

    Legislator

    Department of Health and Support. Thank you. Next we have the State Council on Developmental Disabilities and Support.

  • Chase Silvert

    Person

    Aloha chairs, committee members. My name is Che Silvert and I'm here for Dane Trevartos, our Executive Director for the Hawaii State Council on Developmental Disabilities. We'll stand in our written testimony and support. We just wanted to highlight the one amendment that we had asked for, which is just to remove the age.

  • Chase Silvert

    Person

    It doesn't necessarily just need to be kupuna. It would also really help our population as well. Thank you so much.

  • Jenna Takenouchi

    Legislator

    Thank you. We have the Executive Office on Aging with comments on Zoom.

  • Cristina Valenzuela

    Person

    Aloha chair, vice chair, members of the committee, Cristina Valenzuela. Again here on behalf of Caroline Cadirao. We stand on our written testimony providing comments with amendments for consideration. We recognize the importance of cognitive assessments, especially for the early detection of dementia, but just ongoing.

  • Cristina Valenzuela

    Person

    The discussion regarding the pilot project is ongoing and we have more details that needs to be hashed out. I'm available for questions. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. We have the State Health Planning and Development Agency in support.

  • Unidentified Speaker

    Person

    Chair, vice chair, we stand on our written testimony as well.

  • Jenna Takenouchi

    Legislator

    Thank you. AARP Hawaii on Zoom in support.

  • Audrey Suga-Nakagawa

    Person

    Audrey Suga-Nakagawa from AARP. And we stand our testimony and support and we will defer to the Executive Office on Aging for any recommended amendments. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. We have the Hawaii Parkinson Association in support. Thank you. We have Theresa Sablan in support on Zoom.

  • Theresa Sablan

    Person

    Good afternoon. Chair Yamashita, Vice Chair Takenouchi and members of the Finance Committee. My name is Theresa Sablan and I am a Master of Social Work student specializing in health at the University of Hawaii at Manoa. I am testifying in support of House Bill 700, House Draft 1 relating to cognitive assessments.

  • Theresa Sablan

    Person

    This legislation aims to improve the detection and treatment of Alzheimer's disease and related dementias for MediCare Part B beneficiaries age 65 and older by offering cognitive assessment during annual visits. As the older adult population in Hawaii continues to rise, the prevalence of Alzheimer's disease is also increasing.

  • Theresa Sablan

    Person

    With more seniors living longer, the challenges of managing Alzheimer's are becoming increasingly evident. According to the Alzheimer's Association, more than 31,200 individuals age 65 and older in Hawaii are living with Alzheimer's dementia each year. Alzheimer's disease and related dementia costs Hawaii's Medicaid program approximately $285 million.

  • Theresa Sablan

    Person

    This legislation will address this public health concern by mandating the Executive Office on Aging to partner with the healthcare system to identify early signs of cognitive decline in older adults.

  • Theresa Sablan

    Person

    This initiative will enable timely interventions, proper planning for future care needs, and potential treatments to improve the quality of Life for older adults in Hawaii, ultimately reducing the financial burden on families and the state. Therefore, I urge the Committee to vote in favor of House Bill 700, House Draft 1.

  • Theresa Sablan

    Person

    Thank you for hearing my testimony on this matter.

  • Jenna Takenouchi

    Legislator

    Thank you. We have Peter Weston Black in support on Zoom.

  • Peter Black

    Person

    Yes.

  • Jenna Takenouchi

    Legislator

    Please, go ahead.

  • Peter Black

    Person

    Well, yes, I'm here.

  • Jenna Takenouchi

    Legislator

    Yeah. Please proceed.

  • Peter Black

    Person

    Well, I- I- I'm honored to be asked to testify. I've submitted a written document. I'm 82 years old, and I'm an Alzheimer's patient. Fortunately for me, I had an early diagnosis. And to get that diagnosis was a shocking event in my life for sure.

  • Peter Black

    Person

    But what it did for me when I was 73 years old, it allowed my wife and I to plan for the future and to make sure that I was doing everything I could to slow the development of this disease. And I've been lucky enough to be able to get an infusion now, which for something called leqembi.

  • Peter Black

    Person

    And leqembi has been shown to spell a cure but slow the development of the disease. So I'm getting more months when I'm not completely out of it. So I strongly encourage you, this- you- committee, to approve the funding for this bill. Thank you very much.

  • Jenna Takenouchi

    Legislator

    Thank you, Mr. Black, and thank you for sharing your story. We also received testimony with comments from the State Council on Mental Health, testimony and support from four other organizations and 16 individuals. Would anybody else in the room like to testify? Alzheimer's Association. Yes, please come up. Sorry, we have your testimony.

  • Jenna Takenouchi

    Legislator

    I just didn't have you checked in. Please proceed.

  • Kobe Jock

    Person

    Thank you, Chair Yamashita, Vice Chair Takenouchi, and members of the committee. I'm Kobe Jock. Testifying on behalf of the Alzheimer's Association and strong support of HB 700 HD1 with amendments. In the first hearing, we supported a pilot program for the data component of the bill.

  • Kobe Jock

    Person

    However, our support for the pilot program was intended solely for the data aspect of the bill and not the entire bill. The core of the legislation at the start was to create the requirement that a brief cognitive assessment tool that's validated.

  • Kobe Jock

    Person

    We're not specifying which tool is used at these annual wellness visits, and we're continuing to support this requirement being codified in statute as outlined in our written testimony. It's important to note that we're not expanding the scope of the annual wellness visit, as the Medicare guidelines already say, that a cognitive assessment is part of it.

  • Kobe Jock

    Person

    We're just saying that it needs to be a validated tool that provides a clinical diagnosis. Oftentimes, dementia is not visible until it's too late. You heard from Mr.

  • Kobe Jock

    Person

    Black who was able to catch it early enough where he could access treatment that's only available if you catch it at a point where a brief cognitive assessment may see it, whereas observation just looking at a patient may not. In collaboration with various stakeholders, we proposed amendments ensuring flexibility and provider discretion in selecting the cognitive assessment tool.

  • Kobe Jock

    Person

    And to highlight some of these tools, I have two of them right here. They're very brief, just one page each. They even have instructions so anyone who is not currently using them can easily learn how to use it.

  • Kobe Jock

    Person

    And aside from these tests being brief, they can be administered by APRNs, RNs, PAs, social workers among other trained professional. So it doesn't need to be the physician. We've worked closely with the Executive Office on Aging on the data pilot and defer to them on the data.

  • Kobe Jock

    Person

    Also support the removal of the reference of 65 years of age and the inclusion of Medicare Part C. We respectfully ask for your support in the of our amendments to require the use of validated cognitive assessment tools in statute and we're available for questions. Thank you.

  • Jenna Takenouchi

    Legislator

    Anybody else in the room wishing to testify? Anybody on zoom?

  • Kyle Yamashita

    Legislator

    Okay, questions members. Okay, thank you. I'm going to move on to the next bill. House Bill 952 HD1.

  • Jenna Takenouchi

    Legislator

    First up, Department of Health with comments.

  • Lorrin Kim

    Person

    Aloha Chair, Vice Chair, members of the committee. Lorrin Kim, Department of Health Planning and Policy Officer. The department genuinely appreciates the intent of this. On a personal note, my own mother passed away from complications due to Parkinson's and it's a very long journey to endure.

  • Lorrin Kim

    Person

    So we believe state support would be appropriate, given its prevalence in our state. That said, there are no additional resources for the department to implement this and I have recommended a minimum appropriation of $750,000. And now that I come to think of it, two FTE that I hope will go into the committee report.

  • Lorrin Kim

    Person

    There is no existing program within DoH that can do this, so this will be a new and heavy lift. But we hope the conversation continues. So thank you for the opportunity to testify and I'm available for questions.

  • Jenna Takenouchi

    Legislator

    Thank you. Next, we have the Hawaii Parkinson Association.

  • Glen Higa

    Person

    Aloha Chair, Vice Chair, Members of the Finance Committee. My name is Glen Higa. I'm the President of the Hawaii Parkinson Association. I was diagnosed with young onset Parkinson's Disease seven years ago and I stand on my written testimony as well.

  • Glen Higa

    Person

    But I would like to expand on my written testimony and also thank the Department of Health for their comments as well. Parkinson's is a progressive neurological movement disorder characterized by motor and non motor symptoms. There is no cure for Parkinson's and researchers have not confirmed what causes Parkinson's as well.

  • Glen Higa

    Person

    Parkinson's disease is now considered the fastest growing neurological condition in the world. To give you some context on the growth. In 2019, the Michael J. Fox Foundation estimated there were 4,000 people in Hawaii diagnosed with Parkinson's. They estimated the cost of direct and indirect medical care at $250 million.

  • Glen Higa

    Person

    In 2022, the Queen's Medical Center Parkinson's and Movement Disorder Clinic estimated 8,000 people were diagnosed with Parkinson's. And they project that number of people diagnosed will double to 16,000 in 2030.

  • Glen Higa

    Person

    So just five years from now. No initiative we have done will have the impact of this bill on the community of over 50,000 people impacted by Parkinson's disease and we strongly urge your favorable consideration of this important measure. Thank. Mahalo for the opportunity to testify on behalf of the Hawai'i Parkinson's Association and I'll be here for any questions.

  • Jenna Takenouchi

    Legislator

    Thank you. Do we have still have the Queen's Health System in support on Zoom?

  • Michiko Bruno

    Person

    Yes. Hello. Do you hear me?

  • Jenna Takenouchi

    Legislator

    Yes.

  • Michiko Bruno

    Person

    Hello. Hi. Aloha Chair, Vice Chair and members of the committee. My name is Michiko Bruno. I'm a neurologist, movement fellowship trained movement disorder specialist at Queen's Medical Center and the medical director of the Parkinson's and Movement Disorder Clinic at Queen's Medical Center, as well as professor of medicine at UH Jabsom Medical School.

  • Michiko Bruno

    Person

    Queen's committed to improving health and wellness of everybody who lives in Hawaii. You just heard about the devastating effect of Parkinson and the chronic progressive nature that affects people's patients as well as family and communities, quality of life as well as economic toll.

  • Michiko Bruno

    Person

    So we are really committed in supporting this bill to improve Parkinson's care as well as understanding the disease. Our preliminary research uncovered that there is definitely a racial as well as a rural urban disparity that Hawaii population face when faced with this disorder.

  • Michiko Bruno

    Person

    In addition, this type of research will help trial recruitment understand the environmental effect on Parkinson's. Some of the other states registry has helped uncover the complex etiology of Parkinson's. So we really support this and I'm happy to take questions. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you.

  • Jenna Takenouchi

    Legislator

    We also received testimony and support from Hawaii Family Caregiver Coalition and about 15 individuals. Is there anyone else in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Questions, members? Thank you. We're going to move on to the next bill. House Bill 139 HD2.

  • Jenna Takenouchi

    Legislator

    First up we have DCCA insurance division. Next we have the Attorney General with comments.

  • Andrew Kim

    Person

    Good afternoon, chair, vice chair. Andrew Kim- and members of the committee. Andrew Kim, Deputy Attorney General. We provided our written comments with several issues we found in the bill and provided also suggestions. I'll be available for comments.

  • Jenna Takenouchi

    Legislator

    Thank you. We have Hawaii Association of Health Plans in support. American Cancer Society Cancer Action Network in support.

  • Cynthia Au

    Person

    Thank you. Cynthia Au On behalf of the American Cancer Society Cancer Action Network or ACSCAN. We stand in support of this important bill. When patients of childbearing age is given the news that they have cancer, they they will shortly have a conversation also with their physician about family planning.

  • Cynthia Au

    Person

    And sometimes they don't know that that's going to happen. Fertility treatment becomes an important medical question for many young cancer patients and cost may be significant barriers without coverage. Thank you for hearing this important bill.

  • Jenna Takenouchi

    Legislator

    Thank you. We also have HMSA in support. Thank you. We also have comments from the office of the auditor and support from seven other organizations and five more individuals. Is anybody else in the room would like to come up and testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Thank you. Questions, members? The Attorney General. So you want to explain what the problem may be? You want to explain what the problem is?

  • Andrew Kim

    Person

    So I guess the first one is the bill is incorporating the American Society of Clinical Oncology, any future amendments they might make. So it's kind of leaving unfettered discretion for them to determine what sort of coverage insurers are going to be mandated to provide.

  • Andrew Kim

    Person

    So, you know, in the Constitution it says legislative power is vested in the legislature, so it may be considered unlawful delegation of the legislative power to leave it up to the- this private organization to determine what sort of coverage insurers are going to have to provide going forward.

  • Andrew Kim

    Person

    So we looked at the- the auditor's report, and then they looked at what was the most recent update of the guidelines, and then they identified what that update is. So we just added in our suggestions what that update is. So, you know, we're not leaving it to this private organization to determine what future coverage looks like.

  • Andrew Kim

    Person

    And then we've also provided comments regarding HRS 2351. There's some minor differences between what the auditor looked at in this bill. So we provided language to make it clear that, you know, this- this is not subject to 2351. And also defrail.

  • Andrew Kim

    Person

    We note that they might be subject to defrail and also for health maintenance organizations to make it clear that health maintenance organization plans are going to start at December 31, 2025.

  • Kyle Yamashita

    Legislator

    Okay, thank you. Appreciate it. Any further questions, members? Okay, we're going to move on to the next bill, House Bill 139 HD 2. Oh, I'm sorry. We just did that one. House Bill 1300 HD 1.

  • Jenna Takenouchi

    Legislator

    First up we have University of Hawaii system, Dr. Ueno.

  • Naoto Ueno

    Person

    Aloha, dear Chair and Vice Chair and Committee Members. I'm Naoto Ueno, the Director of University Hawaii Cancer Center. So there are annually currently about 600,000 people dying from cancer every year in the nation. And cancer research is extremely important.

  • Naoto Ueno

    Person

    The reason for this, if you compare from 1970s, currently cancer research has resulted into reduction of about 300,000 people not dying from cancer. So we have the same issue here. And University of Hawaii Cancer Center has been contributing to various clinical research as well as basic research which has impacting reducing the more cancer deaths in this area.

  • Naoto Ueno

    Person

    So this bill is extremely important for us to thrive and further to grow. And I'm just going to give you one as an example because sometimes people have a difficult time getting a sense. One is of course providing clinical care.

  • Naoto Ueno

    Person

    But, about 20 years ago, one of our researcher has developed a drug and this was a discovery to help pediatric cancer called neuroblastoma. And nobody you know probably did not recognize, but last year it was approved by FDA for the children and it helps the children. It takes many many years.

  • Naoto Ueno

    Person

    So the investment that you made, sometimes you fuel it very fast but sometimes you may not, it may take a while. But this is very important because we do not want anybody to die from cancer. So this bill definitely will help us to provide the appropriate infrastructure and the investment to the future growth.

  • Naoto Ueno

    Person

    So as a University of Hawaii Cancer said, we stand on our testimony. Thank you very much for the opportunity to provide the testimony.

  • Jenna Takenouchi

    Legislator

    Thank you. Sorry, I also have a note. Is anyone else from UH Cancer Center submitting testimony separately? Yeah, Lani Park? Yeah, please.

  • Lani Park

    Person

    So hi, my name is Lani Park. I am a researcher at the University of Hawaii Cancer Center. I stand by the testament in support that was submitted by the University of Hawaii and I would be one of the researchers who would be leading this along with doctors Brenda Hernandez and Alika Maunakea.

  • Lani Park

    Person

    So I stand by for any questions. I do have to also note that this is very important because we are one of the only places that can conduct a multi ethnic cohort study.

  • Lani Park

    Person

    And the results from a prior study that was done and it's still in progress over a follow up of 30 years has really helped define some of the criteria for screening across different populations. And that cannot be done without the population in Hawaii.

  • Jenna Takenouchi

    Legislator

    Thank you. We have American Cancer Society Cancer Action Network in support.

  • Cynthia Au

    Person

    Thank you Chair, Vice Chair, and Committee Members. Cynthia Au, on behalf of the American Cancer Society Cancer Action Network, or ACS Can. Cancer is a leading cause of death among Asian Americans and second leading cause of death among Native Hawaiians and other Pacific Islander individuals. It is becoming more evident that health outcomes are impacted by social determinants.

  • Cynthia Au

    Person

    Not only your household income or how far you live from the closest clinic, whether or not you can take off from work to go to preventative screening. But there are many layers, more than where you live or your zip code. It's whether or not you're in a multi generational household. Cultural stigmas.

  • Cynthia Au

    Person

    Do you even want to talk about illness in your family? These are some of the things that impact whether or not you will go to your preventative screening or even if you live near a landfill, for example. These are a few factors that contribute to the disparities that we see in the health outcomes and especially cancer outcomes.

  • Cynthia Au

    Person

    Collecting data on social determinants and environmental factors of these populations of Native Hawaiians, Pacific Islanders, and Asians, including Filipinos, will help to provide much needed information on why these groups have higher cancer rates in Hawaii and help to find gaps in cancer prevention and care delivery of these disparities. Thank you for considering this very important bill.

  • Jenna Takenouchi

    Legislator

    Thank you. We have Waianae Coast Comprehensive Health Center in support on Zoom.

  • Ian Ross

    Person

    Aloha. Thank you very much. Ian Ross with the Waianae Coast Comprehensive Health Center. We stand on our written testimony in support of this measure. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. Also received testimony and support from Oha, Hawaii Primary Care Association, Queens Health Systems. Oh, sorry. Queens Health System on Zoom.

  • Jacce Mikulanec

    Person

    Thanks. Vice Chair, Chair, Members of the Committee. Jacce Mikulanec on behalf of Queens Health System, just wanted to stand our written testimony, but underscore our strong support of this particular bill.

  • Jacce Mikulanec

    Person

    As has been noted by other testifiers, this certainly falls within the scope of our mission to improve the health and outcome the health of Native Hawaiians and all people of Hawaii. And we're also a member of the Cancer Consortium. So strong support. Appreciate you hearing our testimony. Mahalo.

  • Jenna Takenouchi

    Legislator

    Thank you. Also seven individuals, all in support. Anybody else in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Take questions, members. Okay, Representative Lamosao.

  • Rachele Lamosao

    Legislator

    Thank you, Chair. This question is for Dr. Ueno. I wrote the research. Is it okay if I ask also the researcher? Sorry. Happy to answer. I am just concerned that, you know, you folks are asking for 500,000 in FY25 or to 26 and then another and 500,000 for the next fiscal year.

  • Rachele Lamosao

    Legislator

    But then this bill also requires you folks to seek federal funding to complete the study. But with news and threats of federal cutbacks in this type of research. Like what are you folks going to come back to the legislature if this bill passes?

  • Rachele Lamosao

    Legislator

    I know it's a work in progress, but I'm just concerned that then we would have to fund this.

  • Lani Park

    Person

    So we've been looking at other whether it's private foundation, private funding and I will say that I can't tell what the future will bring but our team has been very successful in getting NIH funding in the past and so we would be continuing to try to seek funding.

  • Naoto Ueno

    Person

    Just from my perspective, yes, it is really concerning where the federal stands. But we have to divide in terms of understanding that this is about indirect cost that they're talking at this moment and the direct cost of the research part has not been mentioned at this moment at a cut.

  • Naoto Ueno

    Person

    So we have to put a position that it has not changed in terms of commitment to the cancer related research dollar that's coming in. But infrastructure is a little bit different.

  • Kyle Yamashita

    Legislator

    Okay, thank you for the questions. Thank you. We'll move on to the next bill. House Bill 341 HD1.

  • Jenna Takenouchi

    Legislator

    First up, we have Hawaii Island Community Health center on Zoom in support.

  • Richard Taff

    Person

    Aloha chair and Vice Chair and Members of the Committee. My name is Richard Taff. I'm the CEO of the Hawaii Island Community Health Center. I stand on our testimony in support of this bill and happy to answer any questions.

  • Jenna Takenouchi

    Legislator

    Thank you. We also have Aloha Care in support on Zoom mic. Oh, okay. Lost mic. We also received testimony with comments from Department of Budget and Finance and support from the Hawaii Primary Care Association. Is there anybody else in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Okay. Okay. Thank you. Members, any questions? Yeah, BNF's not in the room. Thank you. Okay, we'll move on to the next bill. House Bill 784 HD1.

  • Jenna Takenouchi

    Legislator

    First up, Department of Health with comments stands by his written testimony. Thank you. Have the Hawaii State Health Planning and Development Agency in support.

  • Jack Lewin

    Person

    We have chair Vice Chair Jack Lewin. Our advisory councils on Big island think this is a very important need and so fair to just underscore the fact that we could use this additional merchant Big Island. Thank you very much.

  • Jenna Takenouchi

    Legislator

    Thank you. Do we have Garrett Nishihara on Zoom in support present? Do we have Kilihea Inaba on Zoom in support?

  • Kawehi Inaba

    Person

    Yes. Good afternoon. Are you able to hear me?

  • Jenna Takenouchi

    Legislator

    Hi. Yes we can. Please proceed.

  • Kawehi Inaba

    Person

    Okay, thank you. Aloha chair, Vice Chair and Committee Members. My name is Kawehi Inaba. I'm actually Going to have somebody else testifying my place today. His name is David De Carvalho. He's also in zoom.

  • David Carvahlo

    Person

    Good afternoon, can you hear me? Yeah, good afternoon. My name is David Decavalho, I'm a paramedic for the Hawaii County Fire Department on the Big Island. The station that I work at is Kailua Station 7, which borders District 21, Makalea Fire Station.

  • David Carvahlo

    Person

    We're the first in medicine to that station in support of this bill due to the the need for a ambulance unit at that station. As it stands right now, Kailua Station is the first in medic to that area.

  • David Carvahlo

    Person

    And that area is anywhere from 15 to 28 miles from the nearest hospital, ranging anywhere from 20 to 50 minutes transport time, meaning from on scene to the hospital, it's going to take anywhere from 20 to 40-50 minutes of driving and that's with lights and sirens and depending on the time of day going through traffic.

  • David Carvahlo

    Person

    Kailua is first into that district due to not having an ambulance at this time. The other two ambulances that would go into that district is District 12, which is Keauhou, and District 6, which is Kealakekua.

  • David Carvahlo

    Person

    When somebody calls 911 as far as response time because they have no ambulance unit for Kailua station, it's going to be anywhere from 10 to 20 minutes to even access the patient wherever they're calling from in that district.

  • David Carvahlo

    Person

    If Kailua is busy in their own district in another district, the next in is going to be District 12, which is Keauhou. And they're going to be anywhere from 15 to 30 minutes before they access the patient. And then District 6, Kalahikua is anywhere from 20 to 40 minutes.

  • David Carvahlo

    Person

    So you know, with EMS, our most important thing is definitive care, which is access to the hospital. So being that there's no medical unit at that station, it can range anywhere from 10 to 40 minutes before there's an actual ambulance, ALS ambulance, advanced life support ambulance on scene.

  • David Carvahlo

    Person

    So that just adds to the time that the patient's unable to get to the hospital to get definitive care.

  • David Carvahlo

    Person

    And then on the big island of Hawaii, as far as critical care for cardiac, pulmonary or even gastrointestinal, they may even have to get transferred out to Oahu for a higher level of care facility like Queens or other other hospitals in Oahu.

  • David Carvahlo

    Person

    So that just elongates the time that the patient's going to have to the definitive care they need. If we had an ambulance stationed at that district, the on scene time would be cut drastically less.

  • David Carvahlo

    Person

    So we'd be able to get an ALS unit on scene quicker, which means the patients would be able to get to the hospital faster and the care would be able to be rendered quicker.

  • David Carvahlo

    Person

    So I'm in strong support of placing an ambulance unit at that station and would definitely benefit the community and everybody that would benefit from that. Both reduction on stress on the ambulance units that we do have in the District of Kona and obviously faster care for the patients. Thank you for your time.

  • Jenna Takenouchi

    Legislator

    Thank you. Thank you for your insights. We also have testimony and support from the Office of Hawaiian Affairs, hhsc, a testimony from Mayor Alameda at Hawaii County, and support from Chair Haleka Goro Inaba from Hawaii County, two organizations and four individuals. Is there anybody else in the room wishing to testify? Anybody else on zoom?

  • Richard Taff

    Person

    Yes, this is Richard Taft with the Hawaii Island Community Health center in Kona, and we would stand in support of this bill. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. Anybody else on zoom?

  • Kyle Yamashita

    Legislator

    Okay. Thank you. Questions? Members for Department of Health, please.

  • Matthias Kusch

    Legislator

    Thank you. I see in your comments that you would prefer a community paramedicine program or a mobile integrated health program. Do you have that in Kalawa, the area of Makale?

  • Unidentified Speaker

    Person

    No.

  • Matthias Kusch

    Legislator

    Do you have that in Kona?

  • Unidentified Speaker

    Person

    No.

  • Matthias Kusch

    Legislator

    Do you have that on Hawaii Island?

  • Unidentified Speaker

    Person

    No, we do not.

  • Matthias Kusch

    Legislator

    So would we include like hoping and praying as part of the policy or?

  • Unidentified Speaker

    Person

    No, it's actually modern practice in the mainline. And so we're looking to do a request for invitation for- for proposals. We have our draft now, we're about to release it. And what happens in these rural districts is yes, we agree, something is needed. They need ALS service.

  • Matthias Kusch

    Legislator

    Neither of those are.

  • Unidentified Speaker

    Person

    Right. That's- That's the paramedic like the guy that was on.

  • Matthias Kusch

    Legislator

    I know.

  • Unidentified Speaker

    Person

    Okay, so what happens is if you provide too much of just that one service, then you don't get the rest of the potential services that can be attained.

  • Unidentified Speaker

    Person

    So mobile integrated health and community paramedicine is just a proposal where the vendor would be providing 4 ALS runs a day, right, as well as in any excess time doing community paramedicine, mobile integrated health contracts.

  • Matthias Kusch

    Legislator

    So just schedule your stroke or

  • Matthias Kusch

    Legislator

    No.

  • Matthias Kusch

    Legislator

    Myocardial infarction.

  • Matthias Kusch

    Legislator

    Or how does that work?

  • Unidentified Speaker

    Person

    So what happens is- What happens is--

  • Unidentified Speaker

    Person

    This is the local agency. In this case, Big Island Fire would pick via analysis, via data analysis, the required date or time, like an eight hour window where they know or the busiest peak periods.

  • Unidentified Speaker

    Person

    And other than that, it can address vital other services like services for the elderly, appointments, right, all the things that they normally get calls on. If you look at the calls from the Big island, you you'd see that a lot of it is I cannot make it to my doctor, I need my prescription meds. Right. And that's the-

  • Unidentified Speaker

    Person

    They're doing ALS and we're dispatching ALS services for that. And so overall as a- as a recommendation, it can fulfill the needs of the community and provide additional benefits.

  • Matthias Kusch

    Legislator

    Okay, when's the rollout for that?

  • Unidentified Speaker

    Person

    If you're asking when we can get it started by? As soon as I can do a RFP. Right. And the vendors will come in and bid. And Big Island Fire can be part of the evaluation. Right. Or they could do it themselves. Big Island Fire is a little different where it's a county based system.

  • Unidentified Speaker

    Person

    So it would be up to them.

  • Matthias Kusch

    Legislator

    Sure. What do you think the cost for these programs is?

  • Unidentified Speaker

    Person

    If- When- When you bring in this hybrid type of program, we're paying for the base of the service, right, so roughly about 1.4 million. The extra 300,000 savings, right, will be made up by the vendor or the entity itself who runs the service, billing. So, they bill for their services.

  • Unidentified Speaker

    Person

    And so you end up in an environment where you're providing the ALS and providing the community extra benefits. Right now these companies have a hard time starting up in Hawaii. Right? But if we expand, I guess the type of services we're willing to issue from the state, because it's all state funded, right? We have this opportunity where we can actually.

  • Matthias Kusch

    Legislator

    So you're saying the private vendor is a preferred methodology to provide ALS support.

  • Unidentified Speaker

    Person

    It could be done. You know.

  • Matthias Kusch

    Legislator

    For our residents over our firefighters.

  • Unidentified Speaker

    Person

    No.

  • Matthias Kusch

    Legislator

    EMTs and paramedics.

  • Unidentified Speaker

    Person

    That's not what I'm saying. It would be up- It would be up to them to see how they would want to do it. Right. But--

  • Matthias Kusch

    Legislator

    I could tell you how they want to do it. I could tell you right now all the testimony except you guys.

  • Unidentified Speaker

    Person

    Well, it's primarily because we do have other locations in the state and you know, we don't want to mention locations. Right. Where the- Where the full blown 1.75 million goes to- to three runs a day. And it's happening right now. So it's just an alternative.

  • Matthias Kusch

    Legislator

    Okay.

  • Unidentified Speaker

    Person

    By all means, you know, it's up to the legislature.

  • Matthias Kusch

    Legislator

    Okay, I just want to be clear. When the Department of Health, who has a outsized role as a department, says stuff like this with really no basis in reality, as far as I can tell, whereas, you know, the paramedics are out there doing it and.

  • Unidentified Speaker

    Person

    It's an established service across the country.

  • Matthias Kusch

    Legislator

    I'm just telling you, I worked that district for a long time. When HPPs medic got held up, lots of people died because of the wait. 10 years of people dying because of waiting. And that's the same thing happening in Claw. So anyway, thank you. I just hope you would reconsider your comments. Thank you.

  • Kyle Yamashita

    Legislator

    Any further comments? Okay, Department of Health, you have something? Go ahead.

  • Nicole Lowen

    Legislator

    Thank you, chair. You know, I'm gonna stand by my colleague from the Big island who served in the fire department and retired from that department. But also my family members who and the police department are often the first responders to some of these calls. And waiting, waiting for life safety care to show up.

  • Nicole Lowen

    Legislator

    One minute feels like a lifetime. So when I'm listening to our paramedics From Kona saying 40 minutes, 40 minutes, it's unacceptable that time transforms people's lives, often to their detriment. There's a huge need in West Hawaii. Medical services an hour away. No critical care. They have to get medevaced here. And I'm going to stand by my colleague.

  • Nicole Lowen

    Legislator

    I don't know how long we have to wait, but this is a way to get them services quicker and faster. Thank you, chair.

  • Kyle Yamashita

    Legislator

    Thank you very much, Department of Health. You can come back. Okay, so what are the things that the Legislature has done and that we have looked at in the past and actually we started with the city and County of Honolulu as we moved EMS to them. Yeah. The- The goal eventually is to do that with all counties.

  • Kyle Yamashita

    Legislator

    Is there any- Anything that you can tell us how the transition when we transferred it to Ceding county?

  • Unidentified Speaker

    Person

    In terms of?

  • Kyle Yamashita

    Legislator

    In terms of was there any kind of hiccups or anything like that? Because right, they- they not only have to take on the responsibility, but they also got the revenue that came with it and things like that.

  • Kyle Yamashita

    Legislator

    And so they- they were able to make more local decisions.

  • Unidentified Speaker

    Person

    Correct. I think it's an effective solution.

  • Kyle Yamashita

    Legislator

    Yeah. Okay. So is the department looking at that going forward?

  • Unidentified Speaker

    Person

    Yes. So we have reached out to various counties. They know they all have the option. Cause we would totally support that, their independence. So- But we were rejected by most of them.

  • Kyle Yamashita

    Legislator

    Yeah. So, you know, one of my big things is that it's not only the services and home rule is one thing where you probably they can make better decision if it's theirs, but also where the services are paid from.

  • Kyle Yamashita

    Legislator

    And I've always been a proponent that it should be paid for out of property tax and it should be our low property tax rate is what's causing people from out of state buying up our properties. So sometimes it's either the state needs to- to have property tax authority or services need to be moved. One or the other.

  • Kyle Yamashita

    Legislator

    I just- Food for thought. Okay, thank you very much. Any further questions? Moving on to the next Bill. House Bill 1179 HD1.

  • Jenna Takenouchi

    Legislator

    First up. I'm sorry, Department of Health in support. Thank you. Next we have Deborah Cartwright on Zoom in support. Not present. We also have Lynn Fulton on Zoom in support.

  • Lynn Fulton

    Person

    Aloha. I stand on my testimony but do want to really stress the value of this for the island of Lanai. This would allow us to be able to better serve. We would. Under this mechanism we would be able to convert two of those rooms to long term care. And today we have a wait list for those beds.

  • Lynn Fulton

    Person

    It would also bring another $3 million into the island of Lanai and allow us to really better serve the health needs of the folks on that island. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. We've also received testimony with comments from the Department of Human Services, testimony and support from Healthcare Association of Hawaii and HHSC as well as one individual. Is there anybody else in the room wishing to testify? Anybody on zoom?

  • Kyle Yamashita

    Legislator

    Okay, questions Members. Okay, moving on to the next Bill. House Bill 716 HD1.

  • Jenna Takenouchi

    Legislator

    First up, Department of Health and support.

  • Unidentified Speaker

    Person

    Will stand on its comments supporting the intent.

  • Jenna Takenouchi

    Legislator

    Supporting the intent Next we have Hawaii State Health Planning and Development Agency, Shipta in support.

  • Unidentified Speaker

    Person

    Chair, Vice Chair Members, if I might make a couple comments on this issue. So this is an aspirational program. The Hawaii Infrastructure Grant Program would be administered through SHIP TA, but through the Department of Health to provide electronic health records services to our safety net and rural providers who lack them.

  • Unidentified Speaker

    Person

    Today I might just share with you that in Hawaii we have one electronic health record. It's the most commonly one used in America. It's called EPIC. I'm certainly not a salesperson for EPIC, but it's been chosen by over 75% of the provider community in Hawaii already.

  • Unidentified Speaker

    Person

    It allows them to exchange information, get patient really quickly, concise patient information, transferred care coordination, quality of care activities and so forth. And our safety net and rural providers, including our Ryan White Clinics for HIV here in Honolulu are left out of this process. They just can't afford to upscale to this service.

  • Unidentified Speaker

    Person

    So this would be a one time expenditure for us to bring the rest of the community that's left out into the system of being able to coordinate care, provide care, exchange data in a very effective way. It's going to save money, it's going to save lives, it's going to be an important kind of thing.

  • Unidentified Speaker

    Person

    It's a scary thing to think about having to put 20 million bucks or more out to make it happen. But once it's set up, these organizations will be able to maintain their status with the electronic health record and they will be modern and up to date and up to speed.

  • Unidentified Speaker

    Person

    So I think it'd be a fantastically visionary thing for us as a state to move in this direction if we could and to bring our safety net, rural providers and those left out up to modernization and full functionality. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. Next we have OCHIN in support on Zoom. Jennifer Stoll.

  • Sylvia Trujillo

    Person

    Hi. Thank you Members of the Finance Committee for the opportunity to offer strong support of HB716HD1. I'm here in lieu of Jennifer. I'm Sylvia Trujillo. I'm the Vice President of Policy and Regulatory affairs for OCHIN.

  • Sylvia Trujillo

    Person

    We're a nonprofit dedicated to providing technology solutions and support to healthcare providers serving communities with the least resources, both here in Hawaii and around the country. Our mission is to improve health outcomes through health IT data analytics and other critical innovations that help providers remain sustainable and competitive in what is now a rapidly evolving regulatory environment.

  • Sylvia Trujillo

    Person

    And this Bill provides really essential upfront investment one time to help rural and underinvested providers modernize their systems so they can drive better health outcomes they can advance the state's interoperability goals while meeting the increasing demands and critically important can have up to date cybersecurity and data driven systems.

  • Sylvia Trujillo

    Person

    Really essential to understand that over time this is vital infrastructure that powers increased efficiency and cost savings as well as improved outcomes which is more critical now than ever in the environment that we're entering into. So for these reasons we ask for your support. Mahalo.

  • Jenna Takenouchi

    Legislator

    Thank you. Next we have Waianae Coast Comprehensive Health center in support on zoom.

  • Ian Ross

    Person

    Thank you very much. Vice Chair Ian Ross again with the Waianae Coast Conference of Health Center. Hawaii's healthcare landscape is undergoing rapid changes. Safety net providers are the backbone of Hawaii's healthcare system, serving some of the most vulnerable populations.

  • Ian Ross

    Person

    Unfortunately, as you've been hearing here, providers often lack the capital to implement a certified posted interoperable health information technology system. Unfortunately, this actually perpetuates these disparities in quality as the access to the innovative payment models. Without those, there's a widening gap between well resourced providers and those struggling to meet basic infrastructure needs.

  • Ian Ross

    Person

    House Bill 716 HD1 helps to address this gap and we testify in support and hope the Committee pass this measure. Thank you very much.

  • Jenna Takenouchi

    Legislator

    Thank you. Also testimony and support from Health Care Association of Hawaii, Waikiki Health, Hawaii Pacific Health and Hawaii Primary Care Association. Is there anybody else in the room wishing to testify?

  • Kyle Yamashita

    Legislator

    Anybody on zoom? Questions member?

  • Matthias Kusch

    Legislator

    For Hawaii Health Planning. Thanks. I see there was a price tag guesstimate of around 20 or 25 $1.0 million. And that would be for would cover kind of everybody who's been left out of the big.

  • Matthias Kusch

    Legislator

    I know Gila Medical center just upgraded to that EPIC program and the director was kind of outlining the benefits of it, which is pretty amazing. So would that cover like everybody who's kind of left out of the state, all the big players after that or the smaller players in this case?

  • Unidentified Speaker

    Person

    Yes. Thank you for that question. Actually, Hawaii has the highest penetration of a particular electronic health record called EPIC, as I mentioned earlier of any state. The average penetration of EPIC in the rest of the country is around 39% of electronic health records.

  • Unidentified Speaker

    Person

    It's by far the biggest vendor and the most popular of the types that are purchased. But Hawaii is already a place where in fact this kind of care coordination could be much more efficiently occur if we could get EPIC compatible or EPIC systems here. And there are some lower cost ones that can be available.

  • Unidentified Speaker

    Person

    So yes, this would reach to critical access hospitals so that Hilo could talk to KAU and Kahala and all the rural health folks out there. And it could happen across the state. It'd be a one time expenditure, but it would be well worth it if we were to do this.

  • Unidentified Speaker

    Person

    So our FQHCs, our Rural Health providers, the left out clinics like Ryan White clinics and so forth, and some of the DoH services that are there and the critical access hospitals would be the target audience.

  • Matthias Kusch

    Legislator

    Okay. And before you go, what's any ballpark idea is what the annual maintenance cost is to maintain the software.

  • Unidentified Speaker

    Person

    It's affordable. We've talked to a bunch of folks out there. It's really, it might be 20 or $25,000 or something like that, but the upkeep part of it, it's really the expense and then the process of training the staff and the implementation, which is the expensive part.

  • Unidentified Speaker

    Person

    And it usually takes a year for that to happen for a hospital to really make it work. So it is a one time expenditure. We think it's going to be a two year process for from start to completion within that cost frame. If we did it, I mean, we could do it over a number of years slowly.

  • Unidentified Speaker

    Person

    But we really think maybe it's worth making this move, making the investment and getting where we want to be. Thank you.

  • Kyle Yamashita

    Legislator

    Thank you. Thank you. Further questions. Vice Chair, Dr.

  • Jenna Takenouchi

    Legislator

    Lewin. One quick follow up. Sorry, sorry. Sorry. Quick follow up. Hi. Just to follow up on Representative Kusch, questions about the recurring cost. So in your talks with all these organizations who would get the startup money if we were to pass this bill, they all indicated that they would also be able to afford.

  • Jenna Takenouchi

    Legislator

    If we were to help them get set up, they would be able to afford the recurring costs fairly easily.

  • Unidentified Speaker

    Person

    We've Talked to the FQHCs Critical Access Hospitals and they believe that the maintenance part isn't the threatening part, it's the purchase and staff training implementation to be up to speed.

  • Jenna Takenouchi

    Legislator

    Okay, thank you.

  • Kyle Yamashita

    Legislator

    Okay, thank you for the questions, members. Okay, thank you. Okay, I'm testing. Hold on. Usually we don't allow people to just come up and ask, but. Okay, thank you.

  • Kyle Yamashita

    Legislator

    All right, thank you.

  • Kyle Yamashita

    Legislator

    Okay, but anybody want to ask him a question?

  • Kyle Yamashita

    Legislator

    There we go.

  • Kyle Yamashita

    Legislator

    Sure you want to.

  • Matthias Kusch

    Legislator

    I have a question for the Cancer Research Center.

  • Unidentified Speaker

    Person

    I would like to testify not as a cancer center Research Director, but I'm testifying as a provider. So one thing I'd like for you to understand is health disparity in this area is significant. So having an electronic medical record is not only about the clinic. So I currently have an EPIC in my iPhone. Okay.

  • Unidentified Speaker

    Person

    So this is what is. You can't look at it.

  • Unidentified Speaker

    Person

    But you know, so I'm trying to tell you that every single medical record could be in my iPhone and if there is a nurse practitioner or nurses request for signing off order, I could even click the button here so you could see that there is a significant efficiency improvement which is needed in this area because we are segregated with multiple areas.

  • Unidentified Speaker

    Person

    So please understand I'm not, I am. Also not selling epic actually. However, it is very important and so I strongly support, you know, trying to giving EMR appropriately into the entire state. Okay, thank you.

  • Kyle Yamashita

    Legislator

    Thank you. Okay. Actually that's not allowed either. You're supposed to ask a question. Okay. No, so. Okay. But okay, members, you know, I'll just make a quick comment. So this is something that's going to be in the budget too that some of our HHSC hospital will be requesting. So we're going to be. We'll have more information later.

  • Kyle Yamashita

    Legislator

    Okay, we're going to move on to the next Bill. House Bill 250 HD2.

  • Jenna Takenouchi

    Legislator

    First step, Department of Health and support. Thank you. Next we have Hawaii Association of Health Plans with comments. Thank you. Hawaii Medical Association in support on Zoom.

  • Elizabeth Ignacio

    Person

    Aloha Chair, Yam Finance Committee, Dr. Elizabeth Ann Ignacio. Hawaii Medical Association. HMA stands on our written testimony available for questions. Chair. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. We have HMSA in opposition.

  • Don Karisu

    Person

    Aloha Chair, Vice Chair, Members of the Finance Committee, Don Karisu, on behalf of HMSA, thank you for the opportunity to testify. And we also want to thank the Committee for taking the time to understand such a complex and really nuanced issue. HMSA stands on our written testimony respectfully opposing the current version of HB250HD2.

  • Don Karisu

    Person

    And we just want to bring to the Committee's attention a few things of note. We want to be clear that we're not opposed to improving and strengthening the prior authorization process.

  • Don Karisu

    Person

    And we're really committed to working together to improve the process while also ensuring the highest quality of care like the providers and the most affordable premiums for our Members and the community at large.

  • Don Karisu

    Person

    However, the unrealistic decision timelines inserted into the measurement will further stress the system cause significant increases in insurance premiums upwards of $180 million annually for HMSA's membership alone and to the tune of 22 million for EUTF and 85 million for Quest, respectively. It will also force health plans to go back to negotiate rates with the insurance Commissioner.

  • Don Karisu

    Person

    Also of note, HMSA provided comments on the measure noting that new CMS requirements beginning in 2026 will actually require health plans to adhere to These and they address many of the concerns raised about prior authorization frustrations. So under these new CMS requirements, PA timelines actually will already be shortened, reducing the burden associated with this process.

  • Don Karisu

    Person

    Transparency around medical necessity criteria and prior authorization reporting will be strengthened and the adoption of electronic PA processes will also be required. We believe it would be premature to add any new statutory requirements around prior authorization this year. And we're definitely open to continuing the conversation and working collaboratively with stakeholders.

  • Don Karisu

    Person

    We also just want to note, I noticed today that there was a RESO that has been scheduled next week that would establish a PA working group. We actually feel that a PA working group would be really productive and the ideal solution to address any improvements collectively.

  • Don Karisu

    Person

    However, should the Committee choose to move this measure forward, we do ask the Committee to consider the amendments noted in our testimony. And again, thank you for the time.

  • Don Karisu

    Person

    We're committed to working with the various stakeholders to ensure that prior authorization is more efficient, definitely less burdensome, and that it continues to ensure the best care for those we love. Thank you and I'm available for any questions.

  • Jenna Takenouchi

    Legislator

    Thank you. Next, we have Hawaii Medical Association in support on Zoom. Dr. Jerald Garcia.

  • Jerald Garcia

    Person

    Hello, everyone, Honorable Chair, Vice Chair and Members. I am Dr. Jerry Garcia, the Public Policy Committee Chair of the Hawaii Medical Association, along with Dr. Elizabeth Ignacio, who gave an earlier testimony. We stand by. I stand by the testimony submitted by HMA and I'm available for questions as well. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. We have Tonia Neal with PCMA on ZOOM not present. We also received comments from EUTF and three other organizations in support. Is there anyone else in the room wishing to testify? Dr. Lin.

  • Jack Lewin

    Person

    Aloha. Again, Chair Yamashita, Vice Chair Takanuchi, and honorable Members, at the risk of overexposing myself to you, I would just want to share that this Bill is something that we, that we at SHPTA really think is very, very important. It contains two basic features. The first is transparency and prior authorization, that is getting information.

  • Jack Lewin

    Person

    As you all know, a guy named Brian Thompson was tragically murdered in New York because the whole nation is concerned about this issue. It's a very important issue for our subacute advisory councils around the state. So it's become a consumer issue as well as a frustration for doctors and hospitals and insurers.

  • Jack Lewin

    Person

    It's a frustration for them too, quite frankly. But the. But the issue here is that if we can get the transparency to understand what are the triggers for it, what are the frequency of those triggers, and understand what the actual process is here so that it's clear to us, we can then look at solutions. The second part of HB250 is the solution.

  • Jack Lewin

    Person

    And in fact it is a working group of insurers, physicians in hospitals and primary care, including primary care folks and consumers like EUTF and others who are on the consumer side of things, to come together to do something which seems relatively simple, which is to agree on what the standards should be upon which we base prior authorization determinations.

  • Jack Lewin

    Person

    I'm a physician who developed for the American College of Cardiology these prior authorization approaches, or at least the guidelines appropriate use criteria around cardiovascular disease with American Heart Association. They're the national peer reviewed standards.

  • Jack Lewin

    Person

    So if you had heart failure, there would be 40 or 50 different kinds of heart failure that would be built into this model, which have gone through painstaking efforts, including Federal Government input, to actually determine what should you get for care.

  • Jack Lewin

    Person

    If it's cancer, it would be down to biomarkers and genetics and all sorts of details that have to be included. And this is what insurers find difficult for them. It's the complexity here. But we don't need to recruit for this Bill. We didn't ask for any money or any staff here.

  • Jack Lewin

    Person

    We should have asked for at least one staff, quite frankly, but we didn't because we thought that would be tougher to go through the Finance Committee and the Ways and Means Committee. But on the other hand, the reason we don't need all that help is because we have the knowledge right here in Hawaii.

  • Jack Lewin

    Person

    Our doctors, our hospitals, our insurance colleagues and the other scientists who work in the provider world.

  • Jack Lewin

    Person

    We know what the standards are and we can look and decide what are the best peer reviewed standards and assign those to each of the infrequency causes of prior authorization so that we could automate the system so that when you leave your Doctor's office, it's determined or not determined to be approved when you were admitted to the hospital, it's determined then, not two weeks later when you might be subject to a medical billing crisis because your care wasn't approved.

  • Jack Lewin

    Person

    I think that this is a solvable problem. It's one that Hawaii should take the lead in solving. And not just the transparency piece, which I'm sure is going to pass because there's so much support for that. But the solution piece is good. I've talked to the insurance division and you know, they're partners with us in many things.

  • Jack Lewin

    Person

    They're not the place where this should rest because their focus is really on the financial solvency of the insurance world here, mostly not on scientific quality of care issues. So we really like to get this problem solved. We think it's an excellent opportunity for Hawaii to take the leadership upon.

  • Jack Lewin

    Person

    And I'm really sorry that I somehow didn't submit my testimony correctly to get to you. Apologize for that. And thank you very much.

  • Jenna Takenouchi

    Legislator

    Thank you. Anybody else in the room?

  • Unidentified Speaker

    Person

    Thank you. Vice Chair and chair, Committee Members, I'm. Sorry I stood on my testimony too quickly. But I did want to make a point that the previous subject matter Committee. The House Committee on Health, collapsed several. Related prior auth bills into this one. And we agree with some of the previous testifiers that they would be very.

  • Unidentified Speaker

    Person

    Burdensome and increase cost of care. So we actually prefer the draft as originally introduced by your House colleague from Kailua. So agreeing with Dr. Lewin that the high level reporting and the consensus working group won't cost anything but our time. And could end up making a big difference. So thank you for letting me embellish my testimony.

  • Jenna Takenouchi

    Legislator

    Thank you. Okay, anybody else in the room? Anybody else on zoom?

  • Kyle Yamashita

    Legislator

    Okay. Okay. Members, we're going to move into questions. Nobody has a question for shift up? No. Okay. We can talk offline. Thank you. Yeah. This measure is going to be very, very important. And the conversation that the intention of this Committee will be always on the money part, but the policy going forward is the two prior committees.

  • Kyle Yamashita

    Legislator

    So in the end we will make recommendations in the maybe in the Committee report on how they should advance, but we will not amend this Bill per se at this point in time. So your conversations should be with the two prior committees as far as the total policy part.

  • Kyle Yamashita

    Legislator

    But Members, if you want to be educated on anything else, you're welcome to ask any question. Okay, thank you very much. We'll move on to the next Bill. House Bill. Yeah. Okay. House Bill 1431 HD1 Vice Chair, University Of Hawaii System in support.

  • Clementina Ceria-Ulep

    Person

    Good afternoon, Chair Yamashita, Vice Chair Takenouchi, and Members of the Committee. My name is Clementina Ceria-Ulep, Dean of the UH Manoa School of Nursing and Dental Hygiene and we stand on our testimony in support of House Bill 1431.

  • Clementina Ceria-Ulep

    Person

    And I would like to expand further that the School of Nursing and Dental Hygiene would like to recommend Dr. Deborah Matthews, who's the Dental Sealant Program Director and the Hawaii Keiki Lead Program Director for the State of Hawaii and also for the School of Medicine, we would like to recommend Dr. Jill Mori, the Director of the Office of Medical Education and Dr. Matthew Oishi, part time faculty in charge of the oral health curriculum for the medical student in the School of Medicine. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. We have the Department of Health in support. Thank you. SHIPTA in support.

  • Unidentified Speaker

    Person

    Chair, Vice Chair, we stand in support. It's—as a former Director of Health, it's been long overdue to bring this kind of expertise into the Department of Health.

  • Jenna Takenouchi

    Legislator

    Thank you. We have testimony from Aloha Care in support, on Zoom. Not present. We have Hawaii Oral Health Coalition in support, on Zoom. Patrick Donnelly.

  • Patrick Donnelly

    Person

    Hi. Aloha, Chair, Vice Chair, Members of the Committee. Patrick Donnelly with Hawaii Oral Health Coalition and Hawaii Public Health Institute. We'll stand on our written testimony in support of this measure, and I'd just like to briefly highlight that the state has not maintained its public oral health program since 2009.

  • Patrick Donnelly

    Person

    And even with the recent investment to reinstate the dental services for adults with Medicaid, we continue to see really high rates of preventable oral health conditions, high rates of emergency Department visits for those conditions, and truly, millions of dollars spent by the state to treat those every year. Wait times are as long as a year.

  • Patrick Donnelly

    Person

    It really is time to invest resources to systematically evaluate Hawaii's oral health systems and develop strategic and impactful solutions. Thank you very much for the opportunity.

  • Jenna Takenouchi

    Legislator

    Thank you. We also received comments from the Office of Information Practices, support from Department of Human Services, Hawaii Dental Association and Hawaii Dental Service, as well as two individuals. Is there anybody else in the room wishing to testify? Anybody on Zoom?

  • Kyle Yamashita

    Legislator

    Okay, any questions, members? Okay, thank you. We'll move on to the next bill. House Bill 1462 HD1.

  • Jenna Takenouchi

    Legislator

    First up.

  • Kyle Yamashita

    Legislator

    Yeah, go ahead.

  • Jenna Takenouchi

    Legislator

    Department of Health in Support. Thank you. Sorry, I have two people checking in for Department of Health. Is that just the one? The same entry and not another branch or anything? Okay. Okay, thank you. Next we have Waianae Coast Comprehensive Health center on Zoom in support.

  • Unidentified Speaker

    Person

    Aloha. Thank you very much, vice chair. We Stand on our written testimony in support of this measure.

  • Jenna Takenouchi

    Legislator

    Thank you. We also received testimony in support from Hawaii Substance Abuse Coalition and Community Alliance on Prisons in addition to support from about seven individuals and two individuals in opposition. Is there anybody else in the room wishing to testify? Anybody on Zoom? Dr. Lewin.

  • Jack Lewin

    Person

    Vice chair, we stand support.

  • Jenna Takenouchi

    Legislator

    Okay, SHPDA the stands in support. Anybody on Zoom wishing to testify?

  • Kyle Yamashita

    Legislator

    Okay, thank you. Question, members.

  • Jenna Takenouchi

    Legislator

    I have a question.

  • Jenna Takenouchi

    Legislator

    Department of Health.

  • Kyle Yamashita

    Legislator

    Okay, vice chair.

  • Jenna Takenouchi

    Legislator

    Hi. I just want to check in if maybe there was. Has there been any other movement or conversation and you know, finding the site or what the actual cost might look like? I know we have the costs.

  • Jenna Takenouchi

    Legislator

    Basically the only cost we have in the committee report is the estimate for what the operation of Iwilei is. But is there any other updates that you guys have done since last committee heard it until this committee? Any movement or updates on how much it might cost to set up the system?

  • Chad Koyanagi

    Person

    Chad Koyanagi with Department of Health. So we've contracted with national expert company that called RI Recovery Innovations. So we tasked them to assess the system of crisis care and substance abuse care and to make recommendations on what types of crisis services would be appropriate for certain parts of the island. So they're still working on that.

  • Chad Koyanagi

    Person

    It probably won't be released till June of 2025. There are recommendations to us if a crisis type center would be to open up on a different part of the island, it would look very different from what exists at the Iwilei Crisis Resource Center.

  • Chad Koyanagi

    Person

    The staffing would be different depending on what the report is from RI, the type of facility might look very different from anywhere from high intensity behavioral health emergency center like we have in Iwilei and all the way down to they may recommend just having crisis beds attached to an already existing emergency room or facility like that.

  • Chad Koyanagi

    Person

    So the whole range in between and number of beds will be determined on their report.

  • Jenna Takenouchi

    Legislator

    Okay, so with that timeline, likely any additional funding requests for next year to start up the actual program. If we're not going to get the assessment till summertime this year, is that likely?

  • Jenna Takenouchi

    Legislator

    Or does apartment have like existing funds that you would be able to pull from if you were able to like identify, you know, a site and a program to set up in another location. Do you guys have existing funds that you could use?

  • Unidentified Speaker

    Person

    We don't have existing funds budgeted for this right now. We were looking at between 7 to 10 million depending on a lot of the unknowns for startup costs and partial operations first year.

  • Jenna Takenouchi

    Legislator

    So would that money need to be in this bill or again, are we just with the timeline coming back next year to try and stand something up.

  • Unidentified Speaker

    Person

    We apologize. There's a lot of unknowns depending on what type of structure, where it's at, where it's going to be located at, how many, how many chairs, how many stabilization beds.

  • Jenna Takenouchi

    Legislator

    Okay, but it'd be a new request, not from any existing program that you guys are working through,

  • Unidentified Speaker

    Person

    Correct.

  • Jenna Takenouchi

    Legislator

    Okay. No, thank you. Thank you for the clarification. Thank you chair.

  • Kyle Yamashita

    Legislator

    Okay, thank you for the question. Members. Moving on to next Bill House Bill 441 HD2.

  • Jenna Takenouchi

    Legislator

    First up, we have the Attorney General in support.

  • Rich Stacey

    Person

    Good afternoon. My name is Rich Stacey. I'm a deputy Attorney General. I run the tobacco enforcement unit. We do support this Bill. Obviously the UH, cancer center has a vital role and needs the funding.

  • Rich Stacey

    Person

    Um, we are also hoping that HB 1085 gets a hearing which was one that we worked on after last session with DoH, DoE tax, BNF NUH. And that one expands the allocation of taxes including the vape tax that only started last year after Act 62 was passed.

  • Rich Stacey

    Person

    We will point out that it's apparent that with cigarette tax revenues going down that affects many agencies including the cancer center, including the unit that I run. Cigarette taxes have not been raised in now 14 years. And with current federal issues this might be a good year to get more resources. But we do support it.

  • Rich Stacey

    Person

    Available for comments.

  • Jenna Takenouchi

    Legislator

    Okay, thank you. Next we have the Department of Taxation with commons. Thank you. Next we have University of Hawaii system Dr. Ueno.

  • Naoto Ueno

    Person

    Aloha chairs and vice chairs and Committee Member. I'm Naot Ueno, the Director of University Hawaii Cancer Center. This bill is essential for our future growth and particularly cancer research resulting into better outcome. As I mentioned before that there are more than 300,000 people who are saved by cancer research. And similar thing is happening here in Hawaii.

  • Naoto Ueno

    Person

    Comparing to three decades ago, we have reduced the cancer mortality about 25%. I have to testify even myself. I am one of the beneficiary from the research. I myself have received a different type of treatment because of the drug development that's been going through investment of cancer research.

  • Naoto Ueno

    Person

    Otherwise I will not be existing and sitting and testifying this moment. Please remember that 40% of this in this room will have cancer. One you may have it or you may have it or you may have it in the future.

  • Naoto Ueno

    Person

    And when you have it, the question is, are we going to get a better care in the future. And this bill is really not simply about just the existing of the cancer center, but it's really about cancer center being a magnet for working with the healthcare to have a better future.

  • Naoto Ueno

    Person

    So thank you very much for the opportunity to testify.

  • Jenna Takenouchi

    Legislator

    Thank you. Next we have the Department of Health and support.

  • Jill Tamashiro

    Person

    Good afternoon. Chair, Vice Chair, Members of the Committee, Jill Tamashiro on behalf of the Hawaii State Department of Health and Dr. Kenneth Fink. The department supports HB441HD2 as a critical public health measure to address the burden of tobacco use in our state.

  • Jill Tamashiro

    Person

    We have included most of our main points in our testimony highlighting the public health significance of price increases as the single most powerful way to reduce consumption of tobacco products and a means of helping people to quit smoking and also preventing youth from ever starting.

  • Jill Tamashiro

    Person

    So regular and substantial increases in particular are one of four foundational and evidence based CDC recommendations for communities to essentially protect themselves against high burdens of tobacco use. So in alignment with other voluntary health organizations, the DoH would support a 5 cent per stick or $1 per pack increase to optimize the public health impact of this measure.

  • Jill Tamashiro

    Person

    And thank you so much for this opportunity to provide testimony and let me know of any questions.

  • Jenna Takenouchi

    Legislator

    Thank you. Next we have SHIP TA in support.

  • Unidentified Speaker

    Person

    Thank you. Stand on our testimony.

  • Jenna Takenouchi

    Legislator

    Thank you. We have Campaign for Tobacco Free Kids in support. Thank you. We have the Tax foundation of Hawaii with comments on zoom not present, Hawaii Public Health Institute in support.

  • Kevin Ramirez

    Person

    Aloha Chair, Vice Chair and Members of the Committee. I'm Kevin Ramirez, the program manager for the Coalition for Tobacco Free Hawaii, a program of the Hawaii Public Health Institute, here to testify in support with amendments for HB441HD1HD2. Sorry.

  • Kevin Ramirez

    Person

    We respectfully request the bill be amended to raise the tax by at least a dollar per pack to maximize potential public health benefits for youth prevention and adult cessation. More details are in our written testimony. Recent polling shows strong voter support.

  • Kevin Ramirez

    Person

    According to an independent poll conducted by Ward Research on behalf of our coalition, 78% of registered Hawaii voters support an increase in cigarette taxes and 89% feel that it is important for the state to dedicate part of its tobacco tax revenue to support tobacco prevention and cessation programs.

  • Kevin Ramirez

    Person

    Thank you for the opportunity to provide testimony in support of HB441. He 2 we respectfully ask you to pass this measure out of Committee with the requested amendments. Mahalo.

  • Jenna Takenouchi

    Legislator

    Thank you. We have American Cancer Society Cancer Action Network in support.

  • Cynthia Au

    Person

    Chair, Vice Chair and Committee Member Cynthia Au on behalf of the American Cancer Society Cancer Action Network or ACS, can we support the bill with amendments? 9,000 residents from Hawaii will hear the words, you have cancer this year and more than 2,000 are expected to die from the disease.

  • Cynthia Au

    Person

    While it's projected that in 2025 more people will be diagnosed with cancer, there is a decline in deaths compared to 2024 because of institutions like the UH Cancer Center, which provides important cancer research, access to life saving treatment, including clinical trials and education, which play a critical role in reducing the cancer burden for our diverse population.

  • Cynthia Au

    Person

    In Hawaii, ACS can supports increased funding for the UH Cancer Center. Cancer again is the second leading cause of death in the state, but tobacco use is the number one preventable cause of cancer. 1400 adults will die from smoking this year.

  • Cynthia Au

    Person

    Please consider increasing the cigarette tax to 5 cents or a dollar per pack, which is proven to help children to not start smoking and to help adults quit. Thank you so much.

  • Jenna Takenouchi

    Legislator

    Thank you. Next we have Retail Merchants of Hawaii in opposition on zoom. zero, do we have Discount Smoke Shop Hawaii in opposition on zoom. Michelle Jordan not present. Taxpayers Protection alliance with comments on zoom.

  • Lindsey Stroud

    Person

    Yes, can you hear me? Yes, please proceed. Okay, perfect. Okay. Chairman, Vice Chair, Vice Chair, Members of the Committee, thank you for your time today. My name is Lindsey Stroud. I'm a senior fellow at the Taxpayers Protection Alliance.

  • Lindsey Stroud

    Person

    I did submit very extensive written testimony and I wanted to highlight some points and I'm speaking on both bills tonight, so I'm going to try to make sure that I'm not repeating myself. So.

  • Lindsey Stroud

    Person

    Since 2021, TPA has examined data from the annual Behavioral Risk Factor Surveillance System Survey, which is administered by the Centers for Disease Control and Prevention. And I'm utilizing data from that. So first, adult and youth combust use of combustible cigarettes is at record lows.

  • Lindsey Stroud

    Person

    Only 9% of adults age 18 years or older were currently smoking in Hawaii in 2023. And only 3% of high schoolers reported past month s. Unfortunately, this Bill will disproportionately impact the most vulnerable in the state. In 2023, adults earning $25,000 or less were three times more likely to smoke than their counterparts who earned $50,000 or more.

  • Lindsey Stroud

    Person

    18.7% of low income Hawaiian adults were smoking compared to 5.9% of high income earners the same year. Adults who had not completed high school or its equivalent were 3.8 times more likely to smoke than Hawaiians with a college degree. Notably, smoking rate reductions are also greater among higher income, higher educated persons.

  • Lindsey Stroud

    Person

    Between 2003 and 2023, smoking rates among low income earners decreased by only 16.6% compared to a 53.4% reductions among adults earning $50,000 or more among adults lacking a high school education rates declined by only 25.5%, compared to a 48.9% decrease among college graduates.

  • Lindsey Stroud

    Person

    And rather than imposing more excessive taxation on the most vulnerable, lawmakers can and should utilize more of the already existing tobacco monies towards programs that provide education cessation and prevention support. In 2023, Hawaii collected more than $117 million in tobacco monies from cigarette taxes and settlement payments, including $76.8 million in state cigarette excise taxes.

  • Lindsey Stroud

    Person

    Yet the same year, the state allocated only 7.6 million towards tobacco control programs. So given the record lows in adult youth, adult and youth use of combustible cigarettes, increasing the tax rate is not needed and will really harm the most vulnerable people. So thank you for your time today.

  • Lindsey Stroud

    Person

    Happy to answer questions and we'll have more numbers for you on the next bill. Thank you.

  • Jenna Takenouchi

    Legislator

    We have American Lung Association in Hawaii on zoom. Pedro Hara not present. Don Weisman in support on zoom.

  • Don Weisman

    Person

    Yes, can you hear me?

  • Jenna Takenouchi

    Legislator

    Yes, please go ahead.

  • Don Weisman

    Person

    Yes, thank you. Yeah, I'm here as a, as a citizen. I retired from one of the major health organizations last year after 34 years of testimony on tobacco control issues.

  • Don Weisman

    Person

    So I've got some background in these issues, but I have a personal interest in this as well and making sure that we continue to work on these issues because it's the leading preventable cause of death in our state, as you heard, and it's affected my family through the years.

  • Don Weisman

    Person

    I'm urging support of this bill, but with amendment to increase the tax to a minimum by, by a minimum of $1 per pack or 5 cents per stick in addition to the current tax.

  • Don Weisman

    Person

    And that's because, not so much because I'm interested in seeing the state get more money, but it's important that a sizable amount of the sizable tax be implemented so that it has the health impacts that we hope it will have. And one minimum of $1 has been proven to be very effective at reducing that.

  • Don Weisman

    Person

    Now, you heard just recent, just now, arguments that higher taxes. Well, this is coming from the tobacco industry really that it affects low income families in the poor and disproportionately. But those are the same companies that have been preying on the low income and poor communities for decades.

  • Don Weisman

    Person

    And the company's efforts to protect low income smokers and from higher cigarette taxes isn't only just patronizing, but it's a self serving smoke screen designed to protect tobacco industry profits and continue smoking costs and harms. You know, now you might hear arguments that this is going to have a negative impact on the state revenue.

  • Don Weisman

    Person

    But the reality is smoking costs our state over 611 million or $611 million a year in health care costs. That's something we all pay, not just smokers. It affects our Medicaid costs, Medicare affects so many different ways.

  • Don Weisman

    Person

    It's in my written testimony, so I won't get into the details but it's a huge impact on the cost to our state. And yet the most recent tax data from the Department of Taxation shows that we're bringing in just over $80 million a year through tax revenue.

  • Don Weisman

    Person

    So we're losing big time in trying to balance these two things. It makes much more sense to try to reduce smoking to bring, to save our state money. And then finally, the last time we actually increased the cigarette tax through legislation was in 2006.

  • Don Weisman

    Person

    But that bill as a favor to the tobacco industry was staggered over five years. 20% increase each year. And that allowed the tobacco industry to provide discounts and coupons each year that this tax went up to offset the impacts that it would have to their bottom line.

  • Don Weisman

    Person

    And so you know, we'd rather see a $1 increase at 1 time and we want, I prefer to see some of the money go towards the education that previous testifier said is needed.

  • Don Weisman

    Person

    We're grossly under underfunded in that area in the state and the state that the SPAC industry spending over $25 million a year marketing these products to our young people. And we're, you heard, we're spending just over 5 million. So we need more money to go to those prevention, control and cessation programs.

  • Don Weisman

    Person

    So I, I ask you to support this bill with the proposed amendment of an increase in the tax. I'm out. Thank you. And I'm here for any questions.

  • Jenna Takenouchi

    Legislator

    Thank you. Sorry. Also Hawaii Smokers alliance in opposition please.

  • Michael Zehner

    Person

    Good afternoon chair and Committee. My name is Michael Zehner representing the Hawaii Smokers Alliance. We are a grassroots organization that stands up for the people in Hawaii that enjoy tobacco and vaping products. And we are in opposition to House Bill 441 in its present format.

  • Michael Zehner

    Person

    So what's going on now is they've so overstressed the revenue source that they once again have to ask for more money only to in the future have to face this again and have to face go to the Finance Committee again to try and get more money so they don't have a long term plan with their revenue source.

  • Michael Zehner

    Person

    If you listen to the testimony that their, they're providing, they admit that the source is drying up and they say that that's good in their opinion. So what is the future? Where is that? Why is that not being discussed in this bill? I think that's a little short sighted.

  • Michael Zehner

    Person

    Of note, a bill pretty much the same as this was at the Legislature last year. It didn't pass all the way through. But what got added in one of the committees is that the cancer research center or special fund could receive philanthropic donations.

  • Michael Zehner

    Person

    And I'm sure that the people involved with that will tell you that the community is really stoked about the cancer research center and they'd like to see more revenue coming into it.

  • Michael Zehner

    Person

    As it stands right now, advocates of the center, as far as I know, can only donate money to it by buying cigarettes and they don't even smoke. So what sense does that make?

  • Michael Zehner

    Person

    So I would encourage something like that be added to the bill where they could accept voluntary donations to help them transition into what they view as a post tobacco era. I thank you guys for your time and I'd be happy to answer any questions.

  • Jenna Takenouchi

    Legislator

    Thank you. We'll take questions at the end. Next, we have Malia Lehua Ball in support on Zoom.

  • Malia Ball

    Person

    Aloha, chair, Vice Chair and Members of the Committee. My name is Malia Lehua Ball and I'm a nationally certified tobacco treatment Specialist with over 10 years of experience helping individuals overcome nicotine addiction. I'm testifying in support of HB441HD2 with amendments.

  • Malia Ball

    Person

    I strongly urge the committee to increase the cigarette tax by at least a dollar per pack to have a greater impact on reducing smoking rates. You know, research shows that a dollar increase in the tax, in the cigarette tax will not only generate additional revenue, but also encourage more smokers to quit by making cigarettes less affordable.

  • Malia Ball

    Person

    You know, higher prices have been proven to be one of the most effective strategies in reducing tobacco use, especially among youth and low income individuals. Raising the tax is a step in the right direction, but increasing it by at least a dollar will have the greatest public health impact.

  • Malia Ball

    Person

    And this is why I am in strong support of HB44 with amendments. Mahalo for your time and consideration.

  • Jenna Takenouchi

    Legislator

    Thank you. We also have testimony in support from five other organizations and 13 in opposition from organizations as well as 14 individuals in support for an opposition and one providing comments. Is there anybody else in the room wishing to testify? Anybody on zoom?

  • Kyle Yamashita

    Legislator

    Okay, Members, we're going to move to questions. Okay. We're going to move on to the final Bill on the agenda. Moving on to House Bill 756, HD 2.

  • Jenna Takenouchi

    Legislator

    First off, Office of the Attorney General.

  • Chelsea Okamoto

    Person

    Aloha Chair, Vice Chair and Members of the. Oh, sorry. Aloha Chair, Vice Chair and Members of the Committee. My name is Chelsea Okamoto. I'm a deputy Attorney General of the Tobacco Enforcement Unit. Thank you for hearing this Bill. Our department's in support of this Bill. And you have our written testimony.

  • Chelsea Okamoto

    Person

    We ask for reinsertion of the appropriation amounts, position numbers, and to restore the original effective date as written in our testimony. But I wanted to expand on one of our amendments that we're asking for, which is to add a section to repeal Section 328J-11.5 HRS.

  • Chelsea Okamoto

    Person

    That statute prevents counties right now from enacting ordinances and regulations related to tobacco sales, which includes the sales of E-cigarettes. And even though we have that statute, most counties have passed their own flavor bans, which will be triggered once that statute is repealed. And so for this reason, those county flavor bans are called trigger bans.

  • Chelsea Okamoto

    Person

    So we're asking to add that section in so counties would be allowed not only to enact the flavor bans that they have right now waiting, but to also have the ability to legislate other tobacco control measures beyond flavor bans. In another hearing during decision making, a question or concern was raised.

  • Chelsea Okamoto

    Person

    Is this county ban or the county bans, is that going to be in conflict with this flavor ban that the state's proposing? And we want to be clear that you don't have to pick one or the other. The state or the counties are letting the counties have their ability to legislate. You can do both.

  • Chelsea Okamoto

    Person

    We're encouraging that and we recommend this. The county bans, I believe Big Island, Maui and Honolulu, and I believe Kauai is working on it right now. Those bans currently give the county police departments the power to issue administrative fines. And even though there's no criminal offenses associated with those bans, it utilizes that law enforcement criminal scheme.

  • Chelsea Okamoto

    Person

    And here in HB 756, we're giving the Department of Health that authority to administratively enforce a flavor ban. And that will be inspections and looking at records and having hearings. And so those two pieces together can work together to allow for a more comprehensive approach.

  • Chelsea Okamoto

    Person

    Approach for addressing the proliferation of these flavored tobacco products that are affecting our keiki. So we're available for questions. Please pass this Bill and thank you for the opportunity to testify.

  • Jenna Takenouchi

    Legislator

    Thank you. Next we have Department of Health in support.

  • Jill Tamashiro

    Person

    Good afternoon, Chair, Vice Chair, Members of the Committee, thank you for hearing this important measure to address lifelong addiction in our state. Again, my name is Jill Tamashiro, representing the Hawaii State Department of Health and Dr. Kenneth Fink. The Department Supports HB 756, HD 2.

  • Jill Tamashiro

    Person

    And the main points that we wanted to highlight in our testimony this year is the evolution of the E-cigarette epidemic. Which started off as primarily a problem amongst high school students and has now become a major addiction problem for young adults ages 18 to 34 and regretfully a pervasive issue amongst middle school as well.

  • Jill Tamashiro

    Person

    Additional data not included in our testimony shows that for the first time E-cigarette use among adults now exceeds combustible tobacco use. Excuse me, combustible cigarette use at 10.1% versus 9%.

  • Jill Tamashiro

    Person

    So it's evident that the teens that were exposed about 10 years ago to unrestricted access to flavored tobacco products, that started 10 years ago have now aged up and carried this habit into adulthood. We also now have evidence that these policies are making a difference in other parts of the country.

  • Jill Tamashiro

    Person

    Massachusetts, excuse me, and California in particular are among the first states to have successfully adopted, implemented and enforced these restrictions. Their evaluations are also showing great reduction in consumption without economic harm to retailers or increases in illicit trade.

  • Jill Tamashiro

    Person

    So we know that flavors are the enticement factor in tobacco use and menthol in particular plays a facilitative role in addiction. So thank you so much for hearing this very important measure and we are available here for questions. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. Next we have the Campaign for Tobacco Free Kids in support.

  • Unidentified Speaker

    Person

    Chair, Vice Chair, Members of the Committee, I want to say a special mahalo actually to, to Representative Lee Loy who, who worked on one of these bills at the county level when she was and as we saw with kids in our name. And I know that the Youth Council will also have comments and a testimony and support today.

  • Unidentified Speaker

    Person

    But I just want to bring back those 10 to 14 year olds into this room and think about what it's like to be a kid in middle school and high school at this moment and having large companies on social media pushing a product that companies are also spending tens and hundreds of millions of dollars to attract you to and then giving you a product that is that addictive into your hands.

  • Unidentified Speaker

    Person

    We've been sitting in these rooms having this conversation about trying to support our keiki and finding a healthy way forward for years now. Now these, these youth are now young adults. Many of them have, were working with us and you know, maybe as freshmen and now they're off graduated college.

  • Unidentified Speaker

    Person

    So I think it's, it's time that we see some movement on this. And I just wanted to highlight what The Department of Health has said California, Massachusetts, New York and Rhode Island have all passed bans on flavored nicotine products. In California, they've seen a 49.6 reduction percent reduction in E cigarette sales.

  • Unidentified Speaker

    Person

    Massachusetts a 89.8% reduction in E cigarette sales, New York a 62.6 reduction in E cigarette sales and in Rhode Island a 55.3%.

  • Unidentified Speaker

    Person

    These policies are very, very effective and I think all of us are committed to the public health and following the best research and this is something that we continue to stand by as being in the best interest of our kids. Mahalo.

  • Jenna Takenouchi

    Legislator

    Thank you. Next we have Aloha Care on zoom in support not present. Thank you. We have Hawaii Public Health Institute in support.

  • Kevin Ramirez

    Person

    Good afternoon Chair, Vice Chair and Members of the Committee. Kevin Ramirez here, the program manager for the Coalition of For Tobacco Free Hawaii, a program of the Hawaii Public Health Institute, here to testify in Strong support for HB756HD2 ending the sale of flavored tobacco products in Hawaii.

  • Kevin Ramirez

    Person

    I've been conducting vaping prevention presentations across the state through the 808No vape campaign since 2017. When schools have incidents involving student vaping, they often contact us for a presentation. For the first three years of this campaign, 2017-2020, my audiences were mostly high schools.

  • Kevin Ramirez

    Person

    In the last three years, the requests for vaping prevention presentations have predominantly been from elementary schools and a few middle schools. Just this morning I had an audience of 76 students, all of the 4th, 5th and 6th graders at Haleiwa Elementary School.

  • Kevin Ramirez

    Person

    And over this week and last week, I went to Dole middle school for six presentations there to cover all 500 plus students in sixth, seventh and eighth grades. Flavored E cigarette products are driving this growing problem now happening among children and they contain extremely high levels of nicotine. 1.5% strength nicotine.

  • Kevin Ramirez

    Person

    E cigarette marketed as containing 5000 puffs contains as much nicotine as 30 packs of cigarettes. The most recent E cigarette product they've been advertising now is for 30,000 puffs. Additionally, the tobacco industry continues to develop, market and promote new flavored tobacco products like nicotine pouches that are growing in popularity among youth.

  • Kevin Ramirez

    Person

    Ending the sale of all flavored tobacco products will reduce their appeal and protect our children from a lifetime of addiction. Hawaii Voters want regulations in a December 2024 poll of Hawaii registered voters conducted by Ward Research on our behalf, 74% support a law ending the sale of flavored tobacco products. Thank you for your consideration of HP756HD.

  • Kevin Ramirez

    Person

    We respectfully ask you to pass this Measure.

  • Jenna Takenouchi

    Legislator

    Thank you. Next we have the Coalition for Tobacco Free Hawaii Youth Council on Zoom in support.

  • Sienna Moore

    Person

    Good afternoon Chair, Vice Chair and Members of the Committee. My name is Sienna Cooper Moore, senior at Maui High School. I am here today for Kazonian Declaration for Tobacco Free Council speaking in strong support of House Bill 756. Over the past seven years ending the sale of slavery's backbone Hawaii has been a priority for our youth council.

  • Sienna Moore

    Person

    We have worked to raise awareness in our communities gathering support from more than 100 organizations and we have testified with countless days. We work to pass bills ending the sale of all favored Tracker products in three of the four counties and 74% of registered notice to coast. What are we waiting for?

  • Sienna Moore

    Person

    Some in opposition claim that slavery e cigarettes are important to help adjoin oh2Adults to help and quit. I asked BN why hasn't a single company filed with the FDA to get their products approved as it's C safe in the best retailers say ending the sale of flavored tobacco products will create a black market.

  • Sienna Moore

    Person

    If the flavored products they sell are not approved for sale by the FDA making them illegal. So they are the black market operating on the same view. We cannot count on the FDA to enforce these rules. We need our state to take action. Last, over 80 youths from across the state submitted testimony in support of HB756.

  • Sienna Moore

    Person

    I hope you took the time to read their stories about the negative impacts that tobacco has had on their lives and those they care about. How it impacts their education, their relationships with family and friends and how it cuts short the lives of loved ones.

  • Sienna Moore

    Person

    Many of my own family Members are heavily addicted to cigarettes and vapes Initially beginning with flavored products. They are now helped and have not been able to quit despite numerous attempts. Their addiction has drastically impacted their life and our family. This epidemic amongst Hawaii's youth demands urgent and decisive action.

  • Sienna Moore

    Person

    The health, well being and future of our Kiki should take precedence over corporate interests. By passing Bill 756 we take a critical step towards addressing this pervasive issue and shielding the next generation from the harmful effects of flavored tobacco products. We cannot stand by while 1,400 people in Hawaii die each year from tobacco related illnesses.

  • Sienna Moore

    Person

    Strategies that rarely make headlines that devastate families across our islands. We need real change now. Please pass House Bill 756 and thank you for your time. Thank you.

  • Jenna Takenouchi

    Legislator

    Next we have retail merchants of Hawaii in opposition on zoom not present. Do we have a discount smoke shop Hawaii in opposition on zoom Michelle Jordan not present Taxpayer Protection Alliance with Commentss on Zoom.

  • Lindsey Stroud

    Person

    Lindy Stroud yes, and can you hear me now? I had to change up my audio. Yes, you're good. Perfect. Okay. Thank you again for letting me testify again. Lindsay Stroud, Senior Fellow, Taxpayers Protection Alliance I do want to emphasize I'm not big Tobacco. I work at a think tank. I've been working at a think tank since 2016.

  • Lindsey Stroud

    Person

    Kind of fell in love with vaping because I was a former smoker. But that's not what we're here for tonight. So I'm going to be doing numbers again, and these numbers are going to be coming heavily from the CDC Youth Risk Behavior survey.

  • Lindsey Stroud

    Person

    So since 2019, states like Hawaii have sought to reduce youth vaping, and there's really positive news across the United States. According to the CDC, youth vaping is at its lowest level in the decade and it's also down in the Aloha State.

  • Lindsey Stroud

    Person

    In 2023, only 28.8% of Hawaii high schoolers had tried an e cigarette and 13.2% reported past month vape use. Among middle schoolers, 16.9% had tried an e cigarette and 10.3% reported past month use.

  • Lindsey Stroud

    Person

    Similar to across the country, vaping peaked in Hawaii in 2019, and between 2019 and 2023, among high school students, every use of E cigarettes decreased by 40.4%, past month use dropped by 56.9%. Among middle schoolers, every use declined by 44.8% and past month use was down by 48.1%. Given these declines, banning flavor simply isn't needed.

  • Lindsey Stroud

    Person

    But it also ignores state and national data on why youth are even using e cigarettes.

  • Lindsey Stroud

    Person

    In 2023, among those 13.2% of high school students that had ever tried an E cigarette, the most common reason cited for use was curiosity, as reported by 33% of Hawaii students, followed by feelings of anxiety, depression and or stress, as reported by 25.2% of students.

  • Lindsey Stroud

    Person

    Only 3.6% of Hawaii high school students who had ever used an E cigarette cited using them because they were available in flavors. This is similar to national data. In 202143.2% of US middle and high school students that were currently or past month using E cigarettes reported using them because they were feeling anxious, depressed, and or stressed.

  • Lindsey Stroud

    Person

    Only 13.2% recited using them because they were in flavors. I'd like to emphasize that even recently, the FDA is acknowledging the role of flavors in tobacco harm reduction products. In January, the agency authorized the sale of 20 nicotine pouches available in a wide variety of flavors from citrus to spearmint.

  • Lindsey Stroud

    Person

    Further, there are hundreds of non traditional tobacco flavored Easter cigarette products that are kind of in this regulatory limbo waiting their decisions on their pre market tobacco applications. Again, there are better measures to reduce vaping, youth vaping, as mentioned in the previous Bill. This simply really isn't warranted given these declines.

  • Lindsey Stroud

    Person

    And I also like to emphasize with doing these numbers and Hawaii is in a unique position. In 2023, there were actually more adults vaping than they were smoking. 10.1% of adults were vaping compared to 9% who were smoking. And that was pretty kind of cool to see in all this research that I've been doing. Again, thank you for your time today and I'm available for any questions.

  • Jenna Takenouchi

    Legislator

    Okay, thank you. Next we have Hawaii Smokers alliance in opposition.

  • Michael Zehner

    Person

    Michael Zehner , again, we at the Hawaii Smokers Alliance are in extremely strong opposition to this Bill. First off, there's no doubt from a Finance Committee perspective that this will be a business killer.

  • Michael Zehner

    Person

    There are mom and pop vape shops that hire people that have people have taken out mortgages on their homes to start, who depend on it for their insurance and their health care and everything. And you take away virtually all of their product line. And these guys are going to be out of business.

  • Michael Zehner

    Person

    And that needs to, I think, to be addressed. In addition to killing these businesses and wrecking these people's livelihoods, this will be expensive to enforce. They're asking for a considerable amount of money just to ruin businesses.

  • Michael Zehner

    Person

    So you've lost the tax base, you've ruined the businesses, and now they want to take more money out of the system to facilitate wrecking that even more. And that doesn't make sense to me and I'm hoping it doesn't make sense to the Finance Committee.

  • Michael Zehner

    Person

    So the FDA is moving forward on regulations, actually evaluating products, whether they're safe or not. And that makes sense. I would say let the FDA do its course and come up with something fair where they can meet with both sides of the issue and do it in a responsible manner.

  • Michael Zehner

    Person

    Also, I'd like to mention since Hawaii Smokers alliance is a group for populist voices, we're not professional lobbyists. We're the people on the street. I, I know from a fact, just from my everyday life that 73% of people are not in favor of this.

  • Michael Zehner

    Person

    Yes, I realize that a paid group can rig the questions over the phone and run the survey as many times as they need.

  • Michael Zehner

    Person

    But you go down there on Beretania street or on King street or whatever you talk to normal people, hey, what's important to you and what they will tell you is, zero yeah, I'm concerned that Michael Zayner here, that's 50 years old is enjoying flavors of tobacco that I don't like.

  • Michael Zehner

    Person

    Is that going to be their most important concern? I was on a neighborhood board for 12 years. Their concerns are the high cost of living, the electricity cost, the vagrancy. I'm sure that you guys have heard this.

  • Michael Zehner

    Person

    The last thing on their minds is worrying about what an adult is doing in their own home or what they're enjoying. So I urge you guys to let the FDA do it in a fair manner. That's across the board. That way everybody's treated different. The same that you don't have an unlevel playing field for different counties.

  • Michael Zehner

    Person

    You don't have black markets products coming in that could have anything in them. They could have fentanyl in them. Right? Because now there's no more, there's no more controls over it and we don't want that.

  • Michael Zehner

    Person

    So I think the FDA is doing the right thing and I hope you guys will consider the financial impact as well, as well as the impact to your constituents on this Bill. I thank you for your kind attention. I'd be happy to answer any questions.

  • Jenna Takenouchi

    Legislator

    Thank you. We take questions at the end.

  • Michael Zehner

    Person

    Okay, thank you.

  • Jenna Takenouchi

    Legislator

    Next, we have American Lung Association in Hawaii on Zoom. Not present. Do we have Luke Itomura on Zoom in support?

  • Luke Itomura

    Person

    Yes. Aloha Chair Yamashita, Vice Chair Takunouchi and Members of the House Committee on Finance, thank you for the opportunity to testify in strong support of HB756. I'm Luke Itomura, a sophomore at Punahou School, and I stand with countless Hawaii youth united against a vaping epidemic fueled by flavored products that threaten our health and future.

  • Luke Itomura

    Person

    At just 13 years old, I was offered a flavored vape not by an adult, but by another youth who pressured me with the appeal of a Hawaiian sun flavor. My sixth grade friends had similar experiences. For kids as young as 12, flavors like watermelon or Jolly Rancher become an enticing trap.

  • Luke Itomura

    Person

    What starts as curiosity can lead to lifelong addiction, lung disease, strokes, and even early death. No other consumer product kills up to 50% of its long term users. Some opponents argue that Hawaii would lose tax revenue by ending the sale of flavored tobacco products. However, the full picture and economic impact tell a different story.

  • Luke Itomura

    Person

    While there may be a short term reduction of tax revenue, the long term cost savings to the state would be substantial. A report linked to my Written testimony found that the financial burden of smoking related diseases in Hawaii is staggering. Smoking related diseases cost Hawaii $611 million annually in healthcare expenses.

  • Luke Itomura

    Person

    Medicaid expenses due to smoking related illnesses total $152.3 million each year and each household pays an estimated $955 in state and federal taxes to cover smoking related government expenditures. Additionally, smoking related premature death and illness result in $1.1 billion loss in productivity. By passing HB756, Hawaii can reduce these costs while protecting our youth.

  • Luke Itomura

    Person

    A fact sheet by John Hopkins Economics for Health shows that Hawaii can expect these savings. They state that preventing Hawaii kids from becoming addicted smokers would secure additional millions of dollars in future health care. Health care cost savings.

  • Luke Itomura

    Person

    Finally, I want to end on the note that 74% of Hawaii registered voters support ending the sale of flavored tobacco products, justifying that this is a highly wanted policy. Flavored tobacco has no place in the hands of Hawaii's youth and passing HB756 is a vital step in protecting future generations. Thank you for your time.

  • Jenna Takenouchi

    Legislator

    Thank you. Next we have Don Lysman in support on Zoom.

  • Unidentified Speaker

    Person

    Aloha. Again, Don Lysman, private citizen, here to support this Bill strongly. And I want to emphasize, you've got my written testimony, I won't go through all of it, but I want to emphasize the importance of making this a comprehensive flavor restriction.

  • Unidentified Speaker

    Person

    You know, mint and menthol flavors especially are important in this issue because they are added to so many of the other flavors as a way to mask the harshness of tobacco products and nicotine. So it's important that this be comprehensive.

  • Unidentified Speaker

    Person

    If you leave any gaps in what's allowable, then the industry is standing ready to take advantage of that with loopholes. So it's important to make this comprehensive.

  • Unidentified Speaker

    Person

    I want to also emphasize that you'll hear, you know, you're hearing from the tobacco industry or its representatives that these products, some of the vape products or the newer pouch products are safer. They always use the term safer.

  • Unidentified Speaker

    Person

    You'll never hear the tobacco industry use the word safe because there is no safe tobacco or nicotine product out there. Every nicotine product causes adverse effects on kids and adults, causing addiction, causing harm to brain development in kids, increasing the risk of heart disease, heart disease and stroke.

  • Unidentified Speaker

    Person

    They've been found to decrease blood flow and heart even more than traditional cigarettes and converse in heart disease risk factors such as high cholesterol. So I mean, heart disease is the leading cause of death in our state. So these have a big impact on why we have these higher rates of these problems.

  • Unidentified Speaker

    Person

    It's nicotine products that are a big cause of the acute, of acute health problems that we face in our state. And then I just want to again point out that tobacco related use in our state costs us over six US taxpayers, over $611 million a year. So the economic arguments are just way out of line.

  • Unidentified Speaker

    Person

    The amount that the state brings in through tax revenue or even those who are selling these products pales in comparison to what we're having to pay for the eventual costs of these for disability and death in our state. So I urge you to strongly support this Bill. Mahalo.

  • Jenna Takenouchi

    Legislator

    Thank you. That is everybody who indicated they'd be joining us today. We also received testimony in support from County Council Member Jen Kagiwata with Hawaii County, 17 organizations and 40 individuals, as well as testimony and opposition from 16 organizations and seven individuals. Is there anybody else in the room who would like to testify? Anybody on Zoom?

  • Jenna Takenouchi

    Legislator

    Oh, someone on Zoom. Oh. Okay. Please state your name and proceed with your testimony.

  • Ian Ross

    Person

    I'm being called up for the video. I'll just say Ian Ross, Conference of Health Center. We will just stand our written testimony. As I know this is the last measure of the day. Thank you very much.

  • Jenna Takenouchi

    Legislator

    Thank you. Anybody else on Zoom?

  • Kyle Yamashita

    Legislator

    Okay, thank you very much. Members, questions? Okay, thank you very much. We'll recess to get quorum for decision making.

  • Kyle Yamashita

    Legislator

    Okay. We're going to reconvene the Committee on Finance for a third agenda for to make decisions on the following measures. First up is House Bill 1427. HD One recommendation is to pass as is. Any discussion? Vice Chair.

  • Jenna Takenouchi

    Legislator

    Voting in HB 1427 HD1 recommendations to pass, unamended. [Roll Call]

  • Kyle Yamashita

    Legislator

    Okay, thank you very much. Very much. Moving on to House Bill 1389 HD1 as is. Discussion? Okay, Vice Chair.

  • Jenna Takenouchi

    Legislator

    Voting HB 1389 HD1 recommendation is to pass as is, noting the excused absences of Representatives, Representatives Holt, Lee, Alos and Ward, who will be noted as excused for the remaining of this agenda unless otherwise announced. Are there any Members Voting with reservations? Any noes? Recommendations adopted?

  • Kyle Yamashita

    Legislator

    Okay, thank you. Moving on to House Bill 237 HD1 as is. Discussion? Vice Chair.

  • Jenna Takenouchi

    Legislator

    Voting on HB 237 HD1 recommendations to pass, unamended. Any reservations? Any noes? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay. Moving on to House Bill 72 HD2 as is. Discussion? Okay Vice Chair.

  • Jenna Takenouchi

    Legislator

    House recommendations to pass, unamended. Any reservations? Any noes? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay, thank you. Moving on to House Bill 714 HD1 as is. Discussion? Vice Chair.

  • Jenna Takenouchi

    Legislator

    Vice Chair voting on HB 714 HD1 recommendations to pass, unamended. Any reservations? Any Noes? recommendations adopted.

  • Kyle Yamashita

    Legislator

    Moving on to House Bill 213. HD1 as is. Discussion? Vice Chair.

  • Jenna Takenouchi

    Legislator

    HB 213 HD1 recommendations to pass, unamended. Any reservations? Any noes? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay. Moving on to House Bill 303 HD2 as is. Discussion? Vice Chair.

  • Jenna Takenouchi

    Legislator

    HB 303 HD2 recommendations to pass, unamended. Any reservations? Any Noes? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay. Moving on to House Bill 474, HD1. We're going to be moving this out as an HD2, blanking out the FTE and tech. Any discussion? Vice Chair.

  • Jenna Takenouchi

    Legislator

    HB 474 HD1 recommendations to pass with amendments. Any reservations? Any noes? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay. Moving on to House Bill 700 HD1 as is. Discussion? Vice Chair.

  • Jenna Takenouchi

    Legislator

    HB 700 HD1 recommendations to pass, unamended. Any reservations? Any noes? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay, thank you. Moving on to House Bill 952. HD1 as is. Discussion? Vice Chair.

  • Jenna Takenouchi

    Legislator

    HB952, HD1, recommendations to pass, unamended. Any reservations, any noes? Recommendations adopted. Okay.

  • Kyle Yamashita

    Legislator

    Moving on to House Bill 139 HD2 Members. We're going to move this out as is, but I'm going to note the AG's concerns in the Committee report. Any discussion? Okay. And for the subject matter committees to work on that in conference if this bill does move forward. Okay. For the vote Vice Chair.

  • Jenna Takenouchi

    Legislator

    HB139, House recommendations to pass, unamended. Any reservations? Any noes? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay, thank you. Moving on to House Bill 1300 HD1 as is. Discussion? VIce Chair.

  • Jenna Takenouchi

    Legislator

    HB 1300 HD1 recommendation is to pass unamended. Any reservations? Any noes? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay. Moving on to House Bill 341, House as is. Discussion?

  • Jenna Takenouchi

    Legislator

    Vice Chair, House Bill 341, House recommendations to pass, unamended. Any reservations? Any noes? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay, thank you. Moving on to House Bill 784, HD1 as is. Discussion.? Okay VIce Chair.

  • Jenna Takenouchi

    Legislator

    HB 784, HD1 recommendations to pass, unamended. Any reservations, any noes? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay, thank you. Moving on to House Bill 1179, HD1 as is. Discussion?

  • Jenna Takenouchi

    Legislator

    Vice Chair, HB 1179, HD1 recommendations to pass, unamended. Any reservations? Any noes. Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay. Moving on to House Bill 716. HD1 as is. Discussion?

  • Jenna Takenouchi

    Legislator

    Vice Chair, HB 716, HD1 recommendations to pass on amended. Any reservations?Any noes? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay, thank you very much. Moving on To House Bill 250 HD2 Members, there is a lot of conversation on this bill and I think, you know, the subject matter has to decide how they're going to deal with it going forward. So it's. It will be expensive for this Committee to.

  • Kyle Yamashita

    Legislator

    If this bill moves as it is right now. So I think we have to keep it moving till conference and we'll be working with the subject matter Committee. So for right now, my recommendation is to keep it moving forward as is discussion. Okay.

  • Jenna Takenouchi

    Legislator

    Vice Chair, HB 250 HD2, recommendations to pass, unamended. Any reservations? Any noes? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay, thank you. Moving on to House Bill 1431, HD1. Okay. We're going to be blanking out the positions, the fte, some technical amendments and also we're going to be making it from permanent to temporary because there is a sunset on this on 2028. So we're going to move make the position temporary. HD2, any discussion? Vice Chair.

  • Jenna Takenouchi

    Legislator

    Voting on HB 1431, HD1 recommendation is to pass with amendments. Any reservations? Any noes? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay, thank you very much. Moving on to House Bill 1462 HD1, as is. Discussion?

  • Jenna Takenouchi

    Legislator

    Vice Chair HB 1462 HD1, recommendations to pass, unamended. Any reservations? Any noes? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay. Moving on to House Bill 441, HD2, as is. Discussion?

  • Jenna Takenouchi

    Legislator

    Vice Chair HB441HD2, recommendations to pass, unamended. Any reservations? Any noes? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay, thank you. Moving on to the final bill. House Bill 756, HD2, as is. Discussion? Vice Chair.

  • Jenna Takenouchi

    Legislator

    HB 756 HD2, recommendations to pass, unamended. Any reservations? Any noes? Recommendations adopted.

  • Kyle Yamashita

    Legislator

    Okay, thank you very much, Members. We are adjourned, and we'll be moving into the final hearing momentarily.

  • Kyle Yamashita

    Legislator

    Okay. We're going to convene the Committee on Finance for our fourth agenda. We have one Bill on the agenda, House Bill 1194 HD1, relating to midwives. Vice Chair.

  • Jenna Takenouchi

    Legislator

    First up, we have DCCA with comments.

  • Alexander Pang

    Person

    Hi there. Good afternoon. My name is Alexander Pang. I'm Executive officer of the Department of Commerce and Consumer Affairs Midwives Program. We stand on our written testimony and. Are here for questions. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. Hawaii Home Birth Task Force. Oh. Hawaii Home Birth Collective in opposition. Sorry, my sheet got messed up, but. Sorry. Yeah. Hi, Kristie.

  • Kristie Duarte

    Person

    Thank you. Thank you, Finance Committee, for having us here. My name is Kristie Duarte. I'm the President of the Hawaii Home Birth Collective, which represents the largest group of licensed midwives. We represent over 20 licensed midwives in our state, and we oppose HB 1194, but with recommendations so that we can support.

  • Kristie Duarte

    Person

    Those are found in our testimony because there are some new legislators. I just wanted to share the history of the 2019 midwifery law. In 2019, there was a news article with a Legislator saying, this Bill strikes an important balance by allowing those who have the credentials and training to seek licensure.

  • Kristie Duarte

    Person

    And it also gives an exemption to traditional and cultural practitioners to come together in a task force to discuss the right level of regulation and accountability.

  • Kristie Duarte

    Person

    The Legislator continued to explain that we look forward to the task force report and hope to bring all groups together to ensure a basic level of consumer protection and safety for mothers and babies.

  • Kristie Duarte

    Person

    While this was the intent of the 2019 law that passed right now, HB 1194 does not yet accomplish what the midwifery law intended to accomplish, it does not yet bring all groups together. It does not ensure consumer protection or safety for mothers and babies when it seeks to restrict access and criminalize traditional practitioners.

  • Kristie Duarte

    Person

    I was the chair of that task force. Our recommendations were introduced and the Department of Health showed up and testified in 2020 that there were no safety issues. And yet the chair, who contacted me and asked me for the Bill so that she could introduce the Bill, killed the Bill that day.

  • Kristie Duarte

    Person

    The reason she said she wanted to wait five years until the sunset date. So here we are.

  • Kristie Duarte

    Person

    We're at the sunset date, and this is the chance that the House can do what it said and intended it would do, because it was the House of Representatives that created the task force and the Committee for the Health Committee in 2019. And chair Yamashita, I appreciate your comment.

  • Kristie Duarte

    Person

    In the news recently when you said efforts are currently underway to reach a compromise, respectfully asking that the Finance Committee please be the one to get us to reach that compromise today and end criminalization of our traditional and cultural practitioners. And please support the families they care for. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. Next we have Papa Ola LĹŤkahi with comments.

  • KeʻōpĹ« Reelitz

    Person

    Aloha, Chair, Vice Chair, Members of the Committee, my name is Keʻōpū Reelitz. I am Policy Director, or I should say Director of Policy and Strategy for Papa Ola Lōkahi. We stand and on our written testimony we're providing comments.

  • KeʻōpĹ« Reelitz

    Person

    While we don't take a position on any other part of the Bill other than the traditional Native Hawaiian healing exemptions, we do want to share that the bill, as was amended in HT1, provides fairly broad exemption. And if you decide to pass this. Bill or some version forward, we would. Ask that those provisions remain in the bill or something like it that is both broad and simplified, remain in that bill here for any questions. Mahalo. Thank you.

  • Jenna Takenouchi

    Legislator

    Next we have Banyan Birth LLC in support on zoom. Taylor Hamil.

  • Taylor Hamil

    Person

    Hi, my name is Taylor Hamil. I'm a licensed midwife on the Big Island. I appreciate the opportunity to testify. I'm testifying in strong support of HB 1194 HD1. I strongly support the requirement for education, peer review, data collection, maintaining up to date NRP and BLS certification as components for the midwifery licensure Bill.

  • Taylor Hamil

    Person

    I also would like to state that I think the narm exam is not an adequate evaluation of comprehension of risk, health status, diagnostics, treatment and management of more complex conditions that can arise in the perinatal period.

  • Taylor Hamil

    Person

    Meek School examinations are much more thorough and more adequately reflect a midwife's training, their ability to identify, order and interpret lab results, refer to the right kinds of providers and provide the appropriate courses of care.

  • Taylor Hamil

    Person

    Peer review and data collection are two components to oversight that ensure the accountability of midwives and can improve safety outcomes for families that are in their care. Thank you for your time. Please vote in support of HB 1194 HD1. Thank you.

  • Jenna Takenouchi

    Legislator

    Next we have the Hawaii Affiliate of the American College of Nurse Midwives and support.

  • Margaret Ragen

    Person

    Mahalo for this opportunity to speak and elaborate upon our written testimony. My name is Margaret Ragen. I am Secretary of the Board for the Hawaii Affiliate of the American College of Nurse Midwives. We represent certified nurse midwives who in Hawaii are licensed as APRNs through the board of Nursing with a specialty in midwifery.

  • Margaret Ragen

    Person

    We also represent certified midwives who are licensed through dcca. We appreciate the opportunity to speak and support this version of a replacement Bill moving forward, subject to amendments which we have elaborated upon at length in our Written testimony.

  • Margaret Ragen

    Person

    We are at a point in the regulatory process where beyond preservation of a licensure program, the value of midwifery care needs to inform the policy. It is not there yet. Sorry, I'm nervous. This is very personally meaningful. Licensed midwives need to be authorized in the statute. It cannot be amended on an administrative level.

  • Margaret Ragen

    Person

    We've been through that in the past five years. DCCA has not been able to address inadequacies in the statute. Therefore, we wish that you would reference national standards for these licensed providers, without which we will not be able to be integrated into the healthcare system.

  • Margaret Ragen

    Person

    Medicaid has expressed their support for clear descriptions of scope, clear definitions, so that we can proceed in integrating these new providers to address provider shortages and expand access to care from our families who need it so desperately. Act 32 also had claimed that privacy and constitutional rights would not be impacted through a licensure program.

  • Margaret Ragen

    Person

    This seems to not be the case. We are hoping that all of these issues can be addressed appropriately in this very complex issue. I'm here to answer any questions. I appreciate. I think I've really gone over two minutes, but I appreciate you letting me speak.

  • Margaret Ragen

    Person

    We have been, as a board, involved in conversations with Department of Health Services, Department of Health, DCCA, and acog. Also representatives who have introduced both previous bills in the hearing in hopes of finding a comprehensive approach to expanding access to care policy should reflect the needs of the public.

  • Margaret Ragen

    Person

    It was not the intent of legislative findings back in 1999 or yet when the previous Bill was introduced, to infringe upon what happens within a community, nor infringe upon the rights of the public. So our intent is to in some way move this vehicle forward in light of all the considerations. So I appreciate your time. Thank you.

  • Margaret Ragen

    Person

    Thank you.

  • Jenna Takenouchi

    Legislator

    Next, we have the Hawaii Midwifery Council in opposition and also, with gentle beginnings, midwifery. Oh, sure, there. I mean, it's back to back. So I'm going to call you next one after.

  • Rachel Struempf

    Person

    Aloha. My name is Rachel Curnel Struempf, and I'm first going to speak for the Hawaii Midwifery Council. We were founded in 2015, and we have a representation on all of the islands except for Molokai.

  • Rachel Struempf

    Person

    And so I would like to read the testimony as submitted by the North American Registry of Midwives, who is the credentialing body of the Certified professional Midwife.

  • Rachel Struempf

    Person

    This is written by Bryn Potter, who is the Director, the Executive Director of the North American Registry of Midwives, to the honorable chair and Committee Members, the North American Registry of Midwives, Narm thanks you for the opportunity to testify regarding HB 1194 HD1 relating to midwives.

  • Rachel Struempf

    Person

    NARM supports licensure opportunities for all midwives who hold the credential of Certified Professional Midwife. This credential is the basis for the midwife licensure in 38 other states and we commend Hawaii for its passage of midwifery legislation in 2019. We were very happy to see the inclusion of Global Signature Authority for the CPM included in HB 1194 HD1.

  • Rachel Struempf

    Person

    Unfortunately, we have concerns about this Bill as submitted. NARM has concerns with the current law. 457J as passed, the only route to the CPM identified in this law was through the attendance of a meek accredited school. The Legislature put into statute the solitary route to the CPM credential.

  • Rachel Struempf

    Person

    However, this route currently represents fewer than 50% of all certified professional midwives holding the credential and will significantly restrict the ability for Hawaii to build and sustain a midwifery workforce that will support your citizens. NARM recognizes additional educational pathways that grant a person eligibility to sit for the NARM exam as equivalent.

  • Rachel Struempf

    Person

    We recognize that a number of Hawaii residents, including Native Hawaiian women, expressed an interest in pursuing the NARM pathway to midwifery licensure.

  • Rachel Struempf

    Person

    They are currently prohibited from doing so under your current midwifery law and will be foreclosed from being from this opportunity to serve their communities unless HB 1194 HD1 is amended to allow the portfolio evaluation process with midwifery bridge option. Under the US Merit Guidelines, all people who pass the NARM exam receive the same credential.

  • Rachel Struempf

    Person

    Every person who receives eligibility to sit for the NARM exam has had their education and training as well as hands on skills evaluated and have been determined to have met the standards. These individuals are able to safely practice midwifery within the same scope of practice.

  • Rachel Struempf

    Person

    There is no evidence to suggest that there is a difference in the quality of education or competency in the skills or knowledge for the multiple pathways to the NARM credential. NARM recommends amending the law to include all qualified routes for certification for licensure and education purposes.

  • Rachel Struempf

    Person

    All CPMs are eligible to practice midwifery in the United States, including those who applied through the portfolio evaluation process, also called pep. PEP students also need to be allowed to learn midwifery within the communities where they reside.

  • Rachel Struempf

    Person

    NARM does not recommend inserting guidance language from entities outside of the United States to set regulation for midwives at the state level. The International Confederation of Midwives Standards were set for countries where there are no pre existing midwifery credentialing bodies, laws and regulations.

  • Rachel Struempf

    Person

    ICM defers to the countries where they are established where there are established midwifery professions, regulations and standards. NARM sets the standards for the midwives who practice in the community setting like homes and birth centers via the CPM credential. NARM fully supports the portfolio evaluation process as a legitimate educational pathway to the cpm.

  • Rachel Struempf

    Person

    Licensure and educational exemption should be available to include and included in the language of HB 1194 HD1. NARM also feels there are redundancies in HB 1194 in regards to the additional requirements for peer review and continuing education for the CPM. NARM requires our CPMs to complete peer review and approved continuing education courses.

  • Rachel Struempf

    Person

    These requirements are a condition for the renewal of their professional certificates adhering to the standards set forth by the CPM national certifying body, which is what is best for the profession of the cpm. As the profession of midwifery may evolve over time, NARM will continue to set the standards for the CPM as we are their credentialing body.

  • Rachel Struempf

    Person

    These redundancies will put undue resource burden on both the licensee and the state administrators. Thank you for your consideration.

  • Rachel Struempf

    Person

    Bryn Potter, NARM and I want to add one thing to that that the Hawaii State licensing laws state that you cannot a license or program cannot unduly restrict all qualified applicants from receiving a license and we are all equal. A CPM is a cpm. There are many routes to the CPM and they are all valid.

  • Rachel Struempf

    Person

    So thank you. That's. Thank you. That's why Midwifery Council okay, so hi, I'm Rachel Curnell Strump and I'll be testifying today for Gentle Beginnings Midwifery, which is my business. I am a licensed midwife. I'm actually the first licensed midwife in the State of Hawaii. My license number is one and I really appreciate the ability to be licensed.

  • Rachel Struempf

    Person

    It has made my practice better. But I will explain to you some ways that I'm limited through the current laws that we have. I am the one who found and put in and advocated for the prescriptive rights for the certified professional Midwife.

  • Rachel Struempf

    Person

    We have a formulary that's approved by the state that through the DCCA of medications that are found to be used in midwifery, things for thrush of your nipples, vaginal yeast infections, antibiotics for moms that have group B, strep rhogam for moms that have a negative blood type so that they can continue to have children and don't get desensitized to antibodies in their blood.

  • Rachel Struempf

    Person

    There's all kinds of reasons that we use medications. And the way the law is written, I'm able to obtain those medications and administer the medications. But do I show up at her house every night before bed to put the vaginal yeast cream in? Because that's what the directions are, and that doesn't make sense.

  • Rachel Struempf

    Person

    So I need to be able to not just administer. I need to be able to give her this medication. And the only way I can legally do that is through limited prescriptive rights. In 2022, the State of Washington had a program that they implemented, and it's going really great.

  • Rachel Struempf

    Person

    It's great for the people, it's great for the state, it's great for the midwives, because when somebody is going through something like mastitis, which is a breast infection that occurs very frequent postpartum, time is of the essence.

  • Rachel Struempf

    Person

    And right now, the only recourse we have is to send somebody into the emergency room for something that would be really simple to just call the pharmacy. The other part of this, you know, subject is that I could use her medical insurance. Quest provides health insurance for all pregnant people who don't have private insurance.

  • Rachel Struempf

    Person

    And if I had the ability to call that yeast cream in, to call that rogam in, to call in just. Just whatever the state says is reasonable for me to the ability to do, then all of their insurance companies would cover these medications because rhogam. My cost on rhogam is just under $700.

  • Rachel Struempf

    Person

    They need two shots, one at 28 weeks and one within three days postpartum. And right now, I have moms that are choosing not to take that shot because they have to choose between taking the shot or putting groceries on their table for their children.

  • Rachel Struempf

    Person

    And already they have to pay cash out of pocket because midwifery care has not been written into the codes. Right. So that we can't Bill insurance. We're not part of the Medicaid program yet. Margaret testified. And so everybody in the State of Hawaii who uses a midwife pays cash out of pocket.

  • Rachel Struempf

    Person

    And so in addition to those fees, we're adding on things that could be easily covered through medical insurance with limited prescriptive rights. What our amendments that we put in there were. It was in the Bill that didn't get voted on. But the amendments in there, they model Washington's law. We didn't think anything up.

  • Rachel Struempf

    Person

    We didn't make it up. We didn't try and add anything extra. We were just like this is working really great for Washington. Let's just copy and paste the same thing with the traditional birth attendant exemption. That program has been running in the State of Oregon for 30 years, more than 30 years, and regulation is what's needed.

  • Rachel Struempf

    Person

    We all agree that it's not safe for somebody to give birth alone. But right now, every woman in the State of Hawaii has the legal ability to give birth by herself.

  • Rachel Struempf

    Person

    But we're criminalizing the traditional birth attendants because they don't hold a certificate when their job isn't to do anything sensational at a birth, but they've seen a few hundred or thousand of them, and they know when something's going against the normal. And they're there as a line of protection for these women that wouldn't otherwise not seek care.

  • Rachel Struempf

    Person

    Because we can all agree not seeking care is way more dangerous than having a birth with somebody who knows what normal physiological birth looks like. Because that's what we're trying to do. We're trying to protect the consumer so we can protect them by allowing their insurance to cover costs for medications that are necessary for safe practice.

  • Rachel Struempf

    Person

    We shouldn't have moms choosing to have a birth at home and having to compromise their care because. Not because we're not competent, but because they don't have the money to afford the medications. And we really need to bring back the traditional birth attendant exemption. The exemption is regulation.

  • Rachel Struempf

    Person

    If a midwife or a traditional birth attendant doesn't follow the criteria to be exempt, she's practicing midwifery without a license and thereby punishable by the law. So it holds those people accountable to their communities and the people that they serve and to the state.

  • Rachel Struempf

    Person

    Also, Rico never had any complaints in the whole three years that the program was running, because from 2019, from. Well, from the 2020 when they started licensing us, till the exemption expired July 12023 there were no reports in derico. There were no problems.

  • Rachel Struempf

    Person

    There was not an issue with the exemption, but the time lapsed, and we weren't able to get the Legislature to pass something or to extend the exemption. So it just expired. Since that time, if you look at the birth statistics, you can see that there are.

  • Rachel Struempf

    Person

    There's an uptick in births that are being reported that aren't being done by a nurse, midwife, a Doctor, other. I'm an other midwife on the form. So. But there's just. It's like we don't know who's attending these people. And that's what we need to be concerned about.

  • Rachel Struempf

    Person

    We need to be offering our people safe options, especially on the neighboring islands. I live on Kailua Kona, and I put 30,000 miles a year on my car driving to all these people because there just aren't enough of us to go around. Okay, thanks for your time.

  • Rachel Struempf

    Person

    zero, also, Ma, the Midwives alliance of Hawaii does not speak for me. I want to be very clear. They do not speak for me. They do not speak for the Hawaii Midwifery Council. They do not speak for over 20 of the licensed midwives in the state.

  • Jenna Takenouchi

    Legislator

    Thank you. Thank you. Next, we have the American College of Obstetrics and Gynecology in support on Zoom.

  • Ricardo Bravo

    Person

    Hi, Members of the Committee. I'm Dr. Molero Bravo. I'm an OBGYN. I'm here on behalf of the Hawaii section of the American College of Obstetrics and Gynecologists to offer Strong support for HB 1194. This Bill is a vital step towards ensuring safe, regulated and equitable access to midwifery care in Hawaii.

  • Ricardo Bravo

    Person

    Protecting the health of pregnant individuals and their newborns while maintaining the right of families to make informed decisions about their birth experience. This Bill establishes clear licensure requirements for certified midwives and certified professional midwives, ensuring that all licensed midwives meet recognized educational and clinical training standards.

  • Ricardo Bravo

    Person

    By requiring licensed midwives to provide clients with essential information about their credentials, licensure status and scope of practice, this Bill empowers families to make informed choices about their birth care. HB 1194 aligns Hawaii with national best practices by establishing continuing education and peer review requirements to uphold clinical excellence.

  • Ricardo Bravo

    Person

    It also mandates data submission to improve public health monitoring and inform future maternal health policies. Midwifery care is a proven strategy for addressing disparities in maternal health outcomes, particularly among the historically underserved communities. Expanding access to regulated midwifery services ensures that more families, especially those covered by Medicaid, can benefit from midwifery led care models.

  • Ricardo Bravo

    Person

    Hawaii has a long history of valuing both traditional and modern approaches to childbirth. HB 1194 respects this balance by preserving cultural traditions while ensuring that all midwives who provide maternity care meet professional competency standards.

  • Ricardo Bravo

    Person

    This Bill does not take away options, it enhances them by ensuring that every pregnant individual in Hawaii has access to safe, high quality and well regulated care. And for those reasons, we respectfully urge the Committee to pass HB 1194. Thank you for the opportunity to testify today.

  • Jenna Takenouchi

    Legislator

    Thank you. Next we have Midwives alliance of Hawaii and support on Zoom.

  • LeĘ»a Minton

    Person

    Aloha Chair Yamashita and Committee Members. My name is Leʻa Minton and I am the Board President of Midwives Alliance of Hawaii. We appreciate this opportunity to testify in strong support of HB 1194 HD1 accredited education is critical for midwifery education as it includes both standardized curriculum and hands on clinical training known as apprenticeship.

  • LeĘ»a Minton

    Person

    The curriculum ensures standardized education is provided and student knowledge is tested through each stage. This field facilitates integration of midwifery knowledge into practice. It additionally requires the schools and teachers to stay up to date on national recommendations and guidelines related to maternal and newborn care.

  • LeĘ»a Minton

    Person

    The combination of hands on clinical skill training with the standardized curriculum ensures that midwives are minimally competent to care for and manage pregnancies, family planning and newborn care. An education with apprenticeship only, also known as the pep, is missing exactly that the didactic portion of midwifery training.

  • LeĘ»a Minton

    Person

    Student midwives trained through the apprenticeship only pathway have many gaps in their knowledge and are only exposed to the knowledge that the one to two preceptors have shared with them.

  • LeĘ»a Minton

    Person

    If the midwives teaching the students don't keep up on the latest information, which they are not required to do nor prove their own knowledge around the national standards of maternal and newborn healthcare, then students can learn inaccurate information and perpetuate it in their own practices and teach others erroneous information.

  • LeĘ»a Minton

    Person

    This has consequences for the consumer and our public health. For example, a preceptor in Hawaii did not know the national recommendation for gestational diabetes screening. This meant that a large proportion of pregnant people receiving the midwife's care who had gestational diabetes were missed.

  • LeĘ»a Minton

    Person

    They were not provided correct information about how a condition could impact them and their baby so that they can make an informed choice about what they wish to do for management during their pregnancy. Their gestational diabetes was not addressed in order to be managed.

  • LeĘ»a Minton

    Person

    Followed up to determine if they had diabetes type 2 postpartum was not done and students then went on to practice with incorrect knowledge. This information had been shared over numerous years with students and this occurred because there is no system of checks around what education is being given to the student.

  • LeĘ»a Minton

    Person

    When we are in an apprenticeship only model like puppies in accredited education, the curriculum is reviewed. Had one of the students of this preceptor been in an accredited midwifery school, they could have shared the correct information.

  • LeĘ»a Minton

    Person

    They learned about the lab values for gestational diabetes with the preceptor and that would have positively changed the preceptor's practice and improved our community. Accredited education also supports the profession of midwifery by helping to update preceptors along the way.

  • LeĘ»a Minton

    Person

    We know PEP and accredited education are not equivalent educational pathways as I myself as a certified nurse midwife licensed in Hawaii as an advanced practice registered nurse, am eligible to sit for the NARM exam to be a certified professional midwife based on my accredited education.

  • LeĘ»a Minton

    Person

    This demonstrates that NARM exam does not mean equivalent knowledge as what I learned in graduate midwifery education is beyond what someone learns in an apprenticeship program.

  • LeĘ»a Minton

    Person

    We further acknowledge that Washington State, which was previously brought up today as an example, did stop accepting the PEP pathway in 2013, does require double the number of births that NARM requires in order to be eligible for licensure in Washington and requires additional pharmacology training and education for their midwives.

  • LeĘ»a Minton

    Person

    So we do not feel that that is an example that we would look to in saying that PEP should be continued in Hawaii. We share that NARM's position on standards for midwifery is to say that each individual certified professional midwife creates their own individual standard standards. Our state cannot use that as a guideline.

  • LeĘ»a Minton

    Person

    We support continued required accredited education. Additionally, we wanted to acknowledge the DCCA's concerns in their testimony today about enacting a process to receive an attestation by 2029 that licensed midwives have participated in data submission and peer reviews and to be able to confirm that licensed midwives have maintained their CPR and neonatal resuscitation certifications.

  • LeĘ»a Minton

    Person

    We share that 21 out of 38 CPR states that licensed midwives require CPR neonatal resuscitation and require data be submitted anywhere from 30 days to annually. Further, 15 out of 38 states require peer review.

  • LeĘ»a Minton

    Person

    We have full confidence that the DCCA will be able to establish a process within the next three years to receive licensed midwives attestation as several other states have successfully implemented these requirements and we are available to assist dcca.

  • LeĘ»a Minton

    Person

    These requirements are critical to licensure of midwives because currently other health professionals participate in hospital and clinic based peer reviews and must follow insurance plan requirements and they submit data through insurance billing data and quality improvement databases through their employers that often are a part of statewide initiatives.

  • LeĘ»a Minton

    Person

    And they submit birth certificate data in a way that captures more accurate information, meaning people like myself, OB GYNs, family medicine physicians. Further, the other healthcare professionals are required by these systems to always maintain their CPR and neonatal resuscitation if they're providing care to adults and neonates.

  • LeĘ»a Minton

    Person

    It is renewed every two years regardless of when their state license renews or their national certification. Licensed midwives are not tied into these systems as demonstrated by a brief example, a midwife who transported a pregnant person and their baby into a Hawaii hospital both near death and at arrival.

  • LeĘ»a Minton

    Person

    The baby died and the mother spent an extended stay in the nicu. The healthcare team in the hospital was required to review this outcome over many months while the midwife did not attend a peer review and this data was in fact reflected in hospital hospital data.

  • LeĘ»a Minton

    Person

    The purpose of licensing midwives is for the safety and protection of consumers and with that we feel strongly that data submission, peer review, CPR and NRP should remain as is in HB 1194 HD1. Thank you for this opportunity and we ask you to pass HB1194HD1. Mahalo.

  • Jenna Takenouchi

    Legislator

    Thank you. Next we have the American Academy of Pediatrics Hawaii Chapter in support on zoom.

  • Maya Maxym

    Person

    Good afternoon, My name is Maya Maxym. I am a pediatrician and the co chair of the Advocacy Committee for the Hawaii Chapter of the AAP.

  • Maya Maxym

    Person

    We stand on our written testimony, but I would like to just take a moment to describe to you what it's like for a child and family to live with the consequences of a birth that hasn't been managed well and to let you know that while home birth is a safe and reasonable option under many circumstances, there are also circumstances where it is not safe and or where emergencies arise that need to be recognized immediately in order to avoid the consequences that I'm going to describe.

  • Maya Maxym

    Person

    So when an infant during the birth process or immediately after birth does not receive adequate oxygen to their brain, they don't have a lot of time before they can have irreversible consequences and preventable lifelong disability. This condition is called hypoxic ischemic encephalopathy, which basically means brain dysfunction due to lack of oxygen.

  • Maya Maxym

    Person

    And the children that I have cared for who unfortunately suffered birth emergencies at home and were not able to be to receive the medical care that they provided quickly that they needed quickly enough, suffer cerebral palsy, lifelong seizures, sometimes are not able to eat by mouth, to walk or to talk, and often result in the parents not being able to work because of the fact that they require around the clock care.

  • Maya Maxym

    Person

    Now, I take care of many disabled children and I love them dearly. But I also know that preventing preventable disability should be a goal for all of us. So when we ask for you to support this Bill, it's because it is a way to prevent this kind of disability from occurring when it's completely preventable.

  • Maya Maxym

    Person

    Emergencies need to be recognized and the midwives who are attending home births should be trained in responding to those emergencies. As others have said, not limited to but certainly including CPR for the mom and nrp, which is infant resuscitation for the baby. So in the interest of time, I will stop here.

  • Maya Maxym

    Person

    But thank you so much for the opportunity to testify. I actually need to go see a patient, but I would be happy to answer any questions by email later on and you have that information in my written testimony. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. Next we have Night Bloom Birth in opposition on Zoom. Jasmine Mayas.

  • Jasmine Mays

    Person

    Aloha Chairs and Members of the Finance Committee and thank you for the opportunity to speak. My name is Jasmine Mays. I'm a licensed midwife on Kauai and a Member of the Hawaii Home Birth Collective. I oppose House Bill 1194 as it is currently written.

  • Jasmine Mays

    Person

    I would like to see changes made that allow me to stand in support of the Bill. The Midwives of Alliance of Hawaii does not speak for me or represent my views. I support and recommend the proposed amendments as submitted in writing by Hawaii Home Birth Collective and I stand by my written testimony.

  • Jasmine Mays

    Person

    I am in support of continued licensure of CPMs and CMS and would like to be able to support this Bill with important changes. I also support the inclusion of all cultural and traditional midwives. Please find a way to address the concerns of your constituents as this Bill moves forward.

  • Jasmine Mays

    Person

    As time is limited, I will speak to a specific section that I would like to see changed.

  • Jasmine Mays

    Person

    I am referring to page 44, line 1, which states that employing, utilizing or attempting to utilize any person not licensed under this chapter where licensure is required is grounds for refusal to grant, renew, reinstate or restore licenses and for revocation, suspension or denial of licenses.

  • Jasmine Mays

    Person

    House Bill 1194 does not provide the ability for CPMs to utilize unlicensed assistance and it restricts the delegation of tasks to administrative tasks. It does not protect me when I'm supervising or delegating tasks and it threatens to revoke my license if I employ, aid or utilize anyone to do anything at a birth that requires a license.

  • Jasmine Mays

    Person

    I'm asking that you please add language to allow us to supervise unlicensed personnel and delegate tasks as a staff. In the Hawaii Nursing Law, which defines unlicensed assistive personnel, we should have as midwives the same ability to have an individual who's not licensed to practice nursing but provides tasks of nursing care.

  • Jasmine Mays

    Person

    In the State of Hawaii, it is unrealistic for those of us practicing in rural communities to be able to have a second licensed midwife present for all deliveries, while a team of at least two individuals certified in neonatal resuscitation is recommended at Every birth. The state does not need to regulate who we ask to assist us.

  • Jasmine Mays

    Person

    Here on Kauai, there are only four licensed midwives actively practicing. To my knowledge, there is only one student currently enrolled in a meek accredited educational program. It is unsafe to restrict the ability of midwives to arrange for a skilled helper or unlicensed assistive personnel to be present at birth.

  • Jasmine Mays

    Person

    It would be physically, financially and logistically impossible to attend my own clients as well as those of other midwives. My standards are high. I want everybody who attends birth with me to be NRP Neonatal Resuscitation Program certified. I want every assistant who attends birth with me and helps me to be certified in adult cpr.

  • Jasmine Mays

    Person

    I believe that I, as a licensed midwife and as a cpm, am able to uphold these standards for myself and that the availability of those unlicensed assisted personnel is the most important piece. Thank you for the opportunity to testify.

  • Jasmine Mays

    Person

    Thank you for your part in helping to increase safe care for the families of Hawaii and for your service to the community.

  • Jenna Takenouchi

    Legislator

    Thank you. Next we have ACLU of Hawaii in opposition.

  • Carrie Shirota

    Person

    Chair, Vice Chair, Committee Members, Carrie Ann Shirota. On behalf of the ACLU of Hawaii, we want to start off by saying that we support license regulations for midwifery. However, we oppose this Bill because it falls short of protecting constitutional rights relating to reproductive freedom, autonomy, privacy in Hawaii, as well as traditional customary practices.

  • Carrie Shirota

    Person

    Having said that, I know that if I get into sort of constitutional theory, I might put people to sleep. And it's been a long day, so I want to share with you a story. Some of you may know that I grew up on the island of Maui in a very rural community about 40 minutes from the hospital.

  • Carrie Shirota

    Person

    And I want to share something that just context. My great grandmother gave birth to 10 children, some of whom went to the medical Western Doctor. Some babies were born at home with the care of trusted midwives in the community.

  • Carrie Shirota

    Person

    My grandmother had eight children, one of whom was born, lived only three hours at the Puu Nene Hospital and died under the care of a obgyn. Then my mother, four children, I'm her third born at Maui Memorial Hospital, and she was hemorrhaging. I almost died because I was breech.

  • Carrie Shirota

    Person

    And at the time, the practice under this hospital was to literally strap a woman down. And there was an umbilical cord around my neck. And people said, well, the doctors helped to save you and your mother. Yes, but there were other midwives who told my mom that I was breached.

  • Carrie Shirota

    Person

    And the doctors didn't do anything to help my mom so that I would be huli opu in her opu and that I wouldn't have been born breech, which could have prevented me from possibly dying and my mom from bleeding to death at Maui Memorial Hospital under the care of a trained physician.

  • Carrie Shirota

    Person

    13 years later, I gave birth on Maui and I was considered a high risk pregnancy. And thankfully I had the option. I gave birth in a hospital. It was my choice. But I also sought complementary care in the community.

  • Carrie Shirota

    Person

    Just last year, my niece, who also lives in Kaupukalua, 40 minutes away from the hospital, she went to the federally qualified clinic in Wailuku, first time mother.

  • Carrie Shirota

    Person

    She was told that in order to continue to receive services from the federally qualified clinic that she would have to sign a paper and give away her rights if she wanted to have a home birth, that they would literally cut her off as a patient unless she signed the form.

  • Carrie Shirota

    Person

    And because my niece is young and she's scared and it's her first pregnancy, she signed that form. But the fact that my niece in 2024 had less rights than I did, or my mother or my grandmother, my great grandmother, seriously, something's wrong here. We say we won't go back, but we have.

  • Carrie Shirota

    Person

    And it is our collective Kuleana to protect the rights of everyone in our community to have choices. For those who want to go to the hospital, we support that.

  • Carrie Shirota

    Person

    But for those who want to give birth at home, which has been practiced since time immemorial, we're trying to criminalize some behaviors which you will not to criminalize a grandmother who is there at the home birth of their grandchild to criminalize potentially a doula or lactation specialist or as a birth attendant. What are we doing?

  • Carrie Shirota

    Person

    And when we say criminalization, it subjects a person to fines and criminal penalties, meaning a criminal conviction and up to one year in prison for being a birth attendant unless we create clear exemptions in the law. And so I'm going to get to the wonky part of the constitutional law.

  • Carrie Shirota

    Person

    I would ask that you include exemptions for religious and cultural birthing practices, that clear exemption. I want to point out that Massachusetts just last year passed an omnibus maternal health Bill, including midwifery license, and they have a clear exemption for traditional for religious and cultural practices. And there's also another exemption very clear for Native Americans.

  • Carrie Shirota

    Person

    Massachusetts, by the way, is considered the number one best state in terms of maternity health care compared to any other states. And I think we know where Hawaii is at a much lower level. So why would we restrict rights and access? And that brings us to the PEP pathway we've heard about.

  • Carrie Shirota

    Person

    Unfortunately, the NARM President was not able to present today. And I think that her testimony, while it was so important to be read into the record, there is a national accreditation body that is recognized and for some reason we are only allowing one pathway to become licensed.

  • Carrie Shirota

    Person

    Now, we've heard here from some of the testifiers about these tragic stories. But for every tragic story that they have shared, I can pull up on my phone the number of cases of malpractice and lawsuits against OB GYNs in the medical establishment. We need to look at data.

  • Carrie Shirota

    Person

    If you look at some of the data in Hawaii from the Department of Health, there weren't severe concerns about homework. In fact, there's a lot of literature that shows nationally and internationally, the more you have integrated care between midwifery and Western medicine, that that produces better outcomes.

  • Carrie Shirota

    Person

    This journal, Hawaii Journal of Health and Social Welfare 2020, talks about that a number of the maternal mortality in Hawaii is preventable. And they list mental health issues and substance abuse treatment. And we all know that there's not enough mental health treatment and substance use treatment in our community.

  • Carrie Shirota

    Person

    So if we want to decrease maternal mortality, that's what we should be focusing, not criminalizing the exercise of the right. Because it is very clear a person has the right to give birth at home, unattended or not. And there are greater risks to give birth at home or anywhere unattended for that matter.

  • Carrie Shirota

    Person

    So the PEP pathway, please take a look carefully at that pathway. And I want to say they're not here today, but at the last hearing, a number of us were very teary eyed and I want to bring this to both of you.

  • Carrie Shirota

    Person

    As Maui residents, there were two native Hawaiian young women who during the fires they helped just Kukua mothers who are in need and they are aspiring to be midwives. And they want to pursue the PEP pathway. This apprenticeship. You think about it, we allow for many apprenticeship pathways.

  • Carrie Shirota

    Person

    We allow carpenters to go to a community college and get their degree in carpentry. But we also allow carpenters and other professions to get their training through apprenticeship programs. But they take the same exam and if they meet those minimum standards, they can get their license. And that's what NARM is doing.

  • Carrie Shirota

    Person

    They're saying both pathways lead to the same exact certificate. So by, for some reason, if we exclude this PEP pathway, we are hurting aspiring people in our community, many of whom are Kanaka Maoli women who want to blend traditional and customary practices relating to healing and birthing along with midwifery.

  • Carrie Shirota

    Person

    Knowledge that they can learn through this PEP plus bridge pathway. And so we talk about the critical health shortage in Hawaii. When we talk about the maternal health desert, this is one way to address that.

  • Carrie Shirota

    Person

    Now, this does not mean that we foreclose the right to the meek schooling, which is a midwifery schooling, but individuals have to travel to the continent to, I think, one of eight or 10 schools. It costs money. There's time. Some people are mothers and they can't travel or they're taking care of their kupuna in their household.

  • Carrie Shirota

    Person

    So we want to keep as many pathways as possible. And if I could just ask all of you, keep in context that at the heart of this is reproductive rights. Everyone's afraid about what's happening at the federal level. Less access to abortion, possibly the abortion pill.

  • Carrie Shirota

    Person

    But I'm concerned right now about the fact that our lawmakers might pass a Bill that's taking away the rights of us and the next generation.

  • Carrie Shirota

    Person

    So I humbly ask that you add back in the PEP pathway as a means to licensure and that you have clearly defined exemptions for birth attendance with consumer protections as outlined by the DCCA, which currently existed until expired in 2023, that we add an exemption for religious and cultural practices, and that you also incorporate the comments that were submitted by Native Hawaiian Legal Corporation, keeping in mind that they are currently in litigation with the state in Kahoohanohano versus the state and ensuring that we have very clear language to protect traditional and customary gathering rights. Please help us to not go back. Mahalo.

  • Jenna Takenouchi

    Legislator

    Thank you. Next we have Hoopai Pono Peace Project in opposition.

  • Laulani Teale

    Person

    Aloha chair, aloha vice chair, aloha members, thank you so much for this opportunity to speak. I would like to- I- I should say, I'm Laulani Teale. My project, Hoʻopae Pono Peace Project, is- it's one that works with Hawaiian traditional practices and Ho'opae Pono and peace work.

  • Laulani Teale

    Person

    I'm also a birth practitioner, and I also work within the community on a variety of issues that relate to this issue. So I would like to. I'd like to emphasize, because this is the finance Committee, I'd like to emphasize some of the financial aspects of this issue.

  • Laulani Teale

    Person

    And I think that one of them is the- the clearest and most obvious one, is that we do not have enough maternal health care for our communities. And it's a very, very stark reality. And we don't realistically, at this moment, we do not realistically have a means to provide that where it's needed.

  • Laulani Teale

    Person

    And I'm just talking about maternal health care, period. You know. So on top of that, and a lot of that- a lot of the issue there is cost, right?

  • Laulani Teale

    Person

    And so when we're talking about access to birthing, either services or practices that are chosen by the person who is giving birth, whatever that person is choosing is, that is a means to actually address that maternal health care vacuum that we have. And it is a very serious vacuum. You know.

  • Laulani Teale

    Person

    I think the speaker before me covered it a little bit. But we as Native Hawaiians and Pacific Islanders have the highest maternal mortality. Until the very recent data came out, we had the highest in the United States of all ethnic groups.

  • Laulani Teale

    Person

    Recently, more data has come out that has put Native Americans and Alaska Natives a little bit ahead. But the increase in maternal mortality for Native Hawaiians, Pacific Islanders has been 77% higher. We're talking about a very serious crisis here.

  • Laulani Teale

    Person

    And I think that we also want to look at the financial implications of enforcement of this law, because when you're out in the community and see what is actually happening out there, the people who are not licensed, and I should say that I'm very much for licensure of clinical professionals. It makes sense, right?

  • Laulani Teale

    Person

    For the CMs, the CPMs, that absolutely makes sense. However, the cultural practices that are out there, and not only Native Hawaiian cultural practices, there are Samoan grandfathers who've been doing this for their entire lives. There are Filipino families who fly people in to assist their-

  • Laulani Teale

    Person

    to assist them when they give birth, you know, and that's how they do it. There are. There are numerous other practices throughout our community that are happening.

  • Laulani Teale

    Person

    And quite frankly, I think that in my interactions with people, a lot of people are not even aware that there is a law, because they've been doing this for so long, you know, so the complications that are involved in that kind of enforcement, because they would clearly be outside of the law, are really problematic.

  • Laulani Teale

    Person

    And the fact that family members are not covered, extended family, a grandmother cannot, under this law, cannot attend her granddaughter's birth even if she's a trained midwife. So I think that those are things that should be considered financially, also simple equity in terms of finances.

  • Laulani Teale

    Person

    So when we discuss the PEP pathway, I think that it's really important to understand that the other pathway, the Meek pathway, is not available in Hawaii and that it I- I need to say it again, it's not available in Hawaii. No one has been able to achieve it. There are no Kanaka Maoli licensed midwives for that reason.

  • Laulani Teale

    Person

    And numerous have tried, clinically trained Kanaka Maoli have tried to get licensed and are unable to because the licensure is simply not available here. So whilst 27 states accept PEP, and in all of those states there has been no difference shown in outcome, and outcome is what I think we really need to look at here.

  • Laulani Teale

    Person

    There has been no difference in outcome, it's proven, between those two pathways. And meanwhile, 97% of current licensees are not from Hawaii and 22%, actually, probably more, but at least 22% do not reside in Hawaii at all. So there aren't these. We're talking about a licensure scheme that's not available to our own people. It's not.

  • Laulani Teale

    Person

    And that is a financial problem for the state. So, I- I ask you to deeply consider these things. Also, in terms of safety, let's look at what really constitutes safety. In the five now six years since licensure has been implemented, I believe there has been only one complaint of an unlicensed provider actually just using the word midwife.

  • Laulani Teale

    Person

    And that was a vindictive complaint, quite honestly. It was found not to be substantial. So I think we should be very concerned about the expense that's involved in a situation in which these complaints have thus far only come in not based on danger, not based on actual problems, but on competition.

  • Laulani Teale

    Person

    And let's be frank that that's what we're seeing here. I- I, you know, as much as I love and respect all members of our community, it is not okay to have an exclusive and proprietary approach to something that our people need desperately. So I'm asking that this co- that this committee please consider. Please consider the actual facts.

  • Laulani Teale

    Person

    If we haven't had those complaints, it means that we're actually doing pretty good as- as we are. Even though the licensure is inequitable, we do know that these practices are still continuing. However, the danger is there, and the danger is not within lesser trained individuals. The danger is not getting to the hospital in time.

  • Laulani Teale

    Person

    And the reason that families might not get to the hospital in time are, number one, distance. There's only so much we can do about distance. But the other reason is stigma. And if they're- The way that they are giving birth is stigmatized, they're not going to go into that hospital when they need to go.

  • Laulani Teale

    Person

    And that creates these problems that- that we're hearing about, because they didn't go in in time because of stigma and trauma. So I ask you to please consider this, that one thing we know scientifically and in public health is that any care is better than no care. And if you criminalize people, you get a lot more.

  • Laulani Teale

    Person

    We have 40% more unattended births. Since 2019, the rates have gone up 40% for completely unassisted births, which are statistically the most dangerous. While they are culturally appropriate in some cultures, those cultures involve a lifetime of training. And that's not what we're seeing here.

  • Laulani Teale

    Person

    So, we need to look at the actual needs of our community, the actual equity that's involved, the actual finances, and where the costs really are. And we need to create something that will address all of those things. And unfortunately, at this moment, this bill is not that.

  • Laulani Teale

    Person

    And therefore, I ask this committee, please, to vote no on this measure at this time. Mahalo.

  • Jenna Takenouchi

    Legislator

    Thank you. Next, we have testimony from Patricia Bilek in support on Zoom.

  • Unidentified Speaker

    Person

    Not present.

  • Jenna Takenouchi

    Legislator

    Not present. We have testimony from Trinette Furtado in opposition on Zoom. Not present. Ronnie Texeira, in support on Zoom.

  • Ronnie Texeira

    Person

    Aloha.

  • Jenna Takenouchi

    Legislator

    Hi. Please, go ahead.

  • Ronnie Texeira

    Person

    Okay. Sorry. Aloha. My name is- committee members, I am Dr. Ronnie Texeira. I'm the Chief of OB at Straub and a practicing OB in Kaneohe. My testimony is not representative Straub, but as a physician, a mother, a Native Hawaiian, and a concerned community member, I strongly Support House Bill 1194.

  • Ronnie Texeira

    Person

    OBs and midwives alike agree that a woman should be able to make her decision with informed consent as to where she'd like to give birth.

  • Ronnie Texeira

    Person

    This is a bill that allows for this and pertains actually to the safety and competency of that licensed midwife that a licensed midwife is able to provide, as well as a means to hold that midwife accountable for any practices do not meet the standard of care in the community. This does not prevent home births.

  • Ronnie Texeira

    Person

    It just allows midwives that are adequately trained to obtain a license. A woman can still be delivered by a non licensed midwife, but at least this way the mother can clearly see what type of training the midwife that she chooses has.

  • Ronnie Texeira

    Person

    Another thing I want to bring up is that FQHCs have not required that form that was talked about previously against home births for over a year. That issue was resolved and addressed. The reason physicians are so passionate about having midwives license is because of all the preventative bad outcomes we are seeing coming to the hospital each year.

  • Ronnie Texeira

    Person

    I've personally experienced more than a few of these bad outcomes. These range from inadequate vaginal repairs to unrecognized infections coming to the hospital too late to unrecognized hypertension leading to Preeclampsia and prolonged admissions. The other concerns I have is for the babies being born at home.

  • Ronnie Texeira

    Person

    The majority of the complications that come to the hospital actually involve the child. Most babies will live, but I can't say what kind of quality of life that child may have. That's actually one of the reasons why OBGYNs can be held accountable for up to 18 years after a child is born.

  • Ronnie Texeira

    Person

    This is also a reason why many private OB's in the community are reluctant to work with midwives because there's no way of knowing who is trained according to the standard of care and who is not.

  • Ronnie Texeira

    Person

    HB 1194 will help to bridge this gap and may even lead to a way for home births to finally be covered by insurance. This bill also protects Native Hawaiian practices, which are actually already protected by the Hawai'I constitution, so I don't feel this is a Native Hawaiian issue.

  • Ronnie Texeira

    Person

    I understand that some women will have to get more training, but more than half of the meek schools are available online and all of their clinical practice can be completed in Hawaii. So I don't think we should lower the standard of care or lower the bar just because it's a harder path to achieve.

  • Ronnie Texeira

    Person

    We have to realize that health is changing. We're dealing with diseases that our former practitioners and midwives did not encounter. These include diabetes, hypertension, obesity, in vitro pregnancies, advancing maternal age, multiple gestations, and many cardiac conditions. And these all come with potential complications during pregnancy and especially during delivery.

  • Ronnie Texeira

    Person

    This is why we're seeing increased infant and maternal mortality. We can't rely on years of experience or going through an apprentice program like the PEP program. You have to keep up to date and learn the science behind each condition so that you can always stay ahead of the game during delivery.

  • Ronnie Texeira

    Person

    Because things can go bad very quickly and become dangerous very quickly during delivery. When these patients Come from home- home births, we're often playing catch up because they're coming too late because of conditions that were unrecognized. Even after delivering over 1600 babies myself, I still need to keep up to date on my training.

  • Ronnie Texeira

    Person

    I do certification, and I keep up on my licensing. You always need to be doing and learning more. And this is the standard of care Hawaii women deserve. HB 1194 will require midwives to complete an accredited educational program and uphold the gold standard of midwifery training.

  • Ronnie Texeira

    Person

    I also look forward to working with the licensed midwives through House Bill 1194 to help provide care to the mothers in Hawaii and help facilitate safe transfers to the hospital. There are many good midwives and many good outcomes, but how many more bad outcomes do we need to see before we make some changes?

  • Ronnie Texeira

    Person

    Many of the bad outcomes are not recorded because once a baby or a mom comes to the hospital and say we have a fetal death or maternal death that is recorded as a hospital death, even if the baby, as soon as we put the baby on the monitor in the hospital, we say there's no heartbeat, it's still counted as a hospital death.

  • Ronnie Texeira

    Person

    So that's not why we're not seeing the numbers that we expect to see. So that's why me and my colleagues come up to give all of this anecdotal information, because things are clearly happening. Please don't lower the bar and just keep standard high for the women of Hawaii and Support House Bill 1194. Mahalo.

  • Jenna Takenouchi

    Legislator

    Thank you. Next on Zoom, we have Pahnelopi McKenzie in opposition.

  • Pahnelopi McKenzie

    Person

    Hello, can you hear me?

  • Jenna Takenouchi

    Legislator

    Yes, please, go ahead.

  • Pahnelopi McKenzie

    Person

    I don't think you can see me, but I'm here.

  • Jenna Takenouchi

    Legislator

    Okay, we can hear you fine.

  • Pahnelopi McKenzie

    Person

    Okay. Okay. Hi, everyone. Thank you so much for having this meeting.

  • Pahnelopi McKenzie

    Person

    We thank you for all the years of all of the testimony, the time that you have spent on this issue and trying to find a solution for reproductive health care here in Hawaii and midwives as a cornerstone of safe prenatal care and birthing care.

  • Pahnelopi McKenzie

    Person

    I think I do stand on my written testimony, but I wanted to share a few things and then share a little bit of excerpts from researchers and authors with clear information.

  • Pahnelopi McKenzie

    Person

    But I want to say, as we discuss this midwifery issue and maternal health crisis, we see that about 2% of births are home births, but we see a maternal health crisis, and we see the most dangerous industrialized nation to give birth in is America. And this is hospital statistics.

  • Pahnelopi McKenzie

    Person

    Home birth is very small percentage of who's actually getting care. So when we look at the maternal crisis. This data is hospital birth. So even as the doctors say, yes, there's transfers, but that's what we're saying is that everybody deserves health care. We may have cancer, we may have heart disease, we may have.

  • Pahnelopi McKenzie

    Person

    That's how we have our practitioners that offer wide range of care. And if we could understand that collaborative care is what the birthing people need, that's what we need to stop this maternal health crisis. These continued regulations are only distracting from the amount of violence and harm that's going on in the hospital and has been going on.

  • Pahnelopi McKenzie

    Person

    We see it when we're doulas in the hospital. We see it, we hear stories, but again, it's not about who's bad and who's wrong. We're all midwives have extreme skill and there's a variation of what that skill looks like. But to remove-

  • Pahnelopi McKenzie

    Person

    to remove midwives because they haven't taken one pathway of education and to destroy the global brilliance that we see that we could be having from Japanese midwives to Brazilian midwives to Colombian midwives, that where are all the midwives? Everybody had midwives. Where did they go? They had to go underground and then they disappeared.

  • Pahnelopi McKenzie

    Person

    Under all of these laws that we see continuing, continuing to happen that have made it now we have zero Kanaka midwives in Hawaii. We have where are. Anyway, I could go off on it, but it really is the birthing person and it really is the- the restrictive laws that have happened. But it's not actually making people safe.

  • Pahnelopi McKenzie

    Person

    If that was true, we wouldn't be seeing the numbers that we're seeing. And it's a global issue and the lack of midwifery care is actually finds the same data. As the high obstetrical rates of harm is happening, so too is little the midwives in America and in- in Hawaii.

  • Pahnelopi McKenzie

    Person

    So I just really want to make sure that we're understanding that the midwife is a small percentage. So the maternal crisis. We must investigate what's happening in the hospital, what's happening long term. But we're here for home birth.

  • Pahnelopi McKenzie

    Person

    So I just- I just want to give a little bit instead of testimony because we have so much testimony and such brilliant. I just want to kind of take us in a little. We can see through history. We have the same story.

  • Pahnelopi McKenzie

    Person

    We're here right now in 2025, but here we are in 1902 in the Victorian Era Midwives Act of 1902, the law mandated formal training registration on a national role, strict supervision to be overseen by the newly created midwife board. It was the end product of a vigorous effort.

  • Pahnelopi McKenzie

    Person

    The Midwife Act was indeed to professionalize midwifery and create new career pathways for single women. The Midwife Institute was determined to cut the lay midwife completely out of the birthing process. The women who were chartered members were not practice midwives as we see today, Although they have been trained at elite centers.

  • Pahnelopi McKenzie

    Person

    The leaders of the Midwives Institute were nurses, hospital authorities and heads of various charity organizations who were interested in social reform. They intended to open up midwifery as a profession where the properly trained middle class woman would have an honorable means of supporting herself. And that's from 1902, but it sounds very similar to today.

  • Pahnelopi McKenzie

    Person

    And then we can go to between 1880 and 1950. A researcher, Susan Smith she states the relation between licensed midwives. Most of this is from- this is from a book called the Japanese American Midwives.

  • Pahnelopi McKenzie

    Person

    But the relations between licensed midwives, most of who were Japanese immigrants and the midwife supervisor was a Chinese American Illustrates women in cross cultural relationships and interactions among different peoples of color. The point of contact revealed its little examined aspect of history of racial politics in health care.

  • Pahnelopi McKenzie

    Person

    In contrast, the more frequently told story of interactions between people of color and whites. The history of midwifery- midwifery regulation in Hawaii demonstrates that midwifery was a site of constant negotiation among women, Whether between midwives and nurses or among midwives themselves.

  • Pahnelopi McKenzie

    Person

    In Hawaii, these power struggles took place among ethnic diverse women within a colonized land with the most powerful players the territorial government, the planter elite and the military representing the haole interests. The very process of midwifery regulation excluded certain groups from the beginning.

  • Pahnelopi McKenzie

    Person

    For example, many Native Hawaiian healers and midwives, the Kahuna and Pale Keke, did not register with the Board of Health, A topic that warrants further explanation. Men as well as women and fathers played an important role. In the 1930s when the midwife licensing began in Hawaii,

  • Pahnelopi McKenzie

    Person

    most of the midwives who applied for a license lived in urban areas, Although most of the population lived in rural. Government records indicated that licensed midwives lived with about 40% of babies born in Honolulu. The Japanese immigrant women gave birth to some 4,000 babies annually and were served by the midwives.

  • Pahnelopi McKenzie

    Person

    The American occupation nurses turned midwifery into merely a field of nursing. And ironically, the name of promoting women's rights and autonomy. The nurses to remake the midwife who were independent practitioners into nurses who worked under doctor supervision. So we see in these as we go through time, we're still doing the same thing.

  • Pahnelopi McKenzie

    Person

    We're still criminalizing the midwife instead of addressing the issue. So midwives, this PET pathway, it is valuable. It does have extreme value here in Hawaii. The lack of techniques, preceptors, it goes on and on. But really, the PET pathway is so important.

  • Pahnelopi McKenzie

    Person

    And cultural practitioners, that's how most of us, our families are alive is because we had cultural practitioners. That's from the beginning of time. So don't let us let this 200 years of obstetrical violence and obstetrical capacity and brilliance too, negate the brilliance of traditional and culturally trained practitioners in today's society. And that's what collaborative care looks like.

  • Pahnelopi McKenzie

    Person

    All of it is welcome for the safety and well being of birthing people here in Hawaii. It's not about the midwife or the Doctor. It's about the baby and it's about the birthing person. And we know that midwifery care is excellent. And so we need to protect these amendments that have been.

  • Pahnelopi McKenzie

    Person

    We are asking for who to choose the birth, who can attend the birth, and that cultural and traditional practitioners have a right. The PEP pathway is valuable. Please, please make that available. We need it to grow this profession. I'm not a midwife. I'm a home birth mother.

  • Pahnelopi McKenzie

    Person

    So I just ask you to look at the amendments that Hawaii Home Birth Collective presented and please add them to this bill so that we can all get the care that we need. Thank you guys for your time. Again, I sent in my written testimony, but I appreciate you all and thank you for letting me speak soon.

  • Pahnelopi McKenzie

    Person

    Thank you very much.

  • Jenna Takenouchi

    Legislator

    Thank you. Next on Zoom, we have Alexandra Kitu in opposition, not present. Next we have on Zoom, Lisa Sikai Darcy in opposition, not present. And next we have Ohia Midwifery Wellness in support.

  • Margaret Ragan

    Person

    Mahalo and aloha again. I...

  • Jenna Takenouchi

    Legislator

    Can you just state your name for the record?

  • Margaret Ragan

    Person

    Yes, of course. My name is Margaret Ragan. I am an owner and staff midwife at Ohia Midwifery and Wellness on the island of Hawaii. I appreciate everyone's patience with all of the people coming forward with testimony today.

  • Margaret Ragan

    Person

    It's already a long day and also this issue has been discussed for years. The regulation of midwifery specifically has been documented in auditors, sunrise evaluations, sunset analyses, and we are awaiting the current Auditor's sunset analysis report.

  • Margaret Ragan

    Person

    I wonder how much of this testimony we would have to be hearing if we actually had solid data on what has happened these past five years. As a practitioner, a licensed midwife who has, as I mentioned before, or.

  • Margaret Ragan

    Person

    Or it's hard for me to remember what I mentioned before actually, have worked extensively with DCCA to address inadequacies that were in 457 so that the CM could practice to the full extent of their credential. DCCA was not able to address limitations.

  • Margaret Ragan

    Person

    I have experienced barriers to trade as a licensed midwife, and though DCCA was open to trying to address these issues, they were not able to address that. Everyone who is speaking here today has issue with the roots of their problem in Act 32 and those that are requesting amendments...

  • Margaret Ragan

    Person

    ...it's very complicated and to be honest, I'm not sure where we're at in this process. In the last hearing, people spoke genuinely from their experience and at the end of it, we were told that a Bill had been chosen between the two and the amendments were prepared.

  • Margaret Ragan

    Person

    So we put a lot of energy into providing information to you from the field and how are you to proceed to understand what is the right course of action.

  • Margaret Ragan

    Person

    So I can explain that as a practicing licensed midwife who previously worked in a state where I had full practice authority, including prescriptive privileges, I could work in a hospital, I could prescribe medications, I could assist in surgery, I was credentialed as a Medicaid provider, I was credentialed with all private insurance companies.

  • Margaret Ragan

    Person

    There was equitable access to care. Enough groundwork had been done as well for people with my credential. I'm a certified midwife who worked within a community setting in a birth center and or in home birth where private insurance companies reimbursed at rates of $15,000 for nine months of care.

  • Margaret Ragan

    Person

    That number might seem high, but the quality of preventative care that midwives provide is worth more than that. The March of Dimes report card for Hawaii was referenced in both the Ohia Midwifery testimony and the Hawaii affiliate testimony. It's important to look at those policy recommendations. Those are based on outcomes, those are based on data.

  • Margaret Ragan

    Person

    The primary c-section rate in the state is generalized across the whole state. That number is not what we see on neighboring islands. And I've had private conversations with the staff at Kona Community Hospital and they talk about the parameters under which they need to work. Why is their c-section rate so high?

  • Margaret Ragan

    Person

    They, they don't have an OB on the floor. They don't have a 24/7 OR ready for a stat c-section. They don't have enough blood and so they need to proceed within their limits. And, and women, pregnant birthing people, are subject to primary c-section that would not otherwise be subject to that on neighboring islands.

  • Margaret Ragan

    Person

    Now once you have a c-section on a neighboring island, which is the majority of the state, these rural, like we're talking Maui, Molokai, Lanai and Hawaii, you only can have c-sections. And to think that this is the way to proceed. You're missing the point of not integrating licensed midwives into public health policy.

  • Margaret Ragan

    Person

    So the way that the discussion has been moving forward is reduction of harm. A very, what do you call it in Hindi? It's a muhavare, an anomaly or whatever. We cannot throw the baby out with the bathwater. We can't just mandate licensing and think that we're going to solve a problem. It is way more complex than that.

  • Margaret Ragan

    Person

    Health issues for mothers, birthing people, for those fetuses, for the newborns, need to have midwifery as a part of an option of where they can receive care. And if you look at the policy recommendations of the March of Dimes, midwives are at the forefront of the recommendation.

  • Margaret Ragan

    Person

    Medicaid, expansion of Medicaid and access to care is at the forefront. We have been in contact with Medicaid office.

  • Margaret Ragan

    Person

    If the statute clearly establishes the scope of practice to the full extent for the CM in equivalence with the CNM, of which we are, we can move forward and bring about that credential as an option to address provider shortage and expand access to care.

  • Margaret Ragan

    Person

    For the CPM, if they are established to the full extent of their credential with limited prescriptive authority, that will help in the same way. Again, they can be credentialed through Medicaid and people can access their care and benefit from the state paying for these services for which they pay for if you go to an OB.

  • Margaret Ragan

    Person

    So I just want to address. I really appreciate the fact that I felt comfortable going off script because for some reason it does seem that you do want to hear from the community.

  • Margaret Ragan

    Person

    And I just want to touch on a couple things that we have been in conversation with ACOG and it'd be nice if it was a conversation but there was mention of equitable access to care. So I tried to address the fact that currently HB 1194 HD1 cannot support equitable access to care yet. Why not?

  • Margaret Ragan

    Person

    It doesn't reflect national standards for the CM nor the CPM. Suggested amendments by HA bring it into that equivalence. So these issues have to do with scope of practice being very clearly defined. So there is. There's vague description of scope of practice. It needs to be. There's the scope of practice of licensed midwives.

  • Margaret Ragan

    Person

    Then there's the scope of practice of the certified midwife. How does it differ from the scope of actions of the professional midwife? If that is in the statute, we can move forward with with Medicaid, can move forward and do what they need to do.

  • Margaret Ragan

    Person

    It's not there yet and the amendments aren't substantial in the changes but they're essential to actually expanding access to care. There was a comment by a representative of MA and I have to say dating back I think it was.

  • Margaret Ragan

    Person

    It's hard for me to keep all the auditors reports in like in alignment but there was caution around how it would be discriminatory to only regulate and or regulate in the sense of uplifting a credential one to the exclusion of others.

  • Margaret Ragan

    Person

    And a lot of the conversation is really only about focusing on how to move a licensure forward for a meek accredited CPM. How many people have actually spoken to the CM besides me? Like really spoken to it? Nobody. Right? It's not important. I'm the only one. And who in Hawaii can understand the value of the CM?

  • Margaret Ragan

    Person

    So just super briefly, the CM is an equivalent credential to a CNM. It was developed by ACNM in the 90s as a specialty. So what is available now to the people in Hawaii? If there were a Master's program, a non-nurse could enter a master's midwifery program and sit for the same exam as a CNM and work in all of those environments.

  • Margaret Ragan

    Person

    Currently There are about 50 CNMs working throughout the state and I and any other CM who could get a license in Hawaii should be able to work in all of those places. So we are asking that these aspects of the Bill that the HA has suggested can correct it and pave this pathway.

  • Margaret Ragan

    Person

    The peer review and data submission is completely inappropriate to require a CM who generally is an employee of an institution to be required to meet these things because every institution would prohibit it by HIPAA.

  • Margaret Ragan

    Person

    So if I have an adverse outcome as a hospital employee, there's a whole infrastructure and there's lack of recognition that there are two different licensed midwives being addressed. And we've spoken to that in our suggested amendments. There was a CPM who spoke to delegation of tasks to an unlicensed assistant.

  • Margaret Ragan

    Person

    The language that was in 1328 was pulled directly from the Hawaii Administrative Rules for Nurses where they are allowed to delegate tasks to an unlicensed assist. Why would midwives not be allowed to do that? For the CPM who only works in a community setting, it would be unsafe to not allow this and she spoke to that very clearly.

  • Margaret Ragan

    Person

    But I just wanted to reiterate that for the CM, it's also very important for me to be able to delegate tasks to an unlicensed assistant. Prescriptive authority. I'd like to speak to that just briefly. The way that this Bill currently is written is that it moves in tandem with licensing.

  • Margaret Ragan

    Person

    So we tried to address that in our amendments. So for a CM who's been working for more than three years, they will not have just completed 30 hours of pharmacology. To maintain your certification through the American Midwifery Certification Board, our national credentialing body, there are pharmacology CEU requirements for every five year cycle.

  • Margaret Ragan

    Person

    There's an accountability to what we are allowed to do. So the way that this Bill is written is it kind of only works for a recent graduate, which is actually not the only people you want to be inviting into your hospitals in Hawaii. So we are asking for an inclusion of proof of prior prescriptive authority. As an other.

  • Margaret Ragan

    Person

    If you can't prove that you just did 30 hours, can you prove that you've been prescribing? And why is it important that it be independent? Well, not every CM might need prescriptive authority to begin working.

  • Margaret Ragan

    Person

    If they couldn't meet all of those requirements just because they can't qualify or prefer prescriptive authority of whatever's established, should that prevent them from becoming licensed? A CM who might want to work within the community. They could work equivalent to a CPM in the community, but they can't if they haven't fulfilled this requirement.

  • Margaret Ragan

    Person

    Or they could fulfill it after on a different timeline. But the way that it's written, it's going hand in hand. And what else? In closing, there was a lot that I felt was very relevant from Laulani's statement. I think that there's a lack of understanding that this regulation is for all non-nurse midwives. Right.

  • Margaret Ragan

    Person

    So nurse midwives have been regulated. So we're talking about regulation of non nurse midwifery. And it kind of goes back to that question of are we going to discriminate and only regulate one particular type of midwife? So there are certain midwives that are moving forward and they are providing essential care to their communities.

  • Margaret Ragan

    Person

    Do we only provide for those that are moving on one track? Which brings me back to the void of having an analysis of how these last five years have gone. I'm sure everything cannot be addressed today. I hope you try hard to address what's needed today to move forward.

  • Margaret Ragan

    Person

    But I very much am hoping from the time that we enter into Senate hearings, presuming that this will pass today - and I don't know what kind of asks can come from the House or asks can come from the Senate to the Auditor's office - but we need something to lean on for direction, and I really hope that that comes forward. Thank you for your time.

  • Jenna Takenouchi

    Legislator

    Thank you. Next up, we have Alfred Medeiros in opposition on Zoom. Not present. Excuse me. We have Rachel Colonel Strump. Not here. On Zoom we have Makalani Franco-Francis in opposition.

  • Makalani Franco-Francis

    Person

    Hi. Aloha. Can you hear me?

  • Jenna Takenouchi

    Legislator

    Hi. Yes, we can. Please go ahead.

  • Makalani Franco-Francis

    Person

    Aloha. My name is Makalani Franco-Francis, and I'm in strong opposition of HB 1194. I am a home birth mother of three. I am a Native Hawaiian midwifery student under the apprenticeship learning. And this Bill affects me in all of those ways.

  • Makalani Franco-Francis

    Person

    This Bill, not including the portfolio evaluation process, is discriminatory against Hawaiian midwives who are pursuing this pathway. And I just want to also clarify and shut down the narrative that this pathway, this pet pathway, is anywhere close to having lower standards. As a matter of fact, we always continue our education.

  • Makalani Franco-Francis

    Person

    As a matter of fact, we were just recertified in neonatal resuscitation. So the narrative that this pathway is any less, standards are lower, we're less smart, less skilled is false. Secondly, as a Native Hawaiian, this very much is a Native Hawaiian issue. This Bill does not protect our traditional and cultural and religious rights.

  • Makalani Franco-Francis

    Person

    If it did, there would not be an active lawsuit against the State of Hawaii for this reason. Yeah, I'm actually a plaintiff in that lawsuit. The Native Hawaiian Legal Corporation is representing me in this lawsuit, so it does not cover us. Lastly, as a home birth mother of three and a consumer of midwifery. Right.

  • Makalani Franco-Francis

    Person

    I guess you would call me a consumer, but not really. I just want to make it clear that the Midwives Alliance of Hawaii does not speak for me, does not represent me. Yeah. This should never have even been an issue. This is not an issue of safety.

  • Makalani Franco-Francis

    Person

    I would like to see when are the hospitals going to be accountable, how many bad outcomes in the hospital? So the OBs are accountable? Yeah. The issue of safety is false when it comes to home birth. The statistics of bad outcomes for Native Hawaiian people are statistics from the hospital.

  • Makalani Franco-Francis

    Person

    And that's why we are choosing to have our baby with our community maternal practitioners, our community birth practitioners, our traditional practitioners. This never should have been an issue back in 2019. And honestly, we're tired of having to keep coming here without a solution, without being able to collaborate.

  • Makalani Franco-Francis

    Person

    The last Bill that wasn't even given a chance was the solution. It was the most collaborative Bill supported by OHA, supported by almost all counties of Hawaii. It never should have been an issue because we as mothers, we're smart enough to decide who we have in our birth space. We have ike, we have knowledge.

  • Makalani Franco-Francis

    Person

    We know our community. We know who our midwives are. We have discernment. Most importantly, we have na'au. We have intuition. And it is only the mothers who decide our reproductive health, period. And it's all of my.

  • Makalani Franco-Francis

    Person

    I'm just very passionate because my apprenticeship started with the birth of my first keiki, my daughter, who's got to be 17 years old, and this will affect her as well. So I really hope that we recognize that there is an attack on our cultural traditions, our religious constitutions. Our traditions, our traditional constitutions.

  • Makalani Franco-Francis

    Person

    And please take this in consideration. We can let this last sunset. We can reinstate the PEP pathway, the portfolio evaluation pathway, which is highly acceptable in many other states. Yeah.

  • Makalani Franco-Francis

    Person

    Midwives who have been licensed in other states through that pathway can come here in practice, but we cannot be offered that pathway. That's discrimination in our own home.

  • Makalani Franco-Francis

    Person

    And I just want to mahalo you for your time again for all of these years, and I really hope that we can just collaborate and not discriminate one midwife against the other. It's divisive and it's harmful. Mahalo.

  • Jenna Takenouchi

    Legislator

    Thank you. Next on Zoom, we have Keani Rollins-Fernandez in opposition. Not present. Excuse me. We have Carice Miguel-Hamakua in opposition.

  • Unidentified Speaker

    Person

    Hi. Thank you for hearing me speak. I'm just gonna stand by my testimony and what I wrote there saying, you know, I'm in opposition to this bill. I just wanted to give a little bit of a personal story that I didn't include in my testimony. I, you know, made.

  • Unidentified Speaker

    Person

    I ended up having a home birth with a certified professional midwife. That wasn't a light decision that I made. I called, I talked to my OBGYN. I called certified professional midwives. I called licensed midwives, I called traditional midwives. I made the choice based on what I believed was best for myself, for my family.

  • Unidentified Speaker

    Person

    And I did not take it lightly. I knew what each certification was able to do and able to not do. And I don't believe that it's you guys jobs to determine whether someone can make that decision for themselves or not, what kind of midwife they want to have with them at their birth.

  • Unidentified Speaker

    Person

    This is a very personal and deep thing that you have to go through when you're giving birth. And it's no one's right but my own to make the decisions of what I want to do for my healthcare. I was actually always planned on doing a home birth.

  • Unidentified Speaker

    Person

    I don't know really why that was always my consideration, but it was really solidified for me after I got to witness births. During training as a paramedic, I had to witness births in the hospital. I assisted with deliveries and I saw C sections.

  • Unidentified Speaker

    Person

    I also had to deliver babies in the field, and that's not my area of expertise at all. That's not what we focus on as far as the main thing we do as paramedics. But it has happened in emergencies.

  • Unidentified Speaker

    Person

    And after seeing field births, hospital births, I made a decision that I wanted to give birth at home with the type of provider I wanted. Another big factor for me was I really lost faith in my OBGYN when she flat out lied to me during my pregnancy with my son.

  • Unidentified Speaker

    Person

    She told me that I had just told her I was considering having a home birthday. I hadn't even told her if I had decided or not.

  • Unidentified Speaker

    Person

    And she told me if I decided to have a home birth and ended up going to the hospital, no one would deliver my baby because they didn't know what happened before I got there, which was really upsetting. That automatically eroded my trust with my OBGYN. I never went back to her.

  • Unidentified Speaker

    Person

    I know for a fact that's not true because I've transported patients in labor about to deliver as a paramedic showed up to the hospital. Nobody knows what happened before, but the doctors are there, they're going to do their best. They're going to deliver the baby.

  • Unidentified Speaker

    Person

    So to have a medical professional try to coerce me into doing something that I was not comfortable with was really upsetting. I know there's a lot of great doctors out there. I'm slowly rebuilding my trust. My current OBGYN was very supportive of me choosing whoever I decided to have be my care provider for my birth.

  • Unidentified Speaker

    Person

    He was supportive of me having a home birth if that's what I wanted to do. So I just, I feel like it should be the patient's own decision on what they want to do, who they want to have at their birth, whether they are licensed or not, whether they're traditional, whether they go to school.

  • Unidentified Speaker

    Person

    It's not your job to make that decision. For me, that is my job as the patient, the one who's going to be having birth. And it's not a light decision to make. All my friends who have had home births, they all have the same.

  • Unidentified Speaker

    Person

    They all have the same viewpoint that this was a decision that they took very seriously, that they really prepared themselves for. They looked at all their options and found out what was the best for them, no matter what it was. Thank you for your time.

  • Unidentified Speaker

    Person

    I just hope you take the consideration into what patients want for their birth experience.

  • Jenna Takenouchi

    Legislator

    Okay, thank you. Next up, we have Violet Arona in opposition on zoom. Hi.

  • Violet Arona

    Person

    Hi. Please proceed. My name is Violet. I was born on the island of Maui and I currently reside in Waiohuli Hawaiian Homes. I'm testifying today in opposition of Bill 1194.

  • Violet Arona

    Person

    Although made and amended with aloha, this bill still does not allow for cultural religious practices or extended Hanoi family other than Hawaiian healers with specific definitions which is a clear regulation. It still doesn't allow for local and accessible pathways such as the pet process.

  • Violet Arona

    Person

    The meek is an online process which is uncomfortable to me and is not in Hawaii. I learned better hands on like the pet pathway and personally don't want to learn how to care for babies and people from a computer.

  • Violet Arona

    Person

    I've learned so much in only 7 months, 7ish months of working with my auntie and to learn from foreigners about my very traditional birthing practice seems wrong to me. I would learn in a foreign way and come back to treat my cultural and traditional people. And to me that's super heavy.

  • Violet Arona

    Person

    HB 119 also doesn't allow for CMS and CPMs to practice to the full extent of their scopes, training and education. This bill seeks to permanently regulate who you have attend your birth, even in the privacy of your own home.

  • Violet Arona

    Person

    It still criminalizes all traditional religious and cultural practitioners who are not considered Hawaiian healers and regulates them out of existence. It does not exempt extended or Hana family, meaning they still can't choose clothes who is at your birth. And personally, I hate that.

  • Violet Arona

    Person

    I would hate to not be able to choose who's around me in the most vulnerable part of my life. And it makes midwife a proper term. Wrongfully taking it from the community and cultures that use it and make it with Aloha. The amendments made to this bill did very little to nothing.

  • Violet Arona

    Person

    We must make clear amendments to this bill before it causes harm not only to the community but to the state. Please understand that these are people's lives. My future as a midwife, a mother and a V. This is my aunties and all our Kupuna's livelihood. Not just work, it's their lives.

  • Violet Arona

    Person

    They've done this for decades and they've done it beautifully. All for the people. They just want to care for the vahine in their community as they wish others would do for them. They do some of the best care and they get treated as if they're obscure and odd and unsafe because their ways are different.

  • Violet Arona

    Person

    But different doesn't mean bad or unsafe. It means there's a whole other world of knowledge that you can work together to incorporate in your work and to become even greater. So let us come together and fix these pilikia. Do some hooponopono. Mahalo Mekhi. Aloha.

  • Jenna Takenouchi

    Legislator

    Thank you. Next we have Maria Mendoza in opposition on zoom. Not present. We have Wyonette Wallett in opposition on zoom. Yes, hello. Hi. Please proceed. Aloha. Can you guys hear me? Yes, we can.

  • Wyonette Wallett

    Person

    Okay, thank you. I'm out in the country. Aloha. Greetings chairing Committee Members. You have a big job. You're held personally responsible for the health and further disparities of my Hawaiian and Non Hawaiian people, our babies and our sacred linnocultural knowledge.

  • Wyonette Wallett

    Person

    So I urge you to make a fact based decision and oppose HB 1194 and move to support apprentice based testing and certification and also support your native Hawaiian population and customs. You have been given facts based along with hundreds of testimonies with the majority opposing the dangerous HB 1194.

  • Wyonette Wallett

    Person

    And yet it's still some kind of denialism and disregarding of facts. I'm uncertain if previous legislatures came with a hidden bias or outside motive reasoning for creating and supporting such a flabby bill.

  • Wyonette Wallett

    Person

    Reminder, you do owe it to the future of our state to make Democrat decisions in favor of the citizen majority which produce knowledgeable fact based solutions for societal problems. When you fail to not acknowledge these things, this is what makes you personally culpable to the further decline of maternal health in Hawaii.

  • Wyonette Wallett

    Person

    In the current political climate of immediate budget and whole Department cuts, do you really want to chainsaw a viable part of women paternal health in Hawaii? If so, this would be pure blasphemy against the well being of all people of Hawaii. Ne calling back to the non supportive gynecologists.

  • Wyonette Wallett

    Person

    We are excited to build bridges with all of them. Like it's very successful in like European countries. They have an excellent maternal care outcomes because midwives and doctors collaborate together. But it's obvious that hate smear tactics is far more important than coming to the table with solutions.

  • Wyonette Wallett

    Person

    And by the way there is vault of testimonies and neglect and debauchery leading from beginning of gynecology. Another fact and do that they should do their research. The foundation of gynecology is owed to Dr. James Sims who did horrific testing on black slaves in the name of science and gynecology.

  • Wyonette Wallett

    Person

    Has that science changed much when women of color and Hawaiian women have the highest maternal deaths? That's a big question there. Can the current monopoly of two medical systems you support even service Hawaii's mass medical consumer needs? Think about all this when dismantling a segment of experienced maternal and emergency health care providers who loyally service Hawaii.

  • Wyonette Wallett

    Person

    I support Hawaii Home Birth Collective. They're a bunch of brilliant women that worked so hard to making really good choices and decisions so that we can come and make proper solutions for this problem. Going back to the choice. We all should have choices because it's our birth of our babies. We should. We.

  • Wyonette Wallett

    Person

    I don't want to go to a gynecologist. I don't. I don't want to go to one my grandchildren and I'm a grandmother. Maybe she doesn't want to go to gynecologist. Maybe she. Maybe she doesn't want to go to a white man gynecologist. Maybe my Hawaiian daughters and granddaughters don't want to go to a white midwife.

  • Wyonette Wallett

    Person

    They want to go to maybe an auntie who is skilled in birthing and comes with mad credentials in the community. That's who, that's who we want to be birthed with. If that's our choice and that should be our choice. This is ours. Just like all of you make choices for your families. I am not.

  • Wyonette Wallett

    Person

    I am not going to go to a. To a white man or a White woman for anything in my family because I'm a Kanaka and I actually feel healthier and safer when I'm with knowledgeable, brilliant, educated people that's going to take care of my family.

  • Wyonette Wallett

    Person

    And that is actual a statistical fact that when women of color birth with other women of color, their outcome and their increase of a safer, healthier birth jumps substantially. So I thank all of you.

  • Wyonette Wallett

    Person

    This is a very heated topic and I just pray that you guys all have a great evening and bless your families and really take this into a deep consideration when coming to a really logical and ethical and spiritual decision on what this all truly means to all of us and the future of Hawaii.

  • Wyonette Wallett

    Person

    And especially if anybody has Kanaka or friends or family, you really should take this, this, this Bill to heart with you. So I just. Mahalo and all of you guys, and God bless you. Have a good night.

  • Jenna Takenouchi

    Legislator

    Thank you. Next up, we have Kii Kahoohanohano in opposition.

  • Kii Kahoohanohano

    Person

    Aloha, Maikakou, Mahalo, chair and Committee for spending the time to be here with us. I started showing up to these hearings, I believe, well, definitely over a decade ago. And when I did begin, it wasn't for me. It was from my elders who would not be able to practice under the law that had been proposed.

  • Kii Kahoohanohano

    Person

    All the laws, including the current law and the currently proposed law. They were pet midwives or they were traditional or religious midwives. I feel extremely blessed to be in.

  • Kii Kahoohanohano

    Person

    A time where they were still living, where I was able to apprentice with them, spend my life's work to learn, and then to care for them in the end of their days, even to bring in countless babies with beautiful outcomes where we got to go back, even to catch the babies of the babies.

  • Kii Kahoohanohano

    Person

    This is very important to us, that connection, not just to each other, but to the places that we're able to go back to Hanau. It's very rare that us as Kanaka even have access to our lands, of which our kupuna gave birth upon for generations.

  • Kii Kahoohanohano

    Person

    And to be able to hold a family in this way for me is why I do this. I've been practicing for over two decades in Maui. And the only reason you know my name or know my face is because I keep coming to testify.

  • Kii Kahoohanohano

    Person

    I keep coming to ask for your kokua, your deeper understanding with this very complex issue. And so far, we haven't received that deeper understanding. That's the only reason I oppose this particular bill. I support licensure. I always have.

  • Kii Kahoohanohano

    Person

    I want the folks who want that option to be able to have Access to that pathway, which is very restrictive. Yes, it is, they say possible through the meek process. But I know people who have struggled for over 10 years to attain that process and they're still not midwives.

  • Kii Kahoohanohano

    Person

    They have moved preceptors, meek accredited preceptors from out of state in order to attempt to attain that, that licensure and that that pathway and to this day are still not able to attain that currently. It's very difficult financially for folks I know that have attempted to do this through the meek process. It's very expensive.

  • Kii Kahoohanohano

    Person

    And even if you do the online schooling, what's really important to understand is what I mentioned. We don't have meek accredited preceptors and if we do have them, they're not from here. That in itself is hard for someone like me and most of my people.

  • Kii Kahoohanohano

    Person

    Like Tita said earlier, it's not always easy to walk into a cold sterile room with a white man or even woman and feel safe for me. And I'm white passing. I still don't feel safe. I'm a home birth mother of five beautiful children ranging from 6 years old to 22 years old.

  • Kii Kahoohanohano

    Person

    They are my greatest teachers and I honor them. First without the people that went on a limb in times where these practices were illegal in their lifetimes to continue their practice anyways and especially to support our Native Hawaiian communities to remember who we are in this work and be able to return birth home.

  • Kii Kahoohanohano

    Person

    Because as Kanaka, we are the one who is the practitioner of Hanau myself as Wahine. It's not about the qualifications of a midwife per se. It's about me having the autonomy to reclaim my own ceremony birth which should not be hindered within the State of Hawaii.

  • Kii Kahoohanohano

    Person

    I do know that this will pass because licensure needs to continue in our state. So please, as you move this forward, which I would highly expect is going to happen, make sure that the proper amendments are included.

  • Kii Kahoohanohano

    Person

    I could go on and on till next week and then some with all of you, which I'm willing to do actually. If you'd like to meet, please call me, please email me.

  • Kii Kahoohanohano

    Person

    We want solutions and we want pono solutions that make sense for our people because we are, other than what is being projected, very interested and safe beautiful outcomes. That is what we are committed to. And like I said, the only reason you know my face isn't because I've had poor outcomes and all these different things occur.

  • Kii Kahoohanohano

    Person

    I'm from your home. You don't know me except for in this space because I have done beautiful work in my community. And I would like to continue to not only uplift and train the future generations, but I want that for my. For myself to feel free again.

  • Kii Kahoohanohano

    Person

    To not feel like I'm a criminal or a horrible person for wanting to hold the people that call me and need me. I turn people away all the time. And even with our injunction, I'm not able to serve because we were trying to write a really beautiful bill which really didn't see the light of day.

  • Kii Kahoohanohano

    Person

    If you want to have conversations, you've got choke resources. If you would like to have clarity or deeper understanding, we are here for it. We need to pass something that we can live with so that we don't continue the harm that is currently happening. I cannot tell you how many people I turn away. I can.

  • Kii Kahoohanohano

    Person

    I cannot tell you. But it has been told to you already. 40% increase in free births in our state. I don't want that any more than you do. Culturally competent care shows to increase better outcomes and that's what we provide. As far as the exemption for Native Hawaiians, I appreciate Papa Lokahi.

  • Kii Kahoohanohano

    Person

    I appreciate your folks due diligence to create something that is functional. Unfortunately, we had to prove in a court of law that that wasn't a functional viable exemption. And that's very much by default. Nobody wants to go to court. Nobody wants to dedicate their lives to this fight. Believe me, I want to go home to my babies.

  • Kii Kahoohanohano

    Person

    I had to pay over $300 just to be here today. And that's just for a flight. And I've been doing this for over a decade. And guess what? I live in a very low income village of Hawaiian people. I don't have this luxury. And that's why you don't see more people, because we don't have that luxury.

  • Kii Kahoohanohano

    Person

    We're not asking for anything unreasonable. And I also want to mention, because it really is like this smear campaign on midwives who aren't up to date with their training and all the things I'm not even practicing. But because of what was instilled in me, I still just got recertified in NRP, which is neonatal resuscitation.

  • Kii Kahoohanohano

    Person

    I also carry CPR, adult and infant. I did that before I practiced midwifery because I think it's a good skill to have. And I live in rural areas, as I mentioned, where that definitely comes in handy. Peer review.

  • Kii Kahoohanohano

    Person

    Before I even really understood what midwifery as a practice or a CPM or a CNM or any of these titles and acronyms meant, I knew what Peer review was. Peer review is such an essential part of how we take care of our people and how we have checks and balances to maintain good standards of practice and care.

  • Kii Kahoohanohano

    Person

    Our communities are small, as you know, in Hawaii, and we are held accountable by them. In fact, in the task force which I sat on as a traditional midwife when this law initially passed, we showed a paradigm of indigenous midwifery where community claim is one of the three components of qualifying as an indigenous midwife.

  • Kii Kahoohanohano

    Person

    Community claim practice, knowing the practice and having the lineage or the koko of that practice. Those are the three. It's a. It's a pyramid. And you need to have two of those three to actually qualify.

  • Kii Kahoohanohano

    Person

    Not even all three, because that covers people like what we would call here in Hawaii, hanai or someone maybe who that Kupuna had taken under their wing for whatever reason, it's not up to us to judge it or whatnot, but had taken them under their wing to share with them their knowledge and their ike and their practice.

  • Kii Kahoohanohano

    Person

    So that's why they set it up that way. And that was what we had brought from an example that's been existing for, I want to say, at least 40 years at this point.

  • Kii Kahoohanohano

    Person

    It was 30 something years at the point that I brought it to the task force from Canada, because when we were on the task force, they asked us actually to show currently existing ways to cover all of these aspects of midwifery, and particularly for me, indigenous midwifery or cultural and religious practices.

  • Kii Kahoohanohano

    Person

    So that was one of the suggestions, not the only, but one of the examples. When I started working with Ha'apai families, it was really because I was a Lomi, Lomi, Lau, Lapaau and Hooponopono practitioner. Those were the things that I was gifted first and foremost before I even started attending births.

  • Kii Kahoohanohano

    Person

    So in caring for my community, I was asked to start coming to births initially in the hospital. That was before I had my own children. And that was what brought me to want to know more, train more honestly, because of the harm that I saw and witnessed in those spaces.

  • Kii Kahoohanohano

    Person

    And I'm going to say in the same breath, I appreciate with all of my being the fact that we have doctors and nurses and our hospitals and emergency services and technology for when it's needed. But what we need to remember is that in those spaces, birth is typically not natural. It's not a natural process.

  • Kii Kahoohanohano

    Person

    It's an induced process. It's a manipulated process. It's like a snowball effect. When you do the one thing you got to do now, the next thing and so on and so on. And I've seen the most harm in those spaces, including my own nieces who won't conceive again because of the harm that was inflicted on them.

  • Kii Kahoohanohano

    Person

    And I had to witness that not just as a palikiku or midwife, but as an auntie that was powerless over those situations. They weren't 30, they weren't full term when they were induced. I could go on and on, sorry, but the harm that is inflicted is not at home.

  • Kii Kahoohanohano

    Person

    And I do recognize that there may be people out there that say that they are something that they're not. I personally haven't experienced that in my whole life in Maui. I've never seen a midwife that ever came in and said, I'm a licensed midwife and wasn't, or I'm trained this way and wasn't.

  • Kii Kahoohanohano

    Person

    And that's one of the reasons I feel like the birth attendant exemption actually was really wonderful because it not only was a way to cover every culture, but it was a way to hold them accountable.

  • Kii Kahoohanohano

    Person

    And for you folks to have the regulation that you seek, you have to not only provide a statement without exemption, which functioned for years with the current law and there were no, no real problems with it, and I want to say again, it functioned unlike other hypothetical solutions. We know that it did.

  • Kii Kahoohanohano

    Person

    Even when there was an anonymous report. That's the thing, it's anonymous. Anybody can do it. You don't have to be accountable to your complaint. But they still went through due process.

  • Kii Kahoohanohano

    Person

    And thank goodness the people that were reported were doing things by the law, as stated, where you have to put on a paper all of your education and training, clearly. And then you also have to have a piece of paper which is an informed consent disclosure form which is provided by the dcca.

  • Kii Kahoohanohano

    Person

    When people come to me or others, typically, like I said, it's a small community. People come to us very specifically because of who we are and not because of who we aren't. So there's no, you know, it's very clear, it's very transparent. It's one of the reasons we had a hard time with the Papa Olokahi exemption.

  • Kii Kahoohanohano

    Person

    God bless them all. But they told us, because the way it's set up to cover Lomi Lomi, Lau, Lapao, Hooponopono and La Al Kahea, that they didn't actually have a Kupuna Council to oversee us, which is putting them in a very precarious place trying to figure it out. And it didn't function.

  • Kii Kahoohanohano

    Person

    So it's one thing to put words on paper, it's another to have something function. And when you tell me, zero, go get covered under Lomi Lomi, because I've been a Lomi practitioner and I could.

  • Kii Kahoohanohano

    Person

    Or Laau LA paao and I could, for instance, and then go catch babies, to me, that's not integral, and that's something that unfortunately is being projected, is that we don't have that level of integrity, but we do, very much so. Because most of the people, honestly, I don't advertise, I don't charge a rate. I work by donation.

  • Kii Kahoohanohano

    Person

    I oftentimes I can think of people off the top of my head. I could give you a list of 20 that haven't paid me a dime. And that's okay because that's my Kuleana and that's a big difference. It's not a profession for me.

  • Kii Kahoohanohano

    Person

    So I wouldn't go get covered under a kupuna council even if I loved the kupuna on that council very much for Lomi Lomi and then go do hanal practices. I hope that makes sense to you, as it doesn't make sense to me to say that that's an exemption for me or a functioning one.

  • Kii Kahoohanohano

    Person

    I feel so blessed that in my lifetime when I had my babies, I actually had the option to choose who I had with me. At this rate, it's not an option that my three girls or my two boys will have. And it's really disheartening.

  • Kii Kahoohanohano

    Person

    And I'm in a place over and over again for years trying to explain the intricacies of this law and what harm it is causing.

  • Kii Kahoohanohano

    Person

    Like I mentioned in the beginning, for the kupuna who came before me, who served our people for decades and ended up building stone houses that they continued their lives in after being threatened repetitively of jail time and uncle, you gotta stop this. Every baby that would come, the police come and they tell him, you gotta stop.

  • Kii Kahoohanohano

    Person

    Stop what? Helping our families in rural areas where there is no other access to care. Kalamai, I know it's a long day and I literally have so much to say. So I will spare you from that and just ask you to please, please take this to heart.

  • Kii Kahoohanohano

    Person

    I'm so grateful and so honored to sit in your presence and please reach out. I know once it passes through this kamiken, we're going to the Senate. As far as I understand, I'm not a politician. Okay? So we still have time.

  • Kii Kahoohanohano

    Person

    And I just really, really hope you folks take heed and encourage your colleagues who aren't in this Committee to make the right choices for Hawaii. I am Kahohanohanu versus the state by default. It's never a place I ever wanted to be in.

  • Kii Kahoohanohano

    Person

    I would love a legislative solution and that is something I have no control over except for to beg and plead with you for over a decade to do the right thing and to really, you know, more than just the right thing, to understand.

  • Kii Kahoohanohano

    Person

    You hear all these CMS, or the CM, sorry, the CM, the CPMs, all the things, there's a lot to it, I understand that. But we're here for that. We're here for that and we need you to actually take the time to understand all the intricate details of this very complex issue. So one thing, I'm sorry I lied.

  • Kii Kahoohanohano

    Person

    I'm going to say one more thing. It's very disheartening and sad for me to see someone, I'm not going to say the name because you all know her very well, sit here year after year and claim the name Midwife alliance of Hawaii as a lobbying tool. Essentially that's to me what it has been.

  • Kii Kahoohanohano

    Person

    She has less births and experience under her belt than I do. She came in and took over our organization that was a statewide organization for, I would say, lobbying purposes. Midwife alliance of Hawaii does not represent the whole of our state or the majority of even licensed midwives in our state.

  • Kii Kahoohanohano

    Person

    So, you know, I know, especially if you haven't been around long enough to be a part of this issue or you just, you know, whatever your scenario is, do some digging, do some asking.

  • Kii Kahoohanohano

    Person

    Because HIHBC came out of all of us traditional and non traditional midwives and families when we didn't have anywhere else to go because our organization was co opted and taken over and then used against us in spaces like these.

  • Kii Kahoohanohano

    Person

    It's interesting that someone who belittles my training, who doesn't actually know anything about my training, will sit there and say these things. But I've been in a room where I was actually attempting before the timing of us not being able to be essentially grandmothered in.

  • Kii Kahoohanohano

    Person

    We could do the pet process and the bridge before 2020, before the law passed. 2020. And so I did the bridge because I just had a brand new baby and I thought, well, maybe I'll do it. I was on the fence, but I'll just go through with it and see.

  • Kii Kahoohanohano

    Person

    And I could see in the actions that these particular individuals didn't actually have the knowledge or training that I had. And I'm not typically here to call them out, but if they're going to call me out and all of us and belittle us and say that a pet pathway is not sufficient.

  • Kii Kahoohanohano

    Person

    I guess I gotta say that because I saw the trainer say, no, that's not what you would do. And all of us are going, whoa. So Kalamai, I hope that made sense to you. But we all need each other. That's really the bottom line too, especially in rural areas where we have no access.

  • Kii Kahoohanohano

    Person

    Mahalo, mahalo, Mahalo for your time. Thank you.

  • Jenna Takenouchi

    Legislator

    Next up, we have Olivia Manayan in support on zoom.

  • Olivia Manayan

    Person

    Good evening, Chair, Vice Chair and Committee Members. Thank you so much for taking the time to hear my testimonies today. My name is Dr. Olivia Manayan and I'm here as an OBGYN practicing in Honolulu in strong support today of HB 1194 HD1. My written testimony is as stands.

  • Olivia Manayan

    Person

    In addition, I want to emphasize that I strongly support peer review and data submission for midwives. As physicians, we are required to review our health outcomes so that we can improve our practices for our community. Through these systems, we are held accountable for the care that we provide.

  • Olivia Manayan

    Person

    This data of our practice helps us to identify areas of improvement for patient safety. We participate in these reviews as physicians through our hospital employers, our health plans, and our statewide initiatives. Systems that the vast majority of licensed midwives do not participate in.

  • Olivia Manayan

    Person

    The care midwives provide can have significant impacts on the health of birthing persons as well as for the babies they deliver. I have chosen to provide oral testimony today on behalf of my patients to ensure that they receive the care that they are entitled to when choosing a midwife.

  • Olivia Manayan

    Person

    In my last five years as an OBGYN, I have taken care of a number of patients who have sought care at a hospital after a home birth attempt. In many of these instances, there have been negative outcomes that may have been preventable if they had been recognized by a trained provider.

  • Olivia Manayan

    Person

    Recently, I saw a patient who presented to our OB emergency room who had been pushing at home for the last six hours and was begging for epidural anesthesia on vaginal exam. She was found to be not completely dilated, which is a requirement prior to starting to push. She was accompanied by her birth attendant who used coercive language.

  • Olivia Manayan

    Person

    When the topic of delivery by a C-section was discussed, I was called to the room to perform an exam and an ultrasound, at which time I saw that the baby's heart was not beating. The patient was rushed to the operating room where I performed an emergent cesarean section.

  • Olivia Manayan

    Person

    While thankfully, the baby ultimately lived, he required resuscitation and admission to the neonatal ICU this bill is not meant to restrict a pregnant person's choice on who she is present at her delivery.

  • Olivia Manayan

    Person

    Rather, it is meant to empower her so that if she chooses to have a midwife present at her delivery, she can be confident that the person she chose is trained to a standard of care that allows for a safe, caring environment for both mom and for baby. Thank you so much for your time and for your attention.

  • Jenna Takenouchi

    Legislator

    Thank you. Next we have Adaure Ezinne Dawson in opposition.

  • Adaure Dawson

    Person

    Aloha. Thank you for your time. My name is Ezinne Dawson. I am a licensed midwife here practicing on Oahu and in the interest of time, I'd like to stand on my testimony with a few comments.

  • Adaure Dawson

    Person

    The first thing I wanted to point out is that the HB 1194 does not honor the pathway that about 50% of CPMs who choose to become CPMs go through, which is the portfolio evaluation process, which is also the same process that I went through to become a licensed midwife.

  • Adaure Dawson

    Person

    One thing that isn't being discussed is what exactly is the portfolio evaluation process? Narm, which is our credentialing body, which the State of Hawaii has decided to use as well, has a candidate information booklet.

  • Adaure Dawson

    Person

    Within that booklet it's a 70 page booklet which gives guidance as to topics and information that the candidate should be able to master and skills that they need to be able to perform and understand and be able to pass off with their mentor in that candidate information booklet.

  • Adaure Dawson

    Person

    I'm not going to read all 70 pages, but I wanted to point out that some of the topics that are covered are professional issues, knowledge and skills of a midwife, general health care skills, maternal health assessment, prenatal skills, labor, birth and immediate postpartum skills, postpartum care, and well, baby care.

  • Adaure Dawson

    Person

    All of these are broken down further into individual didactic and clinical training and skills that one must know.

  • Adaure Dawson

    Person

    NARM also gives access and references, books and texts that that individual must be able to cross reference or find the answers to the questions or to what is the appropriate what is the appropriate response to questions that may be asked on the NARM exam? So the training itself is guided. Each individual can learn at their own pace.

  • Adaure Dawson

    Person

    Each individual is given resources. Each individual also has the opportunity to work with that mentor at length. This isn't something that's done over the weekend. This is something that takes many three to five years to complete before they can feel skilled enough to perform the skills necessary to perform a home birth.

  • Adaure Dawson

    Person

    The other thing about that is that when you're limiting the workforce per se, you're reducing the amount of midwifery care and providers that are possible to be here in Hawaii. Thus, you're also reducing opportunities for local people to have local jobs.

  • Adaure Dawson

    Person

    So that's a big issue when you say somebody who is wanting to pursue a pathway that can also provide for them and their family and they may not have the resources to attain that. For example, like a mother of five.

  • Adaure Dawson

    Person

    I'm a mother of five and when I went through that pathway, I chose that pathway because of limited resources. It becomes an issue and it becomes extremely restrictive and discriminatory. And we should not be unduly restricting those who are qualified and are able to show certification through the credentialing exam that the NARM CPM is able to obtain.

  • Adaure Dawson

    Person

    Furthermore, I also want to highlight that each of us certified professional midwives must maintain continuing education credits annually. We all carry the NRP certification, which is neonatal resuscitation. We also carry CPR.

  • Adaure Dawson

    Person

    We also are able to take a list from a list of classes, continuing education courses which include fetal heart monitoring, gestational diabetes monitoring, different things that we are doing to maintain our skills throughout our practice. And it is important for us to continue to improve on the skills that we have.

  • Adaure Dawson

    Person

    These skills are important not only for us but to our clientele. Also, just want to reiterate the fact that there are other professions in the State of Hawaii, such as electricians, which also allow multiple pathways which include apprenticeship. And why are we saying that that is not available to this midway free path as well?

  • Adaure Dawson

    Person

    Furthermore, I just wanted to point out that there was in the Hawaii News a Hawaii News now article that was shared that was posted on 19th February 2025. And just so you are aware of the article that I'm talking about, I'm just going to read the title of it one moment.

  • Unidentified Speaker

    Person

    Said of the article is the jury awards $10 million to a family whose daughter suffered lasting brain damage during birth. The jury found the hospital and doctor named in the medical malpractice lawsuit negligent in how they used the drug Pitocin. Who was the licensed higher care practitioner that could have prevented that? That's my question to you.

  • Unidentified Speaker

    Person

    This is not a competition. This is about how can we collaborate and work together to make sure that the birthing individual has the support that they are asking for. I want to share an experience with you as I attended a birth in the hospital, standing next to an OB-GYN, immediately after precipitous birth, an unmedicated birth.

  • Unidentified Speaker

    Person

    The OB-GYN decided he wanted to do a vaginal examination, but he wanted to use metal forcep tool, which immediately caused my client to jump and shriek in discomfort and pain immediately after her birth. And I looked at the OB and I said to him, that's not how he would do it at home.

  • Unidentified Speaker

    Person

    And he said, well, how would you do it at home? And I said, well, let's get some gauze and do a gentle exam this way. And so, he did it the way I suggested. And he looked at me and said, well, look at that. You were right. There's gaps in care.

  • Unidentified Speaker

    Person

    If you really want to search for it, you're going to find a gap in care, regardless of the profession, regardless of the practice, right? We don't want to leave families traumatized. Our goal is a safe and healthy delivery for both mom and baby.

  • Unidentified Speaker

    Person

    Every student that I take under my wing is going through that candidate information booklet to make sure that they can successfully say, I understand what is necessary to determine that this is going to be a great, safe outcome for this individual and this family.

  • Unidentified Speaker

    Person

    And the fact that that pathway, the PEP Pathway, is being belittled and tossed away to the side is devastating to me because I recognize that I can't be at every single birth in the hospital to say to the doctor, well, let's try it the way we would do it at home.

  • Unidentified Speaker

    Person

    I'd love to be able to do that, but that's not a possibility. So, I just want to thank you for your time and your attention. It's been a long day. And please understand that licensure is not something that we—I—am personally against. I believe that we can all come to agreements.

  • Unidentified Speaker

    Person

    And the last thing I'd like to say is that Midwives Alliance of Hawaii does not speak for me. They do not represent me. I would like you to consider the amendments that are suggested by the Hawaii Home Birth Collective.

  • Unidentified Speaker

    Person

    They've done a lot of research and collected a lot of information and would be really excited to see that added into this to this Bill. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. Next, we have Daniela Martinez in opposition on Zoom. Not present.

  • Jenna Takenouchi

    Legislator

    Oh, okay. Sorry about that.

  • Daniela Martinez-Guzman

    Person

    In person.

  • Daniela Martinez-Guzman

    Person

    I wanted to see your faces today.

  • Jenna Takenouchi

    Legislator

    Go ahead.

  • Daniela Martinez-Guzman

    Person

    Aloha, Mai Kakou. My name is Daniela Natasha Martinez-Guzman, and I am sitting here before you as a licensed midwife who serves the island of Oahu. I am one of four licensed midwives who has an active home birth practice here on Oahu. We do have other wonderful, amazing, licensed midwives, but they're not attending births in this capacity.

  • Daniela Martinez-Guzman

    Person

    So, just some context of what's really going on here on Oahu, particularly. A few sticking points. The Midwives Alliance of Hawaii does not represent me. The Hawaii Home Birth Collective represents me. That is the largest organization in Hawaii that includes traditional midwives, professional midwives, certified midwives, naturopathic physicians, traditional midwives, native Hawaiian midwives.

  • Daniela Martinez-Guzman

    Person

    They reached out to the community and asked, "Hey, what's going on? What do you need?" They reached out to mothers, the consumers that we are all here to protect. They represent us.

  • Daniela Martinez-Guzman

    Person

    Hawaii Home Birth Collective did the legwork to help you make sense of this very complex issue that we are taking a very long time to try to help explain, because it—I have to say, it's very disheartening that it seems like the Midwives Alliance of Hawaii, their opinion is continuously prioritized, and I'm not sure why that is when they do not represent us. Okay.

  • Daniela Martinez-Guzman

    Person

    One significant point of House Bill 1194 that needs to be addressed is the fact that ACNM, which is for certified nurse midwives, is actually not appropriate of a place for certified professional midwives to be required to refer to for our guidelines, in practice. It's appropriate for certified midwives.

  • Daniela Martinez-Guzman

    Person

    So, that could be shifted to only apply to certified midwives but to request that a certified professional midwife, who is not a nurse midwife or a nurse, at all, to follow those guidelines is just inappropriate. What would be appropriate is to ask us to follow the guidelines of our Board, which would be the NACPM. That's appropriate.

  • Daniela Martinez-Guzman

    Person

    The Hawaii Home Birth Collective has included that in their testimony, so you can refer to what are those guidelines that are established for CPMs. Okay, I'm gonna wrap it up. I know we all want to go home. We're all hungry. Okay. As a licensed midwife, I am here in full support of all of my colleagues. Okay.

  • Daniela Martinez-Guzman

    Person

    I'm licensed, and I'm so grateful for this pathway and I rely on a team of OBs, nurses, certified midwives. I need the CNMs, I need the birth attendant, I need the traditional midwife. I need everyone involved to offer well-rounded care to mothers.

  • Daniela Martinez-Guzman

    Person

    So, when bills restrict who can be a student, who can be an assistant, who can be a birth attendant, you are further limiting the team, and remember, I started out saying, hey, we only got four licensed midwives currently attending home births on a regular basis on Oahu.

  • Daniela Martinez-Guzman

    Person

    So, to further limit who can help serve these women, who I can work with as a licensed midwife, jeopardizes the care that I can offer, even with a license. I am here to very much so support my native Hawaiian colleagues. Oh, she's still here. She didn't fly out yet. Okay. Papa Ola Lokahi Pathway sounds great on paper.

  • Daniela Martinez-Guzman

    Person

    Hey, go to them. They got a Kupuna council. They'll cover you. It's already been proven, that pathway is not real—it's not practical. It doesn't work out. It doesn't work out. They tried. They have tried. It does not work for Native Hawaiians.

  • Daniela Martinez-Guzman

    Person

    And proponents of this Bill are trying to say that non-Hawaiians could go to Papa Ola Lokahi for protection and I—I'm surprised they're saying that because they haven't even been able to cover native Hawaiians, and to say in the Bill that native Hawaiian healers, midwives, are protected by the Hawaiian Constitution offers no further protection for Native Hawaiians.

  • Daniela Martinez-Guzman

    Person

    If that were the case, then we wouldn't need to be here trying to establish protection for them if they were already protected. So, those are the two exemptions that keep getting highlighted, saying, hey, we've got them covered, don't worry, we're taking care of native Hawaiian healers. But they're not adding anything additional. So, those exemptions are just insufficient.

  • Daniela Martinez-Guzman

    Person

    Again, my name is Daniela Martinez. I'm a licensed midwife. I oppose this Bill. I understand it will likely pass because otherwise, the current midwifery law sunsets this year and I just hope we can have some amendments I recommend. Thank you all for your generous time this evening.

  • Jenna Takenouchi

    Legislator

    Thank you. Next, we have Nina Millar in support, on Zoom.

  • Jenna Takenouchi

    Legislator

    Oh, hi. Sorry, we can't hear you. I think you're muted.

  • Nina Millar

    Person

    There we go. Thank you very much for the opportunity to testify today. I am a licensed midwife. I've been on the Big Island for over 40 years and have only been licensed for the last five years. So, in the 35 years that I have practiced, I was attending births without a license.

  • Nina Millar

    Person

    I was providing care to Hawaiian families, many different types of families, not just...families, but I feel that there's been a misinterpretation of the Bill in that we are not trying to restrict any family from pursuing who they want in attendance at their birth. It is a very individual choice.

  • Nina Millar

    Person

    They have the right to choose a traditional midwife if they'd like to. They have a right to choose a licensed midwife. They have a right to choose a Hawaiian healer.

  • Nina Millar

    Person

    But when I started the Midwives Alliance of Hawaii in 1992 and began legislation process in 1998, the intention was to bring about licensure for a licensed midwife. I'm not saying a traditional midwife or a Hawaiian healer.

  • Nina Millar

    Person

    I'm saying for a licensed midwife to provide safety from mothers and babies, so that there was an understanding of what their qualifications were to, to attend the births so that they would be assured to know they were—they met—a national standard.

  • Nina Millar

    Person

    And utilizing the standards or the testing that NARM has put forth is, one, means whether or not we include the PEP process. I myself was a PEP and a bridge, you know, qualifier for this license, but we are looking to reach a level of professionalism that provides quality care for the whole community.

  • Nina Millar

    Person

    And we're not trying to stop care going to native Hawaiians or families that are choosing their out of hospital birth with other attendants. It's an opportunity for us to expand the care that's provided in the community, by licensing midwives through this process.

  • Nina Millar

    Person

    And I am in support with, I'm sure, you know, through this long amount of testimony that we've heard today that you'll take many things into considerations and there will likely be amendments to the Bill. But I do really support the licensure for midwives because it, it provides a level of safety.

  • Nina Millar

    Person

    I mean, things can happen, whether they be at home or in the hospital. There will be women who experience very traumatic births, but there are also very skilled licensed midwives that can serve our community, and I appreciate this opportunity to testify today.

  • Jenna Takenouchi

    Legislator

    Thank you. Next, on Zoom, we have Alana Koa in opposition.

  • Alana Koa

    Person

    Here. Aloha, Chair and Vice Chair and the Finance Committee Members. My name is Alana Koa. I come from the island of Maui in which I am a constituent of your District Chair Yamashita. So, mahalo so much for your time and efforts in the matter.

  • Alana Koa

    Person

    I’m a mother, a member of HIBC, a haumana apprenticing under Malamana Pua Ohamea, and an inspired midwife. I am in strong opposition of HB 1194. This Bill still falls short in expanding access to midwifery licensure.

  • Alana Koa

    Person

    When there is the PEP Pathway, which is an accredited pathway in 39 other states and which once existed here in Hawaii, why can't the multiple pathways coexist? This pathway is the most realistic pathway for myself. I want to be licensed, but I cannot if there is no pathway. The pathway that is realistic to me.

  • Alana Koa

    Person

    HB 1194 gives us less access to critical reproductive care that our communities so desperately needs, especially in Maui County. We still only have one hospital, one option, and only one way to give birth. We also have Molokai and Lanai which still do not have hospitals either.

  • Alana Koa

    Person

    There is many rural communities with families that live off grid on all islands. So, why can't we give our people more access to licensure and different pathways so that we can serve our communities, giving those families in the rural areas more access to care.

  • Alana Koa

    Person

    I also grew up off grid in Honokohau Valley where I witnessed births, as a Keiki, and it was the place where I thought I would give birth. At the time of my pregnancy, I was residing on Lahainaluna Road where we know the closest hospital is still located on the opposite side of the island.

  • Alana Koa

    Person

    Long story short, I gave birth alone three minutes outside of my home from Lahaina. I was not educated enough by any of my medical providers or was able to have access to a midwife, even though I knew they existed. I thought my medical providers were supposed to make me feel safe during my entire pregnancy.

  • Alana Koa

    Person

    But that is not how I felt. And when it came finally to time of my birth, I had to give birth alone and didn't receive any care after my birth from my medical providers until I was—until I had to give a COVID test for them to see me. It doesn't make sense.

  • Alana Koa

    Person

    I made the best decision for myself to call the aunties of my community that provided all the right care I needed when there was no one. I am truly traumatized of our health care system here in Hawaii. I am a victim. I am so afraid of receiving that same care from my only option on Maui.

  • Alana Koa

    Person

    If I was to give birth again, I would choose to give birth alone again unless something was to change. Let's also change the statistics of reducing the cesarean rate in Hawaii. I thought cesareans were meant for emergencies, so why are we scheduling to give birth? Why is that the new norm?

  • Alana Koa

    Person

    If a mother feels that is right—the right route—then, that is her decision. There should always be other options.

  • Alana Koa

    Person

    The Hawaii State Constitution guarantees the fundamental right to reproductive Autonomy, whereas HB 1194 falls short and does not include clear wording and restricts the protection of our reproductive freedom, privacy, family support, religious and cultural birthing practices. The proper amendments need to be made. If not, it should be deferred.

  • Alana Koa

    Person

    We please ask you make the right decisions, a decision for the community. I am a Lahaina fire victim and I have been through so much trauma and we know the healing starts with community. Mahalo so much for your time and aloha. Mahalo.

  • Jenna Takenouchi

    Legislator

    Thank you. Next up on Zoom, we have Tatum, in opposition. Not present. On Zoom, we have Karen O'Mahony, in opposition. Not present. Melissa Kim on Zoom, in support.

  • Melissa Kim

    Person

    Aloha from Maui. I'm Dr. Melissa Kim. I'm a Pediatrician on Maui and I'm speaking in support of this Bill as the first step in the right direction. A bit about my own birthing process is that none of my kids were born via a doctor either.

  • Melissa Kim

    Person

    Actually, my kids were born by certified nurse midwives, and so, I do see the importance that they play with our birthing options. However, coming to practice here on Maui, I was very surprised to see that there's no standard of care amongst the certified professional midwives and all the other birthing attendants.

  • Melissa Kim

    Person

    They've been some bad outcomes that I have witnessed in my career here, the worst being death. And there's been actually a few deaths, a loss of the baby, mother morbidity. And some of the best outcomes would be mothers coming to her clinic crying because their certified midwife stopped coming to the home because they had not paid.

  • Melissa Kim

    Person

    And so, usually they present a package to the parents, and it includes after-birth care of the baby and the mother. And in instances where she cannot pay, they're left alone, and she does not know what to do. So, at times the babies would come in malnourished, severely dehydrated, severe loss of weight, and yellow to our clinics.

  • Melissa Kim

    Person

    And of course, us knowing no records, we'd have to try to find the midwife, which is very difficult. There's no collaboration and many times, we're not able to get those records from the midwives. So, that's sort of the culture we're struggling with here on Maui.

  • Melissa Kim

    Person

    And unfortunately, I'm hearing from my colleagues that there's been increased numbers of these instances, instead of decrease. And so, I do believe there needs to be a standard of practice and a scope of practice that's clearly set, a need for home birth records to be made.

  • Melissa Kim

    Person

    Right now, there is no birthing records for home that is recorded since these babies do come to the hospital that have poor outcomes. They're recorded as a hospital birth, so there's no way to differentiate that, and it is reported as a poor outcome in the hospital.

  • Melissa Kim

    Person

    I also believe there needs to be along with that disciplinary action for anyone whose standard of care is not met with that. So, I appreciate you listening to my testimony and aloha and good night. Have a good weekend.

  • Jenna Takenouchi

    Legislator

    Thank you. Next up, we have Yvonne Gray in opposition. Oh, on Zoom maybe. Yvonne. Oh, thank you.

  • Yvonne Gray

    Person

    Can you hear me?

  • Jenna Takenouchi

    Legislator

    Yes, we can. Please proceed.

  • Yvonne Gray

    Person

    Yeah, I have—I have to pull over here as soon as I can, but I am stopped at a red light. So, my name is Yvonne Gray. I am a licensed midwife since last year. I went through the MEAC accredited program. And I have two things I would like to say.

  • Yvonne Gray

    Person

    First, if the goal is to extend care, why does the current Bill actually limit the postpartum care to six weeks only? The other Bill proposed 12 weeks, which is so much more comprehensive. Six weeks is just about, yeah, past the initial healing. And 12 weeks would make it much more safer for baby and the mom giving birth.

  • Yvonne Gray

    Person

    If nothing else, I would like to propose that we go back to the eight weeks, like it is right now. So, this should be fairly easy. And my second reason for opposing this Bill is the very, very high cost. I went through this program. I spent close to $50,000 on my MEAC education.

  • Yvonne Gray

    Person

    It is not sustainable for single moms. It is not like I was, you know, I had a husband, I had some sort of support who would be able to pay my rent and all the things. But if a MEAC school is required, how should people pay for this? Most of them do not take FAFSA.

  • Yvonne Gray

    Person

    You can become a nurse, you can become a plumber, going through a community college and then you can use FAFSA. But with most MEAC schools, you cannot take student loans. So, it all has to come out of your pocket and out of your family's resources.

  • Yvonne Gray

    Person

    I mean, right now we are paying, you know, almost 10 bucks for eggs. So, how is this sustainable? So, if this is a requirement, then there needs to be some sort of change and scholarships, especially for Kanaka midwives, that they can attain this education. And that's it. It's late for all of us.

  • Yvonne Gray

    Person

    Thank you so much for letting me talk. My name is Yvonne Gray. I'm a licensed midwife. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. Next, we have Tanya Anessian in opposition.

  • Tanya Aynessazian

    Person

    Aynessazian. Thank you.

  • Jenna Takenouchi

    Legislator

    Sorry.

  • Tanya Aynessazian

    Person

    That's okay. Aloha, Chair, Vice Chair, and Members of the Committee. My name is Tanya Aynessazian and I offer my personal testimony in opposition to HB 1194, HD 1, as written. We need more maternal care in Hawaii and multiple pathways to midwifery.

  • Tanya Aynessazian

    Person

    But in addressing those needs, we must also recognize and uphold maternal and birthing rights and the right to choose. Birthing is not just a medical event that we often see in the western way of looking at things, but it's a deeply personal and empowering rite of passage.

  • Tanya Aynessazian

    Person

    And I know we don't talk about rites of passages in our westernized, colonized, day-to-day ways of living, but rites of passage are threshold events, and these are ones that recognize our growth from one stage of life to another. They're really important in humanity.

  • Tanya Aynessazian

    Person

    In rites of passage, we usher in ourselves in new roles and status and ceremonialize our human resilience and potential. Childbirth as a rite of passage is a transformative ceremonial and medical event. Midwifery is one of the oldest professions deeply rooted in the history of human civilization.

  • Tanya Aynessazian

    Person

    Midwives are birth attendants emanating from the need for community, care, and wisdom during one of life's most transformational experiences. Our rural communities need more midwives more than ever, and we want to usher in life as consciously as possible, especially given what's happening today in the world.

  • Tanya Aynessazian

    Person

    So, I ask that we honor the sacredness of the birthing process and the right of each person to shape this experience in a way that aligns with their own values and beliefs and find a way to meet the needs for collaborative maternal and reproductive care, because I know we can do that.

  • Tanya Aynessazian

    Person

    So, I oppose this measure and ask that it not move forward in its current form. There's so much—well, there was—so much awesome women here and who want to work this out. So, I really hope that you guys can do that. Thank you for considering my testimony. Aloha.

  • Jenna Takenouchi

    Legislator

    Thank you. Next, we have Jonathan Barang, in opposition. We have Sarah Kahele. Oh, okay. Hi.

  • Sarah Kahele

    Person

    You guys are my heroes for being here so late. Aloha...I have all my keiki with me. Well, half of my keiki with me this evening. My name is Sarah Kahele. Mahalo for the opportunity to speak.

  • Sarah Kahele

    Person

    I'm in strong opposition of this Bill, and if I'm being honest, as a consumer, I'm a little bit confused as to what a Finance Committee has to do with my choices as a woman and a mother and what I do with my body and who I choose to be with at my birth. I'm a mother of six.

  • Sarah Kahele

    Person

    I have five girls and one boy, and two of them were born in hospitals. My son was born in a hospital in 2003. Birth was done to me. I was induced without consent. I had a cascade of interventions in my 31-hour labor. My son was given formula without my consent. He struggled to nurse.

  • Sarah Kahele

    Person

    He ended up with asthma and eczema and the list goes on. It was a birth that, as I heard earlier, wasn't managed well by licensed professionals. After my second child, who was also born in the hospital and vaccinated without my consent, I did not want to have any more children because I felt assaulted and helpless.

  • Sarah Kahele

    Person

    However, I had a third child and was relieved to find that I had the option to give birth at home. The most beautiful experience that everyone in my family got to participate in. I felt safe. I felt that I was experiencing birth and not that it was being done to me.

  • Sarah Kahele

    Person

    The midwife that I chose was traditional with years of experience. I trust her with my life and all of the lives of my children. How many people can say that about their care provider? For me and many other mothers is probably not a lot, but I trust her with my life.

  • Sarah Kahele

    Person

    I had the choice to invite her into my birth and my daughters have expressed that they would like that same choice. They desire that same choice and unfortunately, that choice was stripped from them in 2020.

  • Kyle Yamashita

    Legislator

    Okay. We're gonna reconvene the Committee on Finance to continue our fourth agenda. We had some technical difficulties. Sorry. Please proceed.

  • Unidentified Speaker

    Person

    Okay, I'm just going to pick up. Where I left off. Is that okay? Okay. As I was saying, I have my three youngest daughters sitting here with me. We come out from Ewa Beach, we sat in traffic, we found parking. But they have been watching me fight for their future since my 15 year old was a baby.

  • Unidentified Speaker

    Person

    And the other day I told them that I will not stop fighting. I say we because there is a bigger community than you may realize. I'm asking you today to oppose HB 1194 or as I'm hearing as it goes through to make the necessary amendments because this Bill is flawed, which makes it dangerous.

  • Unidentified Speaker

    Person

    It eliminates majority of the midwives here in Hawaii. Palikeiki are necessary, needed and wanted. Traditional midwives are necessary, needed and wanted. Lay midwives are needed, necessary and wanted. When you eliminate something that people are seeking, they aren't going to settle, especially not moms. We don't back down because our life purpose is to nurture and protect our keiki.

  • Unidentified Speaker

    Person

    And like another midwife said, you know, women will go through to great lengths to do what they feel is right. And this includes birthing alone. And that is more dangerous to have women birth unassisted, unattended. Mahalo nui loa for your time and consideration to hear the people of Hawaii thank you.

  • Jenna Takenouchi

    Legislator

    Okay, next we have Shannon Matson on Zoom.

  • Shannon Matson

    Person

    Aloha mai kakou. Mahalo nui for everyone who is still in attendance. Thank you for taking my testimony. My name is Shannon Matson and I am on Hawaii Island. I am speaking in opposition of HB 1194 as currently written. I am currently 15 weeks pregnant with someone else's baby. This is my first time serving as a surrogate.

  • Shannon Matson

    Person

    I have been pregnant five times before this. Multiple miscarriages and two healthy and successful home birth babies which you might be able to hear them in the background. My oldest is 10 and my youngest is 6.

  • Shannon Matson

    Person

    For my last birth in 2018, I was attended and assisted by nine people in my home, only two of whom wouldn't have been potentially subject to criminalization under the current laws and this proposed law, one of whom was my husband, so he was exempt from any prosecution or criminalization.

  • Shannon Matson

    Person

    And then the other, I believe my midwife is actually on this call and I hope she gets a chance to testify as well. I know it's been a very, very long day for everybody. As a person who is currently pregnant and will be birthing again very soon, bringing new life into this world.

  • Shannon Matson

    Person

    I am pleading with you not to pass this Bill without making further amendments for all of our protection and for the continuance of this practice of midwifery and birth work.

  • Shannon Matson

    Person

    I believe that this Bill as it is currently written, will further hinder safe and equitable access to reproductive health care for those who are bringing babies forth, as we have done for thousands of years, attended by those of our own choosing.

  • Shannon Matson

    Person

    During my current birth, I will be laboring and delivering in the hospital due to the terms of my contract. I willingly signed this contract. But I believe that birth is primarily a natural process.

  • Shannon Matson

    Person

    And while I am grateful for Western medicine in times of necessity, I do not believe that most healthy, uncomplicated births require any sort of medical intervention. I also firmly believe that every pregnant person deserves the right to choose with whom and how they bring life into this world.

  • Shannon Matson

    Person

    This is what we need to protect: the right to choose, and I believe this Bill actively reduces that right. I dream of a future where birth workers are welcome and encouraged in the medical community and there is no fear from our birth workers seek to to seek additional medical interventions when necessary.

  • Shannon Matson

    Person

    We need more properly supported and well trained midwives and birth workers, not less.

  • Shannon Matson

    Person

    By allowing the PEP Plus Bridge pathway that was allowed before 2020 and was initially included in prior legislation on this topic, we are expanding accessibility and inclusion, especially in our rural areas and thus creating safer options for our community to work towards licensure and and this Bill does not allow for that option.

  • Shannon Matson

    Person

    This Bill will result in contributing to the loss of Native and cultural wisdom in our birthing practices. Notice I didn't say Native Hawaiian. I firmly believe that Native Hawaiian practices and culture needs to be protected as we are in Hawaii nei.

  • Shannon Matson

    Person

    But I also believe that there is wisdom and value in all Native and Indigenous cultural wisdom surrounding birth. There are so many practices and so much knowledge that has been lost over the years and carving out exemptions just for Native Hawaiian cultural practices is not enough.

  • Shannon Matson

    Person

    Without additional exemptions to protect all of our birth workers and whatever their Native traditions might be, we are furthering the divide between modern medicine and cultural wisdom. We need legislation to bridge that gap to create more safety and support for our laboring and birthing community.

  • Shannon Matson

    Person

    Please, please listen to all the testimony today and create legislation to protect the most sacred and important human rights, the right of body autonomy for those birthing the next generation. Mahalo nui loa.

  • Jenna Takenouchi

    Legislator

    Thank you. Next we have Amanda Moore on Zoom. Okay, not present. Dani Dougherty on Zoom.

  • Dani Dougherty

    Person

    Okay. My name is Dani I 'm a licensed midwife and mother of three who's been practicing on the Big island for 15 years now. And I have taken a step back from the leg legislative efforts over the last couple years, even though I've been involved with the Midwives Alliance Hawaii and formerly was the President since 2010.

  • Dani Dougherty

    Person

    And I took a step back because it was taking so much energy away from my practice as a midwife that I've spent the last few years actually asking the families that I care for what it is that's important to them, the majority of these families being Hawaiian.

  • Dani Dougherty

    Person

    So listening to their responses has been my biggest indicator of what the public wants rather than hearing from all of the midwives. And what I hear families saying is that it's a pretty big leap for Hawaiian families to. To consider home birth when. When actually the norm right now is to give birth in the hospital.

  • Dani Dougherty

    Person

    And I agree with the testimony from both sides tonight that home birth is a very viable option for our situation right now with a lack of health care providers. I have women who are coming to me because they actually can't get in with their OB for another two or three months.

  • Dani Dougherty

    Person

    And so I think that in order for these families, the families I'm caring for, the families that I'm getting feedback from, that they want to know that they're in the hands of a competent care provider. They want to know that we would be able to respond accordingly if there was an emergency.

  • Dani Dougherty

    Person

    And they want to know that we have a level of training that we are all adhering to. And with that said, both pathways that we've discussed, the PEP process and MEEK accreditation, both of them require apprenticeship. There's no way around apprenticeship. To become a CPM, you have to apprentice with an experienced midwife.

  • Dani Dougherty

    Person

    And every student midwife gets to choose who that apprenticeship is with and who they learn from. So I believe that the accredited pathway to the title Licensed Midwife can help provide a standard of knowledge alongside apprenticeship, that the two are both essential to midwifery practice in a rural community.

  • Dani Dougherty

    Person

    And because we're an outer island and many of the islands are, we should be even more well prepared for scenarios that might require us to use our skills at full capacity, which means having a good foundation of knowledge that we know is a standard. And like I said, apprenticeship is required either way to become a cpm.

  • Dani Dougherty

    Person

    Whether a student does the PEP process or attends a MEEK accredited school, either online or in person. And we currently have a student, myself and Nina Millar share a student that attends births with both of us.

  • Dani Dougherty

    Person

    She's enrolled in a meek accredited school and I really appreciate that because I can rest assured when things get really busy and all we have time for is to go to births and go to postpartum visits and do prenatal visits, that we can rest assured that she's learning from a comprehensive curriculum that includes current day practices while also attending verse with us and learning hands on skills from us, her preceptors.

  • Dani Dougherty

    Person

    And the truth is that there is not always enough time to sit down and teach academic classes and concepts to our students when these situations are occurring. We need them to already have that knowledge base of how the human body works and basic health sciences.

  • Dani Dougherty

    Person

    So I fear that some knowledge might slip through the cracks of a student's understanding if the apprentice or the preceptor is her sole teacher. And I also just want to say that she's never had to leave the island once during her MEEK accredited midwifery program. Our student It's a very viable option for student midwives.

  • Dani Dougherty

    Person

    There are scholarships and grants available for the same online schooling that she's doing, which makes it even more accessible. And her total cost has been $6,100 per year for a bachelor's degree, which is more than I'm about to pay for my 18 year old daughter to go to college. So it's, it's doable. And I myself, like Nina, learned from an experienced midwife.

  • Dani Dougherty

    Person

    I really believe that passing this knowledge down from generation to generation is something that I want to see preserved and that we can further the profession of midwifery for our daughters and our daughter's daughters through licensure and protect that same age old wisdom and marry it with some modern day science that we know saves lives.

  • Dani Dougherty

    Person

    That if we want to be carrying these medications, we should know why we're administering them. So because I learned from an experienced midwife myself who had no formal schooling, I was a CPM before she was.

  • Dani Dougherty

    Person

    There are many things I've learned over the years since then that I realized she was not able to teach me because she did not know what she didn't know. And this is inevitable if we rely on passing down a wisdom from generation to generation without seeking out higher knowledge.

  • Dani Dougherty

    Person

    So that's why after I became a CPM and did the bridge, I also did the bridge to get my licensure. I also on my own sought out my bachelor's degree in health science from University of Hawaii because my midwifery training did not actually provide me with the comprehensive knowledge of human anatomy and physiology and basic health science.

  • Dani Dougherty

    Person

    I wanted to be able to understand the reasoning behind certain recommendations that I would make that I had memorized because I'd heard my preceptor say them and had an idea of why we would give certain recommendations, but didn't truly have that working understanding because I didn't go through a comprehensive curriculum and things can slip through the cracks, like I said.

  • Dani Dougherty

    Person

    So additional notes I wanted to make, aside from the path to CPM, is that I know we've talked a lot about trauma that has occurred on both ends and we've heard stories from midwives of all the trauma that they've seen occur in the hospital, which I've also witnessed.

  • Dani Dougherty

    Person

    And I just to be fair, want to also say that I have heard plenty stories of trauma occurring at home too because of mismanaged care. And I've had clients come to me who have gone to unlicensed midwives or midwives who don't believe in certification or don't. Yeah, don't want to pursue that. And they were not providing the type of care that the clients were looking for.

  • Dani Dougherty

    Person

    So, yeah, I've just been listening to the desires and concerns of the families that I care for over the years and what they continually express is that they wouldn't, the majority of them would not feel comfortable birthing at home without a standard of care and education requirements.

  • Dani Dougherty

    Person

    So that's the most important thing to me is that we not only make this a viable option, but we make sure that in doing so by saying, like, oh, midwives are the answer to our rural healthcare situation, that we aren't just saying, so let's just use whoever's willing to do it.

  • Dani Dougherty

    Person

    We're saying let's make sure that anybody who is filling that gap and taking on that responsibility is truly ready for whatever might occur. 45 minutes, an hour, an hour and a half from a hospital, which is then another 40 minute flight to a NICU.

  • Dani Dougherty

    Person

    We have to take that into consideration if we're going to step up and say that we want to be licensed midwives. And licensure is in my mind saying that we are considering ourselves licensed care providers. We're not calling ourselves traditional healers.

  • Dani Dougherty

    Person

    I believe that traditional healers are an essential part of the process and that they can both occur simultaneously. But it is important to define what it means to be a licensed midwife. And that's what we're trying to do here through licensure. And I think that many, most of the families that I know of appreciate that.

  • Dani Dougherty

    Person

    So thank you for your time. I think I'm the last one, so thanks for hanging out this long. Let me know if you have any questions.

  • Jenna Takenouchi

    Legislator

    Thank you. Christina Mao on Zoom.

  • Christina Mao

    Person

    Hi. Aloha mai kakou. I am Christina Mao and I oppose this Bill as, oh, giving standardized care is...we need quality care. I understand that each island has its own problems, but here on Maui, my brother has slipped through the cracks. My brother has slipped through the cracks in our hospital system.

  • Christina Mao

    Person

    We have moms here who are slipping through the cracks who are trying to go to different islands to get help. So it's not the home birth or the midwives at home, and it's everything. It's everything that's not being connected.

  • Christina Mao

    Person

    So it's that the moms don't feel safe in the hospital, and there's limitations to the care that can be outside to get educated. So we can be coming together and educating our moms and supporting our moms, but also giving a quality, standard care. Because right now, a standard care on the masses is not quality, that is quantity.

  • Christina Mao

    Person

    We need to feel seen and we need to be heard, and we need to know that our bodies are being taken care of, not just. Not just being told what to do and expecting no trauma out of it.

  • Christina Mao

    Person

    Because, you know, when we are having trauma from a home birth or a hospital birth, we are then giving it to our kids. We end up taking it home. And we can't be the best mothers we could be because we have to hold on to something and we're filled with anger and resentment and we don't know why.

  • Christina Mao

    Person

    It's. There's not enough workers, and we need to not limit the pathways for us to get the care that we need. I had a hospital birth and I was on Kauai. It's still a small community. It's still. It's still what it is. And I didn't.

  • Christina Mao

    Person

    I came out the door thinking I have the best birth, but within the months of times of like three years, I didn't realize how much trauma I was holding in my body, in my nervous system, and doing that as a mother.

  • Christina Mao

    Person

    It wasn't till I was educated to know my rights as a mom, as a woman, that passage of right from a traditional halikeiki. So there is this gap that we have between licensed midwife, traditional. No, it's.

  • Christina Mao

    Person

    We need to be able to communicate clearly to what our families need in our communities, not just base it off of each island and make it all together.

  • Christina Mao

    Person

    Like, we all need to individually come together and be able to work this out because this is getting out of hand and I just hope that you are able to listen to what the community needs and what our families need. Yeah, so this is my son. His name is Sam and he was born at home. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. Members, that's all the people I have on the list who identified themselves as being signed up to testify. Is there anybody else in the room wishing to testify? Please come forward and state your name for the record.

  • Jaymie Lewis

    Person

    Aloha. My name is Jamie Lewis. I'm a home birth mother of three. I'm very grateful for you to take these extra few minutes to hear the rest of us who somehow missed the list. I've been involved in birth work here in Hawaii. Hawaii birthed me as a birth worker. I moved here in 2006.

  • Jaymie Lewis

    Person

    I had my first child in 2007 or, sorry, 2008. And by 2010 I started attending births in our community. I am considered an elder though. I was a midwife. And then the law passed and then I became a traditional birth attendant.

  • Jaymie Lewis

    Person

    And as a traditional birth attendant, I actually became a preceptor for midwifery College of Utah so I could help folks in a MEEK accredited school get the license here. They recognized me as an experienced elder midwife. I had to show them laundry list of qualifications and births I had attended and my stats.

  • Jaymie Lewis

    Person

    And in order to do that, then our birth attendant exemption expired. Now I'm nothing. I am not even allowed to give information or advice, not only to mothers and babies.

  • Jaymie Lewis

    Person

    I am not allowed to support the students that I helped bring into licensure because they're not allowed to have an assistant who isn't a MEEK accredited student or who isn't a licensed midwife. There is nothing.

  • Jaymie Lewis

    Person

    And I've sat in the hearings or the meetings about trying to make rules for midwives and how they should practice and the scope of practice. And guess what? DCCA said we can't write that in because it's not in the law.

  • Jaymie Lewis

    Person

    So there's no administrative rules that will allow an assistant that is beyond what is written in the law. And right now this current version of this Bill makes it very restrictive and very clear that you actually can't have an assistant. So what happens to 600 plus deliveries that I've supported here in the community, families, knowledge. You know, I have a great track record and yet I'm nothing.

  • Jaymie Lewis

    Person

    The DCCA has given comments saying that they are willing to support the traditional birth attendant exemption, that it worked, that it is a form of regulation, that it gives information to the public to make a decision that feels right for them, that they had no complaints and no issues. So why is that being eliminated?

  • Jaymie Lewis

    Person

    Why is that not being a viable option? I know everybody here got a little form, a little flyer saying, well, in Oregon, these are the outcomes of all these different people. But guess what? Oregon collects data. They give information so their people can make informed choice instead of burying data, hiding it.

  • Jaymie Lewis

    Person

    And then that's how you end up getting bad outcomes, because people don't have access to make good, informed decisions. Or they go hide or they go birth by themselves.

  • Jaymie Lewis

    Person

    The more you criminalize certain things that people have come for years saying they want, the more you criminalize it, the more you do make it dangerous. The more smearing one side or the other actually does not create communication, and it doesn't create safety. It creates division. And it just feeds that fear. And it feeds that fear.

  • Jaymie Lewis

    Person

    So why is there no grandmother clause? Why is there no birth attendant thing that the DCCA says that it works fine? And that would cover all kinds of people's religious beliefs, their cultural beliefs. Thank goodness we have something that they've tried for Native Hawaiians. This is their land.

  • Jaymie Lewis

    Person

    We are privileged to be here, but let's do better by them, too. We need to do better. There has been so many years of the community coming and asking for this collaborative effort, asking over and over again. And Hawaii Home Birth Collective, they did what the task force tasked them to do. They talked to people, they communicated.

  • Jaymie Lewis

    Person

    We communicated with EMS, we got data, we got statistics. We worked with Department of Health, we worked with DCCA, we worked with reproductive justice organizations, we worked with legislators, we worked with. Gosh, I could go on and on. Just look at all the endorsements of what Hawaii Home Birth Collective's Bill had. Why was that just tossed away?

  • Jaymie Lewis

    Person

    Why would we not even see that as a viable option? We're answering what was tasked to do by the task force and what the initial law had written into the preamble, that we will find solutions. We will find a way to recognize and regulate the profession of midwifery.

  • Jaymie Lewis

    Person

    Having an exemption form is a way of regulation. Honoring licensure is a way of regulation. It doesn't have to be one or the other. And so I really want everyone to just take some time to think about all the words, all the testimony. Nobody's opposed to licensure. That's not what this is about.

  • Jaymie Lewis

    Person

    It's about honoring that different people have different belief systems and different pathways, and that those pathways exist. Why are we not respecting that? What are we so Hard pressed to deny what people are asking for.

  • Jaymie Lewis

    Person

    That form from the DCCA keeps that state you're not liable anymore. Guess what? People have the information. They're making their choice. They're signing that document. It's not on the state anymore.

  • Jaymie Lewis

    Person

    You don't have to worry about being liable for not vetting those people. So I really want you to consider that. I want you to just know that it's a shame to lose our elders, the people that have carried the knowledge and exchange it for an online program.

  • Jaymie Lewis

    Person

    You can get a midwifery degree online, but you can't. And sure, yeah, you have to apprentice too, but what about your people in your community that are your elders that are there teaching you, they're there for you when things get hard. And we're really separating that out. And I think it's really important to think about that.

  • Jaymie Lewis

    Person

    Keeping the knowledge in the community bring in more knowledge too, but don't make it all outsourced. People want choice. People are offended. I know that there's been a lot of frustration over the years about this and a lot of it is because we just really don't feel heard. We have come up with solutions.

  • Jaymie Lewis

    Person

    We just don't understand why they're not being vetted and why they just get shut down. So I thank you very much for your time and your energy and your thoughts. And I appreciate everyone taking the time to be here at 8:00 at night. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. And we do have your written testimony. Apologies, I didn't have you as signed in. Anybody else in the room wishing to testify? I think we had you at the beginning. Kristie.

  • Kristie Duarte

    Person

    I have one minute.

  • Jenna Takenouchi

    Legislator

    Can you just restate your name for the record for everyone on YouTube.

  • Kristie Duarte

    Person

    Okay, sure. One minute. Here we go. My name is Kristie Duarte. Thank you for having me. Wanted to show you something. These are the certificates at the top. It says, the North American Registry of Midwives does hereby certify that. And these are the certificates.

  • Kristie Duarte

    Person

    One is a PEP, one is a MEEK. Exact same certificate. What I wanted you to know is that it does not say ACOG who certifies the CPM or midwives. Other organizations. It's NARM. They are the national organization that does that. Number two, I wanted to point out in the injunction in the courtroom.

  • Kristie Duarte

    Person

    ACOG was there and the court actually ruled on page 20.66 that the defendants presented no evidence that Hawaii's rates of maternal and or neonatal mortality are attributable to Palikiki and Hanau practitioners. In fact, the record reflects that all pregnancies and all birth settings come with risks and benefits.

  • Kristie Duarte

    Person

    Point is, we can go back and forth with our stories, but the court said there was no evidence.They had a chance to show it. Last thing we had one midwife sharing about how her families gave feedback and what they like. I want you to know that midwife charges $10,000. What kind of families can pay $10,000?

  • Kristie Duarte

    Person

    Let's think about that. Okay? So just asking that you consider the context of this midwifery situation. And thank you so much. Mahalo.

  • Jenna Takenouchi

    Legislator

    Thank you. Anybody else in the room? Okay. I think on Zoom, we have Amanda Moore.

  • Amanda Moore

    Person

    Hello.

  • Jenna Takenouchi

    Legislator

    Hi. Please proceed.

  • Amanda Moore

    Person

    Hi. Thank you for allowing me to speak. I had to step away urgently. I'm Amanda Moore. I have been a certified professional and licensed midwife in good standing standing in both states of Oregon and Hawaii for 25 years. I've submitted written testimony highlighting my concerns within this Bill.

  • Amanda Moore

    Person

    I clearly want to state that I support midwifery licensure as it provides public safety standards and midwifery standards of care. Unfortunately, I do not support the current licensure Bill as written. It needs to be amended and revised as written.

  • Amanda Moore

    Person

    I oppose Bill 1194 specifically with the involvement of the American College of Nurse Midwives practice standards being referenced and involved, influencing or governing any of our licensing rules or law regarding certified professional midwives seeking licensure in Hawaii.

  • Amanda Moore

    Person

    Certified professional midwives have their own route of education and certification which is governed by our own board, the North American Registry of Midwives, not the ACNM. The ACNM governs certified nurse midwives. As the Bill is written, there are ACNM tables that are referenced as to protocols for out of hospital birth management and and standards.

  • Amanda Moore

    Person

    These references will seriously infringe on our practice standards which differ greatly and should have no bearing or say in written law. CPMs and CNMs have a very serious difference in education, training, practice. In the communities we serve. Our governing boards are not the same.

  • Amanda Moore

    Person

    We do not want the ACNM to be involved in the oversight, involvement, reference or government of license midwives in Hawaii. In addition, I would like to clarify that the cpr, NRP and peer review are prerequisites and requirements for the CPM under the North American Registry of Midwives.

  • Amanda Moore

    Person

    It would simplify Hawaii licensing, regulation and board requirements who oversee that a licensed midwife would be in compliance with active CPR, NRP and peer review. NARM requires active CPR and NRP for licensure or relicensure, including peer review.

  • Amanda Moore

    Person

    It could be simply stated that a licensed midwife must remain current with active certifications at any time under license in Hawaii and under NARM standards for certification, including peer review. This would eliminate fiscal and board requirements verifying these certifications for licensees. Thank you for your consideration.

  • Amanda Moore

    Person

    And of these matters, I think it's really important that we do have licensure. I did submit written testimony and we have to amend this Bill. It cannot move forward the way it is. And I thank you so much for your time and consideration. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. And yes, we do have your testimony, your written testimony. Anybody else on Zoom wishing to testify?

  • Kiana Rowley

    Person

    Yes. Hello, this is Kiana from Pacific Birth Collective.

  • Jenna Takenouchi

    Legislator

    Hi. Okay. Please proceed.

  • Kiana Rowley

    Person

    Thank you. Chair Yamashita and Members of the Committee. I'm here today as the President of Pacific Birth Collective and we stand in opposition to HB 1194 alongside the credentialing bodies, human rights organizations, counties, the majority of practicing midwives attending home birth, and individualize individuals testifying year after year across the state on this Bill without the necessary amendments.

  • Kiana Rowley

    Person

    As stated in our written testimony, HB 1194 restricts access to community case based models of care and it infringes on the reproductive rights of individuals. It is obvious that our community is extremely divided on this issue and I want to thank the Committee for taking the time to allow everyone to speak.

  • Kiana Rowley

    Person

    Please recognize the obvious conflict of interest presented by ACOG and OB/GYNs who are trained exclusively in the medical framework of birth and stand to benefit financially from the restriction of midwifery care being proposed by 1194 and excluding more than half of the currently practicing midwives, certified professional midwives, who are trained via the PEP process.

  • Kiana Rowley

    Person

    The vast majority of opposition is from this medical framework and the stories being presented on individual cases are not based on comprehensive data. There is a problem that we don't have a completed Auditor's report.

  • Kiana Rowley

    Person

    And please do not mandate the medicalization of the birth process and impose a western paradigm on birthing people against their wishes without adequately addressing the considerations or the data that will improve safety.

  • Kiana Rowley

    Person

    Removing pathways to practice and limiting access to providers does not change women's desire on where they choose to birth and the evidence does not support this.

  • Kiana Rowley

    Person

    Restricting reproductive rights does not equal safety. Please include amendments to protect reproductive autonomy and do not leave it as a matter for the courts to decide. Thank you.

  • Jenna Takenouchi

    Legislator

    Thank you. Anybody else on Zoom wishing to testify?

  • Unidentified Speaker

    Person

    Hi, if I may say one more thing. This is Dr. Molaro.

  • Jenna Takenouchi

    Legislator

    Uh. Sir, are we?

  • Kyle Yamashita

    Legislator

    Yeah, you know what? You got to testify earlier. We're not letting people like jump in. Thank you. Anybody new? Okay. Okay. Thank you very much.

  • Kyle Yamashita

    Legislator

    Okay. We'll move on to questions. Members, you have any questions at this point? I know you're tired, but thank you for sticking around. Okay, what are we going to do? We're going to defer decision making to a later time to get all the Members back because some of them had to leave.

  • Kyle Yamashita

    Legislator

    They had other prior commitments. So we're going to allow them to vote and we're going to repost notice and then have decision making at that time. Thank you very much for sticking around with us tonight. And we are adjourned. Thank you.

Currently Discussing

Bill HB 640

RELATING TO CHILD WELFARE.

View Bill Detail

Committee Action:Passed

Previous bill discussion:   February 11, 2025

Speakers

State Agency Representative