House Standing Committee on Consumer Protection & Commerce

Welcome. Good afternoon, everyone. It is Wednesday, February 11, 2pm we are here in Capitol Room, Conference Room 329. Like to welcome you to this joint hearing of the House Committee on Health and the Committee on Consumer Protection and Commerce. My name is Greg Takayama.

On behalf of myself and Chair Matayoshi, we would like to welcome you and first of all apologize for having to postpone this hearing from Monday. We all lost today. Just a couple of housekeeping measures. Let you know that we have no microphones. The microphones are installed in the ceiling. There are devices with the green lights on.

So we ask that when you testify. To testify, to do so at the podium in a clear voice. Just a reminder that the microphones are really good at picking up sounds, especially from the audience. So be careful of what you're whispering about the persons who happens to be testifying.

For those on Zoom, we ask that you stay muted until you're called up and also not have any trademark items visible on your screen. We have just two bills before us, but we have a lengthy list of testifiers. So we're going to ask that testifiers try and abide by a two minute time limit.

I know that we may disagree on some issues, but let's all agree to be. Let's go. Agree, disagree, agreeably. Something. You know what I mean? Okay. Well, first up we have Hospital 2501. And it requires hospitals to provide reports regarding costs associated with Medicare and uninsured patients. First up, we have the Department of Health.

Good afternoon. Chairs, Vice Chairs and Members of the committees. My name is Lauren Kim, representing the Department of Health. The Department of Health genuinely appreciates the intent of this measure. This is something that keeps people who work in healthcare up at night and public health up at night about the financial sustainability and viability of critical community assets.

Our comment is that this is going to be a complicated, complex task. That's not a reason to not do this. But as currently drafted, some of the proposals in this measure are impractical just because the Department does not possess that expertise and we would need to contract or build out that expertise.

Healthcare financing just with CMS alone is very, very complicated. There are formulas for calculating the cost of keeping lights on, depending what island you're on, you know what physician salaries are like. So we are willing to be at the table to keep moving this conversation down the road. But this is a tough one.

The United States of America still hasn't sort of solved this problem. And you know, this may be another opportunity to think about financing health care Differently. But we will stand on our comments and I'll be available for questions. And I wish us all good luck in this conversation. Thank you.

Thank you for your good wishes. Hawaii Health Systems Corporation on Zoom.

Good afternoon. Chairs. Vice Chairs. Edward Chu, President and CEO of Hawaii Health Systems Corporation. I'll stand on my written testimony providing comments echo the comments of the Department of Health and that this is a very complex discussion, but we'd be happy to participate in any further discussions on this topic. I'd be happy to answer any questions.

Thank you.

Thank you. We have written comments from the Office of the State Auditor.

Point of privilege. I can't say anything. Anything when I was saying is a point of. Can I call a point of privilege?

No, you cannot. Thank you. Health Care Association of Hawaii. Paige Choi.

We'll stand on our submitted comments. Thank you.

Thank you. The Queen's Health System.

Chair Takayama, Chair Matayoshi, Members of the Committee, JC Miki on the Queen's Health System. I just want to thank the Committee and the Chair for. And Chairs for introducing the measure and interest in the topic.

I think with the challenges facing health care in our state right now and potentially in the future, understanding how costs are shifted over time, especially with Medicare, Medicaid and uninsured, it's quite a critical topic.

And so Queen's is willing to work with the Department on addressing as many of the information required in the bill and look forward to providing this information going forward. Thanks very much.

Thank you very much. Let's see, that's all the persons we have submitting testimony. Anyone else wishing to testify on this bill? 2501 seeing none. Members questions? Chair Matayoshi.

Thank you, Chair. Department of Health, please.

Yes, Chair, how can I help?

So how much does the state subsidize given subsidies for hospitals generally? Round number.

I don't have that number off the top of my head. One of the practical considerations is that hhsc, the public hospital system, sort of manages their own appropriation requests. I can get that number to you, but I'm sorry, I don't have it off the top of my head.

The Department is not really in the hospital, does not run hospitals outside the Hawaii State Hospital. There was a point in time many years ago when we did have a community hospital division, but that's decades.

So my understanding was that the state does subsidize or does give hospitals generally certain subsidies. I'm not exactly familiar with what, but I mean, just take an example for Kapiolani Hospital. Does the state provide Kapiolani Hospital with any funds.

General Fund requests for private entity. I don't want to misspeak. I don't know. I'll need to look that up. The Department does have certain special funds like the Trauma Special Fund that we use to support trauma related services and expanding levels of care and trauma services throughout the state. That's one very small sliver.

I'll ask HH. Let me move on to something else. You said that the calculations are complex. Are those calculations federally mandated or state? Are there parts that we can't change?

There are many, many Medicare requirements for how you bill and what you are able to bill and how much you get reimbursed. But there's many different contracts that a hospital would have with payers, including CMS. There's the Medicaid side, there's the private sector side.

I'll defer to the hospitals, but it takes quite a bit of time and effort, emphasis on time, for Medicare to change their requirements, requiring a tremendous amount of evidence and documentation. And again, it's just entirely very, very complex that we would need some outside assistance to just begin unpacking this.

It's a worthwhile journey to go on, but it's going to be a rough one as drafted. Thank you.

So if I may Chair for HAH. Do you know what the state subsidies hospitals are like?

I would echo what Lauren would say. I don't believe that there are generally subsidies provided to our private nonprofit hospitals. Mr. Chu might have some idea about what each region receives in both its operating and CIP requests.

In terms of subsidies, what I can say that the private non hospitals do get support on from the state is through our provider tax program, which we've brought before the Legislature. It's now Evergreen. We used to come in every year and then every two years.

And under that program, which is a federal program that 49 states participate in, hospitals and nursing homes actually impose a tax on themselves.

That tax is then put into a special fund and those dollars are used to draw additional federal dollars to have the reimbursement from Medicaid go up to Medicare so that it's not a direct subsidy from a state, but that is a state program that we use to help cover some of these uncompensated care costs, but they don't cover all of them.

So it is a little bit complicated in figuring it out because we do have some of these subsidies for the public hospitals. We do have the provider tax program. I think figuring out the remainder is something that we could work with our Members on to get to this Committee.

Okay. So for the provider tax program, the hospitals will pay into sort of a pool. That pool will be used to get matching federal funds, and then the federal funds and state funds will be kind of redistributed to the hospitals through that special fund.

Yes, I think that's. I think if Meredith is listening, she's probably going to tell me that I've oversimplified it terribly. But that's essentially how it works. And the funds are distributed based on the number of Medicaid patients you take. So the more Medicaid patients you take, the higher your benefit will be from the program.

So it is really designed to support, I would say, hospitals that are taking the underinsured, but also. Right. Make sure that you're not benefiting those that might cherry pick a little more, which we don't do here. But I think that's how the program is designed nationally.

How much is in that special fund, typically year to year?

So I need to check on the numbers usually. Let me get back to you with the exact numbers. Things are changing a little bit because some of the rules around it, because of HR1, are affecting some of how we're using the program. So.

So let me just make sure that I have the correct numbers and I can provide them to you.

Can you give me a ballpark number?

Yeah. For hospitals, the net benefit, what I can say is around 150 million. And that's a net benefit. That doesn't mean that that's just, you know, extra money that's flying around. Again, that's meant to cover the gap between Medicaid reimbursement and Medicare. So again, it's not covering full cost.

And for the nursing facilities, I'd say say it's about 20 million in net benefit. Let me make sure I get those numbers correct and get back to you, folks.

So you. 20 million in net benefit for the.

Nursing homes and then for the hospitals, closer to about 130-150.

Okay. Okay. Thank you.

Members, any other questions? Let's move on to the next Bill. HB 1875, expanding protections for gender affirming health care services. First up, the State Insurance Commission.

Good morning, Chairs, Vice Chairs, Members of the Committee, Justin Chu for the Insurance Division. We stand on our written testimony providing comments. We're in. Bill for any questions.

Justin, if you could for just a second explain your testimony in regards to malpractice insurance. Sure.

So the measure credits prohibits any medical malpractice insurance company from taking any prohibited action. Paragraph 4 of the Prohibited actions state that it would be a prohibited action includes imposing any sanctions, fines, penalties, rate increases, or other type of unfavorable change. So our concern is that the term.

First, that the term other type of unfavorable change is pretty broad, pretty vague, and so we're just not sure what type of unfavorable change would be considered a prohibited action. And let me preface this by saying that the entrance division isn't actually charged with enforcing the statute since it's within the Department of Health statutes.

And then second, our concern is that a rate increase prohibition would be a first of its kind for the insurance code. And typically the rate are determined by what's actuarially sound.

So if a provider who provides low risk services includes, you know, a reproductive care or gender affirming care services, we might expect that it would increase the risk profile and potentially, you know, a malpractice rate of increase.

So under the current wording of the statute, our concern is that that would be considered a violation if they did so. Okay, thank you. Thank you for clarifying.

See, we have the Office of Information Practices providing comments. Hawaii State Commission on the Status of Women.

Good afternoon. Yasmine Cheney for the Commission on As Women. I stand on my written testimony and strong support of this measure. Thank you.

Thank you. Hawaii State LGBTQ Commission, Michael Golojuch Jr. Good afternoon.

Michael Golojuch Jr. He, him. Pronouns. I am the Vice Chair of the Hawaii State LGBTQ Commission. It is my honor and privilege to stand here today to defend this bill. This, the commission was built to stand for and to advocate for this bill. The legislation like we see here today.

We are here today because of the constant attacks against our mahu, transgender and gender non conforming ohana. These attacks started in conservative states years ago and now go all the way up to the White House. Last month, Lumpkin Institute issued a warning that we are in the early stages of a genocide for our transgender community.

Let me say that again. The United States, for the first time in Our history is put on a genocidal watch and it's because of the actions that have been taken at the federal level and unfortunately, some of those conservative states. Today's Bill will help ensure that that genocide never reaches our shores.

Prior to these attacks, our transgender Ohana had already faced discrimination across this nation and the state. Today there is a person in our state that believes that this world would be a better place without them in it. Please tell them that is not the case and it is never any case.

By passing this Bill protecting access to these life saving services, you will hear later today, later in this hearing from medical care providers that actually provide this life saving services, you will hear from those with lived experiences. Please listen to them. Please absorb what they have to share with you, which you've already seen in your informational packets.

And we encourage you to pass this Bill. Say no to discrimination. Protect access to life saving health care. And we would like to thank our friends over at the Youth Commission as well as the Commission on the Status of Women for their support on this Bill. Thank you.

Thank you. See, we have Ohio State. Excuse me, Hawaii State Youth Commission, Amelia Sophos. Thanks. Support private work on Zoom not present. Okay, thanks. Apart Hawaii Public Health Institute.

I'm Chris Caulfield from the Hawaii Public Health Institute testifying in strong support of this measure. As numerous public health organizations have said, gender affirming care is health care and health care is a human right. This bill is about drawing that line clearly and decisively here in Hawaii.

For those who seek it, gender affirming health care is evidence based, medically necessary and life saving. The science is clear. A 2022 study from Stanford University found that transgender individuals who access gender affirming care experience significantly better health outcomes.

A comprehensive review of more than 50 studies published in the Journal of Gay and Lesbian Mental Health found consistent reductions in depression, anxiety, suicidality and suicide attempts following access to gender affirming care. This is not ideology, it is data. Every major public health and medical authority agrees.

The American Public Health association and the American Psychological Association both affirm that access to comprehensive gender affirming care is essential to health and well being across the lifespan. Just last year, Hawaii's own Attorney General joined a multi state coalition stating plainly that these decisions should belong to patients, not politicians.

At a time when federal actions and Executive orders are actively threatening access to this care across the country, Hawaii has both the authority and the responsibility to act. HB 1875 protects patients, it protects providers, and it protects the fundamental principle that health care decisions should be guided by medical expertise and human dignity.

Hawaii has long chosen compassion over fear and science over misinformation. This bill continues that legacy for future generations. Please pass this bill and let Hawaii remain a place where healthcare is safe, accessible and rooted in evidence and aloha. Thank you very much. Thank you.

Stonewall Caucus of the Democratic Party Party of Hawaii.

Aloha Chairs, Vice Chairs and esteemed Members of the Committee. My name is Abby Simmons. I am Chair of Stonewall Caucus of the Democratic Party of Hawaii and I stand in strong support of HB 1875. I am also here as a transgender woman who has personally experienced what gender affirming care makes possible.

Before I had access to appropriate care, I lived under a constant fog of hiding and pretending, but forming a gender assigned to me at birth, not based on who I actually am. That takes a toll on your mental health, your relationships, your ability to fully participate in society. Gender affirming care lift the.fog.

It allowed me to show up, show up fully in my life, to function, to serve my community, to lead and to contribute here in Hawaii. For many people, this care is life saving and it is supported by decades of medical research in every major medical association.

The choice before you today is clear science or misinformation, bodily autonomy or governmental control. Hawaii Making decisions for Hawaii or letting outsider politicians dictate our health care. HB 1875 keeps healthcare decisions where they belong, between patients and doctors. It protects providers practicing ethical, evidence based medicine.

It protects families caring for their children and it protects our state from outside political interference. In closing, I am standing before you because gender affirming care allowed me to live a healthy and fully engaged life. Our Trans and Mahu youth deserve the same Mahalo for your support.

Thank you very much. P Flag Oahu Cameron Miyamoto.

Aloha Chair Takayama Chair Matayoshi Vice Chair Teokahapuli and Vice Chair Grandietti and Members of the committees. Mahalo for this opportunity to testify today. My name is Cameron Miyamoto and I am co Chair of PFLAG Hawaii along with Reyna Yamada, PFLAG Hawaii.

We're committed to the educational, supportive and advocacy efforts on behalf of parents, families, friends of LGBTQ people here in Hawaii. We have a vast membership of many, many families who have transgender kids here in Hawaii and their well being and livelihood depends on bills such as this.

We're proud to embrace our diverse ohana and we want to really ensure that Hawaii remains a place of compassion, aloha and fairness. Many members are transgender and have family members who are transgender, but they don't feel safe enough to come to testify before you today.

So I want you to understand that I'm speaking on their behalf in a climate where it's a chilling effect on our transgender communities.

That's why things like this shield law are really necessary to help ensure that we have safety for our local families and also for our medical providers, because our medical providers are also under attack and deep scrutiny at many, many levels.

These medical providers are doing very critical work that's approved by National Medical Associations representing over 1.3 million doctors, including the American Medical association, the American Academy of Pediatrics and the American Psychiatric Association. We at PFLAG Oahu are asking you to stand with our local families and to stand with science and our medical providers.

Please vote in support of HB 1875. Mahalo.

Thank you very much. So we have Dr. Jack Lewin in the audience from SHPDA.

Thank you. Chairs, Vice Chairs, Members ship to has advisory committees scattered across the state, geographically and in around topic areas.

And so I'm here representing the views of many of our citizens from across the state who would strongly support this, believe it's supportive of our families in Hawaii and of the kind of ethical system we'd like to have in the future for healthcare. So thank you very much for the opportunity. Thank you. ACLU of Hawaii.

Good afternoon, Chairs, Vice Chairs and Members of the committees. My name is Donovan Kamakani Habano. I'm speaking on behalf of the American Civil Liberties Unit of Hawaii. I'll largely stand on our testimony in support of this measure, but wanted to highlight a couple of points.

This bill not only adds protections for gender affirming care, but also strengthens protections for reproductive health care. At the heart of it is guaranteeing everyone's fundamental right to bodily autonomy and privacy. We have seen persistent attacks from the Federal Government on transgender people and interfering with patient and provider relationships and insurance coverage.

But these medical decisions to accessing life saving care improves health, life and well being and should remain private. This measure is an opportunity to stand firm in protecting the people who have always been here from abuse from the Federal Government, outside states and the courts. Hawaii must protect its cultural and genealogical integrity.

As a Mahu Kanaka Ibi, I urge you to pass this measure. I'm available to answer any questions.

Thank you. Drug Policy Forum of Hawaii.

Aloha Chair, Vice Chairs, Members. Nicol Slevens with Drug Policy Forum of Hawaii this bill is fundamentally about freedom, privacy and protections of patients and care providers. A gender affirming shield law is in accord with the state's constitutional and statutory protections.

Our Constitution expressly protects an individual's right to Privacy In Article 1, Section 6, which provides the right of the people to privacy is recognized and shall not be infringed without the shoring of a compelling state interest. Gender identity and gender expression are protected categories in Hawaii's non discrimination law.

Every major medical association in the United States recognizes the medical necessity of transition related care for improving the physical and mental health of trans people. So very much you know, patients and our providers need protection from predatory Attorneys General on the continent as well as opportunity opportunistic litigants.

So mahalo for the opportunity to provide testimony and look forward to speaking more.

Thank you, thank you on Zoom. Kumukahi Health and Wellness, Not Present. Healthcare Association of Hawaii and support. Thank you on Zoom. The Hawaii County Democratic Party.

Aloha Chair and Members My name is Charles Brister. I am a resident of Puna on the Big Island. I'm self employed as an accountant and I'm a father and grandfather. I also serve as the Chair of the Hawaii County Democratic Party. I'm speaking on behalf of myself and on behalf of Hawaii County's Democrats.

I see this issue as one of equality. Everyone in this country has equal rights and it should go without saying that includes equal rights when it comes to privacy, medical care.

When I go to the doctor or the hospital, there are laws that protect my privacy and with advice from my doctor, my decisions about my medical needs are mine alone. No one has the right to weigh in about my choices or to intervene. It's the same for you and for everyone in America.

Apparently the Federal Government and some other states want to carve out some crazy exception for people who are transgender and their medical providers. We say emphatically no to that idea. Equality means equal. It means everyone treated fairly, treated the same. Equality doesn't mean that everyone's equal except this one group that we don't agree with or understand.

I do realize some people still believe that gender is a binary, just male and female, no other options. But that's old school thinking and it's based on ignorance of reality.

But even if that is your view, even if you personally feel it's wrong to be transgender, or if you just don't understand the idea of it, the fact remains everyone has the same rights in this nation and in the state of Hawaii, both those who agree with you and those who don't agree with you.

When those rights come under attack, let's make sure Hawaii protects our people, all of our people, including those who are patients and those who are doctors. We are counting on you as our elected representatives to provide us that protection.

Thank you very much.

I appreciate the chance to express unequivocal support.

Of House Bill 1875.

Thank you.

Thank you for your justice.

Mahalo Chair, Vice Chairs and Members of a Committee. My name is Yanghee Overlee from AAUW of Hawaii. We stand on our written testimony. But in addition, I just wanted to share with you some things I heard recently.

Friends of my son who are residents when they graduate from medical school are choosing not to move to blue State, not to move to Puerto State or residents because they don't think the state lawmakers will protect them. These are doctors and they are not all OBGYN for both gender affirming care, but also reproductive.

And I heard recently from a friend who has a son who's a neurosurgeon born and raised in North Carolina. He went to Duke University for undergrad medical school. He even did residency there. He recently decided to move to Colorado for same reason. North Carolina has Democratic Governor but he did not feel protected there.

So I ask you to pass this measure so that we don't lose the doctors we are already shown. And then if Mala Winger from Indivisible Team from Volcano was here, she would ask you to she want to share with you.

She used to teach genetics in college for years that this is not a choice no matter what people think. So thank you for listening. Thank you. Thank you very much.

On Zoom Aloha CARE, not present. Not Present. In support. American College of Obstetrics and Gynecology.

Hello Chairs and Vice Chairs. My name is Dr. Melaro Bravo and I'm here on behalf of the American College of Obstetricians and Gynecologists in strong support of HB 1875.

HB1875 was carefully written to strengthen Hawaii's existing protections for what is lawful reproductive health care by extending those same protections to gender affirming healthcare that is already legal in the state. Importantly, this Bill does not change the standards of medical practice. It doesn't mandate care. It doesn't lower professional expectations. It shields unlawful or negligent conduct.

The protections in this bill apply only when care is provided in accordance with Hawaii law and generally accepted standards of practice.

HB 1875 directly addresses a growing problem Clinicians are facing across the country even when cares legal providers are increasingly facing retaliatory consequences, including loss or denial of malpractice insurance, exclusion from health plant networks and possibly even out of state litigation.

This Bill responds by explicitly prohibiting medical malpractice insurers from refusing to issue, canceling, refusing to renew or penalizing coverage solely because a provider delivers lawful reproductive or gender affirming care in Hawaii. It also prevents health carriers from terminating provider contracts on the same basis. These protections matter in Hawaii, where we already face a health care workforce shortage.

As we just heard, when providers fear losing insurance coverage or professional standing simply for following the law. Access to care suffers particularly for our patients who face who already have so many barriers. I'll conclude there since it's almost two minutes, but we support thank you very much Julia Namamo and so forth.

On Zoom. Bradley Greenlee not present in support.

Melissa Nelson, Aloha Chair Marayoshi, Chair Takayama. I would be remiss if I did not say that your shirt is amazing today. And to all of the Members of the Committee, thank you so much for this hearing today.

I'm testifying today as a gender affirming therapist, as a public health professional, and really most importantly to my heart as the wife. As a trans person, gender affirming care is safe and legal in Hawaii.

However, much as with abortion and other reproductive health care, as we've heard, it's under attack from out of state interests who want to intimidate and erase trans people from society. This puts real people at risk of losing essential health care and it puts providers at risk of burdensome investigations and of losing their license.

This is terrifying for people seeking care. Trans youth suicide rates have skyrocketed in the last few years because of these attacks. And as we all know, we can't afford to lose providers and we can't afford to lose any more trans people. Hawaii took swift action in 2022 when Roe v. Wade was overturned by the Supreme Court.

Thank you so much the many representatives on the committees who drafted and submitted this legislation in response to the ongoing attacks on evidence based health care. Your support helps me, my family and my friends feel supported by their community and it keeps them safe and we are just so grateful for for your care. Thank you so much.

Thank you very much. From here on we're going to be calling names of individuals who submitted testimony and said that they would either be on Zoom or in person. And just so you know that I'm calling him, calling your names in order in which we received your testimony in person.

We have Olivia Manayan.

Aloha Maikako, Chairs, Vice Chairs, and Members of the Committee. Thank you so much for hearing me today. My name is Dr. Olivia Minayan. I'm a board certified OB GYN and a provider of gender affirming care.

As a physician who provides both gender affirming care and full spectrum reproductive health care, for me, the thing that I prioritize most for my patients is is bodily autonomy. And not just so that they're able to survive in this world, but to live a full and rich life to be their full selves.

I also am a person who loves someone who has received gender affirming care in a way that has transformed their life so positively.

I've been able to watch them not only make decisions about their own body, which I believe that every person has the right to do, but I've seen them live a life that they have always dreamed of living and to be able to be perceived in the way that they see themselves has made such a big difference to their mental well being.

At a time Right now in this legal landscape where we're facing people who are constantly challenging science and evidence based medicine, it is so important that we continue to fight back so that we can provide our patients the best possible care.

My written testimony is as stands, but I also did want to bring up a really important and recent event in Illinois that shows how important explicitly providing or accounting for gender affirming care within this Bill is. There was recently a provider who tried to get malpractice insurance for providing care in Illinois.

After shopping around to more than 10 malpractice insurance providers, they were not able to get a policy that would include gender affirming care. All policies that were offered were only to exclude that care. They were finally able to find one carrier who would cover them for that care and the premium went from being $10,000 to $50,000.

So we know that this is happening in other parts of the country and that's why it's so important for us to be preemptive and to work and to make sure that we not only protect providers but also patients and not to erode the trust to this population of patients who already seek so many barriers to care.

Thank you so much for your time today.

On Zoom, Sheila Medeiros, not present in opposition. On Zoom Shonda Brock, not present in support. Kay Lee.

Aloha Chairs and Members of the committees I am testifying as an individual and a Member of the community in strong support of HB 1875.

As I've mentioned in my written testimony, I am blessed to have a lot of amazing, fantastic trans people in my life, friends, family and I've seen firsthand how absolutely vital this gender affirming care has been for them to be able to live just full, rich lives.

Transitioning is a deeply personal journey and one that politics and politicians have no place in any politic, any politicians, but especially, especially politicians half an ocean away. Please support this Bill and allow trans individuals and their families to navigate their journey safely and with D. Thank you. Thank you.

Kekoa Kealoha.

Aloha Chairs, Vice Chairs, Committee Members My name is Kekua Kealoha and I am in strong support of this bill for a number of reasons. You have my written testimony.

But one thing I do want to highlight is the importance of state sovereignty and the ability of our state to be able to exercise our laws free of the influence of others.

There are a number of states who have legislated who gets to live and who gets to die and it is unacceptable to allow other states legislation to influence who we allow to practice in our state.

I don't want to spend time asking you to recognize the humanity in our trans people because that feels inhumane in and of itself. Because there are a number of people who are intent on reframing this Bill as something that it is not.

So I strongly urge you to base your decisions on evidence, not on ideological bases that are rooted honestly just in bigotry and hatred. So thank you.

Thank you. Shalani Placentio.

Aloha Chairs, Representatives and Committee I strongly support this bill because you know, as a trans woman of a Native Hawaiian experience, I'm also working, giving services as gender affirmed care services at Hawaii Health and Harm Reduction Center.

Seeing the improvement of when they first come in, being scared, afraid for their lives and me watching them and walking with them through their services and seeing how more comfortable they are with their lives and more strong. I solely strongly support this bill and I hope you guys too. Thank you.

Let's see. Elaine Chen.

Aloha Chair, Vice Chairs and Members My name is Dr. Elaine Chan. I stand here as an OB GYN who practices gender affirming care and full spectrum reproductive health care. I am also a member of the queer community, a friend and family member to many transgender and gender non conforming people in my life. As a decision.

I'm here today in strong support of HB 1875. It's my responsibility to provide care that is evidence based, ethical and centered on my patients health and well being. By the time that patients have reached me they have already faced so many hurdles.

Gender affirming care and reproductive health care already have rigorous standards to make sure that it is safe and evidence based. Physicians who have committed to provide this essential health care should be able to provide it without the fear of our privacy our patient's privacy being invaded. Importantly, as stated before, this Bill does not change medical standards.

It reinforces existing standards and protects the patient provider relationship which is essential to trust, safety and access to care. This Bill ensures that patients can access reproductive and gender affirming care without fear and and that physicians clinicians are not subjected to abusive lawsuits, insurance penalties or licensure threats from outside the state simply for just doing our jobs.

I know that this care is not only safe but it is life changing and life saving. Each birthday I get to celebrate with my transgender friends and family is a precious one and uncertainty around legal and professional risk drives providers away.

Not just OB gyns but primary care physicians, surgeons and it limits access, especially in an already underserved community like Hawaii. HB 1875 helps prevent that. I respectfully urge your support and I thank you for the opportunity to testify.

Thank you. Jen Hayashi.

Hi, my name is Jen Hayashi. Thank you so much for your time today. I am also an OB-GYN, but I'm a resident physician in training. I'm also a member of the queer community and also have several loved ones who identify as transgender. So this is very dear to my heart and I do strongly support HB 1875.

I just want to acknowledge, as you may know, OB-GYN is a very sensitive area of health care, and as was already stated, it is particularly important to preserve this patient physician relationship and the safety of choice in OB-GYN.

So in my career, I'm interested in dedicating it to OB-GYN care for LGBTQ folks because I know that OB-GYN care can be specifically sensitive for those who are gender diverse as well.

And while I do think that transgender folks in all states do need champions, regardless of what the laws are there to have, the protection and support of this government is so valuable at the practicing physician and does make a difference in our lives when we choose where to work.

And I do want to acknowledge that the medical system has not always been kind to transgender gender diverse people. So by supporting this and showing our commitment to transgender individual health care, not just for gender affirming care, but for all care, primary care, preventative care, I think that the community deserve that.

Ariel Howell.

Hello. Thank you, Chairs, Vice Chairs and representatives here for holding this meeting and listening to us today. My name is Ariel Howell. I'm an OB-GYN here in Hawaii as well, and I'm here to express my support in HB 1875. As a doctor.

When I enter patient rooms, my goal is really to meet patients where they're at and to have a space where they feel safe to get their health care goals met. And this bill will act in a way that allows us to do those things and meet patients where they're needed to be.

This shield law allows us to perform gender affirming care in an evidence based way. It doesn't impact what care that we are already giving. It just allows us to do it safely without fear of legal action, loss of insurance, or loss of employment. It also allows patients to access it freely without fear.

Overall, it's something that will help us continue to do what we're already doing, but in a more safe manner and secure in getting that care.

Thank you. Thank you, Janice. I'm going to ask audience to refrain from applauding because I know you want to express support for those with whom you agree, but there may be people you disagree with and we want to be respectful of them as well. Janice Berry.

Aloha Chairs, Vice Chairs and Committee Members My name is Janice Berry testifying as an individual and community member in strong support of HB 1875 in addition to my written testimony. Through my advocacy in mental health and suicide prevention, I see how fear and barriers to lawful health care increase stress, isolation and harm during already vulnerable moments.

People in Hawaii deserve access to care and to provide access to care that is safe, private and compassionate. Protecting both patients and providers helps strengthen trust in our healthcare system and supports overall community well being. I respectfully urge you to pass HB 1875. Mahalo for the opportunity to testify.

Thank you. See we have on Zoom, Suzanne Froenick.

Aloha Chairs, Vice Chairs and Members of the Committee I'm submitting testimony as an individual in strong support of HB 1875. Several of my close friends and loved ones are trans and access to gender affirming care has made a huge difference in their well being.

I'm lucky to have them in my life and sharing my support for protecting their access to care is the least I can do as a member of this community. I believe every family deserves access to medically necessary care without fear of political interference. This bill protects our neighbors, friends and loved ones.

Please stand with our community and support HB 1875. Thank you.

On Zoom, Joy Badua not present. We have an individual. I just have K like the letter. Anyway he or she is in support. Dale Vanderbrink.

Alumni affairs and Vice Chairs My name is Dale Vanderbrink. I am the second Vice Chair of the Ala Moana Kakaako Neighborhood Board and this is my personal testimony. I stand in strong support of HB 1875. The last several years have been a painful and frightening experience for many in our community.

Our Federal Supreme Court, our Federal Government has failed us and and as a result, out of state entities and individuals have the means to interfere in health care decisions here, either by blocking the medical treatment outright or via fear and intimidation by suing to request private medical records.

Living in a blue state is not enough when our laws do not meet the moment. Our state or Legislature needs to stand up and meet that moment. HB 1875 helps meet that moment by cementing protections for reproductive rights and gender affirming care.

It gives our state the means to shield our residents seeking medical care from outside state entities or individuals who file frivolous lawsuits. It prevents our state from being puppeted to enforce the lawsuits and penalties of others. It also helps protect their medical community who simply wish to Provide the necessary medical care to those who need it.

While this bill does not help me, I fight for it because it helped my friends and family and those within my neighborhood and community. So I ask you on this Committee, when you vote, please remember those in your districts who need this protection and please support and pass HB 1875. Mahalo. Thank you.

On Zoom. Joshua Kaina, not present in opposition. Scott Johansen.

Thank you for this opportunity. My name is Scott Johansen and I'm here in support of this bill. I have spoken to several trans people. Most in their own story expressed how prior to receiving acknowledgement, understanding and support, they had contemplated suicide.

Receiving gender affirming care in its many forms was part of that understanding and support that eased their anxiety and depression, bringing them farther from suicide. Today's national political rhetoric. Trans people are demonized and politicians warn us about the trans agenda spreading fear and hate. We have nothing to fear about the trans agenda.

They just want to be part of our society. Nothing about trans is cause for excluding them from our society. Whether it's how they dress, what pronouns they choose to use, the medical treatments prescribed by their doctors, or how they understand gender in a more complex and profound way than other people in their society.

Trans people are people, citizens, our neighbors. They deserve the right to seek medical services appropriate to their needs. This bill allows trans people, citizens and our neighbors to to seek care from their chosen medical providers.

Failure to support this bill will promote and legitimize the fear and hate being spread isolating these people and pushing them to consider suicide.

I don't know what arguments are presented by others to resist this bill, but whatever tragic cause they may present to you, withholding medical care to our citizens, other people and our neighbors is not the answer. I urge you to vote in support of this bill.

Thank you for your time. Thank you, Madeline. Madeline Sisypasar.

Aloha Vice Chair Members and My district, Daisy Hartfield. Thank you for letting me speak. My name is Madeline Sisypasar. I'm also a Samoan trans woman. It's amazing to hear all these people supporting us because doing this work since 1998, I've seen the growth when it comes to gender affirming care for transgender folks.

And it's pretty amazing what you all are saying about transgender folks because this is life. This is our life that you guys are trying to put on the table. This is our life. We need you to stand with our clinicians because they need it. We don't have much. We need you to stand with parents.

Parents that are trying to support their children. We didn't have that back then. We were being kicked out. A lot of my friends were kicked out of their homes because parents didn't understand. Now we need to protect those parents and we need to protect Patience. I'm a patient because this is my life. This is my health care.

My health care is just as important as anyone here. And so I need you to please support this bill because this is our life. It shouldn't be a political stance, but for some reason it is. So please do the right thing and support us.

Thank you. That's all. The persons I have listed as being present to testify. Did I miss anyone? Who else who wishes to testify, please form a line, step forward and identify yourselves.

Thank you so much. Chairs, Vice Chairs and Members of the Committee, Heather Lusk with the Hawaii Health and Harm Reduction Center. And I'm obviously technologically challenged because I did not resubmit my testimony. I thought I did. So my apologies. We. We are a provider of gender affirming care.

And I stand here as a cisgendered woman spending over 30 years of my life dedicated to health care. And I'm here because this bill will save lives. I've had the right and the privilege to get access to health care, and there's no reason why anybody else should. Have that as well.

As you've heard, HB 1875 protects Hawaii's right to make our own health care decisions. We all should be able to make the health care decisions with our providers, our doctors, our nurses, our families. However, there are so few gender affirming care providers right now. Actually, our providers going to another island next week to provide this.

And we're providing care on almost every island via telehealth because providers are scared they're getting harassed. Our community is being harassed. I have never in my life seen as much hate come to our agency, to our providers, and to our community. And I live through the HIV crisis. So that's saying something. Gender affirming care is health care.

It's not politics. It's not ideological. Ideological. It's medical necessity. And as you've heard, the American Medical association, the American Academy of Pediatrics, the American Psychological Association, the American American Psychiatric association, all of them say that this is medically necessary care.

So I ask you, just like we joined the West Coast, the West Coast Health alliance, to be able to mirror vaccines and immunization standards that are best practices, please pass this bill. This is not just an academic exercise. It's lives at stake. Thank you.

Thank you. Chairs Vice Chairs Members of the Committee for allowing me to testify in strong support of House Bill 1875 relating to health care. I'm testifying on behalf of the district for Hawaii Democratic Party. The District 4 Chair. District 4 is located in Lower Puna on Big Island.

And we are known for our passionate support of individual liberty and protection of the rights of marginalized people. We defend those who need our help right now in the current climate of the United States. We, we stand together with the transgender community and the medical providers who help them stay alive.

As you can hear from my accent, I grew up in the American South. I understand bigotry towards the oppression of those who are deemed different, better than most.

We must protect our Hawaii residents who from other states laws that only seek to harm people who are merely trying to live their own lives and the doctors, families and support systems who assist them in that effort. We need safeguards that protect both reproductive and gender affirming care. It's the right thing to do. It's the moral thing.

Today. Please pass out this bill as written and show your compassion for encourage to care for those in need of our health. Thank you for your time.

Aloha. My name is Richmond. I live in District 42. I oppose this bill. Every single patient deserves. Has legal rights to be protected from medical malpractice. If this bill, this bill shields people, not every person but a specific group of people are having their rights to be protected, removed from them by this bill.

This bill is not justice. It's not equality. It's not protecting children. It's removing the rights of people that anybody that has any medical procedure deserves these legal rights to be protected. So I'm on behalf of the patients, regardless of our sexual orientation or how many years we've been fighting for our causes.

The rights of every individual must be protected, not just a specific group and not to be. And they're not. They're being. The specific group is literally the ones that are being targeted and their rights are being removed from them. So I, I invite you to please oppose this bill. And I thank you.

Hi, I'm Genzia Bombard. I'm one of the OB-GYN resident physicians at University of Hawaii. I just wanted to say that I support this bill. I am somebody who studied in a red state for my medical school training.

And it's just really important that we create spaces for people who are interested in this type of medical care to have a space to actually learn about it. Training in a red state.

I would say there are certain words such as abortion, transgender that are often not spoken about in open medical forums, which I found very disheartening, especially because it was very exclusionary to specific subsets of our population. Additionally, I think it is a huge asset to your guys community to provide that care.

It's going to bring especially empathetic people to your state who want to provide care for everyone, despite who, how they identify or who they love. I think it's very important to reinforce those concepts and to really make sure that this is a place that values equity, respect for other people. Thank you.

Cameron Hurt. I didn't submit to. I didn't think I was going to testify, but I will be after this hearing testifying actually as an individual on my own. These are my own words reflecting my own personal thoughts and beliefs.

The idea, the concept of what we know today in American English as transgender is not new to this land. It's been here. This random objection though, is new. It's about 50 years new to a group of people that have existed again on this land for hundreds of years prior to this new feeling.

I'm personally going to share with you all that I am a very much a convicted man of faith. I'm also a very proud father who's raised two boys to adulthood. They're both doing well. I, as an individual, can't say that I understand transgenderism. I don't. I don't need to.

Every Mahu person that I've met since being in this land, to every transgender person that I know throughout this world, has done nothing but enhance my life while not bringing any type of harm to it whatsoever. That is what should be focused on.

And again, I say as a single father, what my kids intake, what any agenda, anybody in this world has, begins and starts and stops in my household, so I don't have to be worried about an outside influence. But what we've seen from our community members is that this is real for them.

And I don't need to bring my CIS straight male experience into this to understand these people deserve dignity. These people deserve access and they deserve safety. People have asked me time and time again, what made you come to Hawaii, Cam? Why are you here? And I say, as a black man, this is the safest I've ever felt.

When I see blue and white lights behind me, I feel safe. Please make sure they feel safe. And as a person who comes from a group of people who has had their existence debated and legislated on to every maho and transgender person, I am deeply sorry. But you are seeing, you are Very much loved.

Thank you. Anyone else in the room wishing to testify? Anyone on Zoom wishing to testify? I just for the record, want to note that I made a real quick rough count of the individual written testimonies and counted about 180 in support and 26 in opposition. So with that, we'll open it up to member questions. Members, any questions?

Chair?

Representative Hartsfield, thank you.

I'm not sure who should answer this question. It's directed, I guess to the I'll call you white coat since you're wearing your white coats. You know, I read through the testimony and a lot of the testimony in opposition had to do with, with children who decide to, you know, move forward with gender affirming health care.

And I'm wondering, in your practice, how common is it that your patients are individuals under the age of 18? So if any of you. Dr. Bravo.

Dr. Bravo.

So, Dr. Bravo. I'm one of the OB-GYNs with ACOG. Particularly in my practice, I don't see as many pediatric patients, but I have seen a few. I can't certainly tell you a number. Usually they're coming in with their parent and we're having a full discussion on what the care would be.

And this is why this bill is important because I definitely understand the concern that a lot of parents are having. Usually when they get to my office, they have thought about this for a long time. This is not like they're coming in to ask me about it and I'm just going to tell them everything.

They have thought about it sometimes for years. And both the parents and the patient are kind of struggling a little bit with the decision that they want to make to move forward with care.

And if we don't have the protections where I would feel comfortable giving the care, because then my malpractice insurance is going to go up, then I'm not going to be able to give them the counseling that is already evidence based medicine.

Thank you.

Thank you, Chair. Any other questions, Members? Representative Garcia, thank you for DCCA, if you're still here. Thank you.

Your testimony, I could barely hear you earlier, but your, your testimony goes over the malpractice concerns for insurance. Could you briefly elaborate on that again?

Sure, yeah, no problem. So just to describe the section, the statute prevents or prohibits medical malpractice insurers from taking prohibited actions under paragraph 4. The definition of prohibited action includes imposing any sanctions, fines, penalties, rate increases or other type of unfavorable change. So our concerns are twofold with first, the other, another type of unfavorable change.

Very broad, vague, definite phrase without a definition. So, you know, arguably any kind of, any kind of change that a provider seems that would think is unfavorable could be, you know, could be seen as an unfavorable change that would be a prohibited action. And again, the insurance division isn't charged with enforcing the statute.

So whoever would be charged with enforcement of statute would have to make that determination. Second, the term or the prohibition of rate increases. The insurance code requires that insurance rates be actuarially sound so the actuary will take into account all risks when determining what a new rate would be.

And you know, if a provider begins offering gender, gender affirming services or reproductive services, that could add a new risk profile that would increase that, that provide risk and rates would therefore need to be adjusted according to that.

And so when there's a prohibition on that, our concern would be that the rates that are offered would not match the actual risk profile.

Do you think that the risk would warrant insurance companies pulling out from Hawaii?

I'm not sure. I mean, my understanding is that insurance companies don't offer insurance when the risk doesn't match the rates. Not necessarily because the risk is too great. But I can speak to what the insurance companies. Thank you.

Any other questions from health Committee Members?

Any CPC Members have any questions if you want to.

Or DCCA, thank you. So if this bill passes though, and the protections that are here would protect. Physicians who have malpractice insurance. So wouldn't it actually decrease the stress on malpractice insurance with this particular population?

If this law goes into effect and it actually shields, it would actually, in terms of the provider of insurance, wouldn't it actually potentially lessen the amount of their payout or the amount that they would of claims?

I can't speak to what the real effect would be, but the fact that there is a cap, right. So it could go up, it could go down, but in the case that the risk does go up, the insurer will be handcuffed.

Any other CPC Members have questions? Rep. Ichiyama for DCCA.

Thanks so much for your testimony. So my understanding, three other states have passed similar language regarding medical malpractice. And to my understanding, those other states still have medical malpractice offered in those states.

So I'm wondering if maybe you can reach out to your counterparts and find out, you know, how this law has affected or not affected them, because it is, it is law in other states. Sure.

And then of course we'll do that. And then I would also note that we've Provided an amendment that we think would solve our concerns, which is to say that the rate should still just be based on sound actuarial principles. And by implementing this amendment, it would.

It would also help on the opposite side of the coin, where if a insurer does raise rates and they're not actuarially sound, then we can say that does prove that it would be more likely solely based on these prohibitive reasons.

Thank you. Thank you, Chair. Anyone else from CPC questions?

Seeing none. We're going to pause for decision making to get our voting sheets in order. Bear with us.

So first up, we have decision making on HB 2501. Chair's recommendation is to add a defect date on the bill to keep it alive. I'm going to call on Chair Matayoshi to explain another amendment.

We just want to change the language for in Section 2, subsection A to make sure that the language reflects the amount that hospitals are net losing, that. They're not the amount that they're expending, but the amount that they are. Not. Getting reimbursed to reflect their net loss. That's the number that we want reported to the government.

We'll work on that language.

Thank you. With that, that's our recommendation. Members, any questions, comments or concerns? Seeing none. Vice Chair for the vote.

Thank you. Chair. Members voting on House Bill 2501. Chair's recommendation is to pass with amendments. [Roll Call] Reservations. Chair, your recommendation is adopted.

Members, same recommendation.

Vice Chair voting on HB 2501, Chair's recommendation is to pass with amendments. [Roll Call] Okay, Chair, your recommendation is adopted.

Thank you. HB 1875. I'd like to move this bill forward. Forward. So my recommendation is that we add a defective date and secondly, adopt the language proposed by the Insurance Commissioner. To wit, on page four, lines one and two shall read imposing any sanctions, fines, penalties or rate increases that are not based on sound actuarial principles. Period.

That's the change. So with that, Members, any questions, comments or concerns?

Chair, comment. First of all, I want to thank everyone that testified, even those that testified in opposition. Based on the testimony I heard today, though, it doesn't Change the fact that gender affirming health care services is already lawful in Hawaii. And from the testimony that I, I heard today, you know, Hawaii is a state of aloha.

And, and so I just wanted to make that comment. Thank you, Chair.

Any other comments? If not Vice Chair. I'm sorry, did I miss.

I want to echo the sentiments that Hawaii is a state of aloha. The. The concerns I have is not with the gender affirming care for, for those who choose to engage in those services. It is the fact that this adds on Act 2, which was passed in 2023.

And the reason why I oppose Act 2 then was the fact that it allows access to minors without parental consent. And so that's the issue for me. So for those reasons, I'll be voting no. Thank you.

Thank you. Any other questions? Or any other comments or questions? If not, Vice Chair for the vote.

Thank you, Chair. Members voting on House vote. 18 seconds. 75. Chair's recommendation is to pass with amendments. Noting Member Terez Amato excused and a no vote from Member Garcia. Any Members with reservations? Any other Members voting? {Roll Call] Thank you, Mr. Alcos. Chair, your recommendation is adopted.

CPC Member, same recommendation. Any comments? Rep. Tam?

Thank you, Chairs for passing this out. For your recommendation. I just want to make a statement to say that, you know, at the end of the day, I think this is about trying to, you know, protect the providers, but it's also to protect our transgender community.

You know, I know that there are a lot of talks today about how this saves lives, and it's very true. And the reason why I'm supporting it so passionately is because I don't want a family to wake up one day and to find their child or their.

Even their partner, whoever in their family, Members that are no longer with us and have that empty seat at the dinner table at night. It is really sad. So for those reasons, I'll be voting in support of it. Thank you, Members. Any other comments?

Thank you. I just want to thank Representative Tam, Representative Ichiyama, many of the community Members who contributed to this piece of legislation, and thank you to the chairs of both committees for providing us this opportunity to hear from the public and to cast our vote.

Thank you, Any other comments from CPC? Okay. Same recommendation. Vice Chair.

Voting on HB 1875. Chair's recommendation is to pass with amendments noting the excused absence of Representative, Representative Lowen and Representative Pierick. Are there any reservations? Any Noes? [Roll Call] Chair, your recommendation is adopted.

Okay.

Thank you, Members.

Thank you all.