Senate Standing Committee on Health and Human Services

Good afternoon and thank you for joining us today. This is the HHS hearing on Thursday, February 12 at 1PM. We are convened in Room 225. I would like to, well, there's no one to introduce.

This meeting is being streamed live on YouTube. In the unlikely event that we must abruptly end this hearing due to technical difficulties, the committee will reconvene to discuss any outstanding business at 1:05PM, Monday, February 16, Room 225, and a public notice will be posted on the legislator's website. To facilitate this hearing in a timely manner, we will be enforcing a 1 minute limit on testimony. I will be reading a list of individuals who submitted written testimony for each measure.

We apologize that closed captioning does not accurately transcribe the names.

If you're interested in reviewing the written testimony, please go to the legislator's website. You'll find a link on the status page for the measure. We appreciate your understanding and remind you that the committee does have your testimony, and that we review them. So I encourage you to use your time either to add additional comments, or you can stand on your written testimony.

And like I was saying at the break, we have 20 bills today. So if you could stand on your written testimony and be concise, I will be strictly enforcing the 1 minute rule. So first up, SB 2283, relating to prescription drugs. First up, DCCA Board of Pharmacy in support. Comments?

Okay. It says support. Thank you. Next, we have Dr. Lewin, State Health, Chipta, in support. Jack Lewin.

No. Walden Au. HMSA in support. Oh, supports the intent.

Good afternoon, Chair San Buenaventura, Vice Chair McKelvey. Walden Au on behalf of HMSA. We see this as a measure that would benefit not just our members, but residents across the state. This measure could allow residents to access more affordable medications and achieve better long-term health outcomes. Mail order pharmacy offers more than just convenience. It's a proven strategy to lower costs and improve health outcomes.

Our members will always have a need for retail pharmacies for acute medications, short-term prescriptions people need when they're sick or have an injury. These are medicines that can't wait, and retail pharmacies will always play an essential role in providing them quickly. But maintenance medications are different. These are long-term therapies that people depend on every day, often for life. For these prescriptions, the automatic and reliable refill process provided through mail order supports better adherence, reduces gaps in therapy, and prevents avoidable hospitalizations.

Thank you for the opportunity to provide testimony in support of this measure.

Thank you very much. Next, we have PCMA, Tanya Neal, in support. Tanya Neal, are you present on Zoom? Tanya, please proceed. You have one minute.

Yes, ma'am. Thank you. This is Tanya Neal with the Pharmaceutical Care Management Association. We'll stand on our written testimony.

Thank you very much. Next, we have Rachel Wilkinson, Hawaii Association of Health Plans, in support. Rachel, are you present?

Thank you, Chair. We just added our written testimony.

Thank you very much. Next, we have those who have registered. Molokai Drugs in opposition. Kimberly, please proceed.

Okay. Good afternoon. I stand on my testimony, but I would really like to state that one of the reasons why we are heavily in opposition of this bill is that almost all of our Molokai residents have to go to one of five post offices to pick up their mail. Because of our small numbers, the post offices maintain very limited hours.

One post office on our island is only open from Monday to Friday, from 9AM to 12PM. If you do not pick up your mail order prescriptions by Friday noon, your mail order insulin, for example, on ice may be stored in a non-air-conditioned facility for 69 hours until Monday at 9AM. When this happens, we can always guarantee the ice is melted, since no mail comes to Molokai overnight.

I'm also here for my 23 full-time and part-time employees, who are taxpayers and support 102 people in their households. If a bill such as Senate Bill 2283 passes, it will cause pharmacies such as Molokai Drugs to cut hours, lay off employees, and possibly close our business. Pharmacy is a very challenging industry. Thank you for your time.

Thank you very much. Derek Tengen, Five Minute Pharmacy, in opposition. Hawaii Pharmacists Association. Please proceed.

We oppose. I'm Derek. I'm the owner of Five Minute Pharmacy. Corrie and I work together. We have 100 full-time employees, locations primarily on the West Side, Waipahu. Stores we had to close in the past, Nanakuli, Waimanalo, a lot of rural areas, because of bills like this.

People in the room here, you and I, middle class, middle, upper class, mail order, I can see it working. A lot of patients we serve are poor, rural, changing addresses all the time, changing phone numbers all the time. They depend on independent pharmacies to do deliveries, face-to-face interactions. With mail order, medicines get mailed.

They just sit there, and who knows if they really take it or not. And we've seen it for these patients. English is their second language. This is a challenging population outside of patients that are perhaps sitting in this room today.

Thank you very much. Next, we have Corrie Sanders, Hawaii Pharmacists Association, in opposition.

Chair, Vice Chair, members of the committee, we're going to stand in strong opposition of this bill, which we put in our testimony. It looks like this came up in 2013, and these provisions were enacted especially to support independent pharmacies. There's been a lot of research since 2013 that shows that mail order pharmacies aren't necessarily cheaper, and they do increase the cost of care overall. There are unintentional refills, with continued refills for maintenance medications.

And I do want to point out that, specifically for our independents across the neighbor islands, sometimes this community pharmacy is the only touch point that they get in healthcare.

At this time, other chronic disease states are found and helped to be managed. They're able to get in touch with their provider. There's just more of a continuity of care when there's touch with the independent pharmacies. And a bill like this would really restrict local touch points to the independents and potentially force them out of business. So I think there are unintended consequences of this.

It looks really good on paper, like it's access to care, but the downstream effects on the ability of the independents to run their businesses will ultimately be really detrimental to our neighbor island communities.

Thank you very much. Next, we have Hawaii Primary Care Association providing comments. Eric Abe, Walden Company, Tiffany Yajima, providing comments. National Community Pharmacy Association in opposition, Joel Kurtzman. Kelly Gold, Molokai Drugs Inc., also in opposition. Kevin Carter, Westside Specialty Pharmacy, in opposition.

We have Krizia Lugaro. Are you present on Zoom, Krizia, in opposition?

Okay. We also have Alec Marie Anne Rola, also in opposition. Alec, are you present on Zoom?

Oh. Are they or not?

Okay. Thank you. And we have 20 other all individuals, all in opposition. Anybody else wishing to testify in SB 2283? Members, any questions? Okay. Seeing none. Moving on. SB 2855, relating to opioid antagonists. First up, we have Insurance Division, DCCA, providing comments. Okay. Thank you very much. Next we have Dr. Mayor Alameda, County of Hawaii, in support. Walden Au, HMSA, providing comments.

Good afternoon. Walden Au on behalf of HMSA. Just real briefly, medically necessary opioid antagonists are already covered by medical plans. We believe that the issue that's trying to be addressed is if at a point of sale it's recommended to pick up an opioid antagonist that there wouldn't be a prescription. We feel that this could be an educational type fix that we can do on our back end. Thank you.

Thank you very much. Next, we have Hawaii Association of Health Plans providing comments. Thank you. Nobody else having registered to testify. We have Hawaii Island Fentanyl Task Force in support. Big Island Substance Abuse Council in support. Hawaii Island Fentanyl Task Force Mitchell Tam in support. Nine other individuals all in support. Anybody else wishing to testify in SB 2855? Members, any questions? Okay. Moving on. SB 3045, relating to health insurance. First up, DHS in support. Meredith, are you present on Zoom? Okay.

Okay.

Not present, Chair.

Okay. Hawaii-- State Health. I see SHPDA in support. Come on up, Dr. Lewin.

SHPDA-- morning, Chair, Vice Chair. Thank you. Good afternoon. We stand in support. This comes up each year. We think if we're gonna be consistent with carriers on the mainland-- people on insulin therapy have the right to have a continuous glucose monitor. I think you know that our SHPDA secretary tragically died of hypoglycemia after being denied a CGM several times.

Thank you very much. DCCA, providing comments.

Afternoon. DCCA stands on its written testimony, providing comments.

Hawaii Medical Association, Elizabeth-- Dr. Ignacio, in support, American Diabetes Association in support, Hawaii Health Task Force in support, Mohala Health in support, Hilo Benioff Medical Center Foundation, Lisa Rantz, in support, Kaiser Permanente on comments. John Kumitza, are you present on Zoom or in person?

Not present, Chair.

Okay. Next, we have HMSA, providing comments.

Good afternoon. Walden Au, on behalf of HMSA. We appreciate the intent of the measure and we hear what the community is saying. Currently, HMSA has updated their coverage policies for CGMs: while not strictly tied to Type1 diabetes before injectable insulin, members, that they will have access to CGMs. We also wanted to note that while there was a study that was conducted by the auditor, we have not seen that study yet this past interim. So at this time, we're still waiting for that. Thank you.

Okay. Thank you very much. Next, we have Hawaii-- Rachel Wilkinson, Hawaii Association of Health Plans, providing comments.

Thank you, Chair. We'll stand on our testimony, offering comments.

Hawaii Primary Care Association, providing comments. Stacy Haumea in support. Stacy, are you present on Zoom?

Not present on Zoom, Chair.

I see Kiran Polk present on Zoom. Please proceed in support.

Aloha, Chair, Vice Chairs, members of the committee. Kiran Polk. I am in support in this as an individual, and I just wanna clarify that and not as a part of my agency or organization. Thank you.

Thank you very much. Michael Olderr in support. Melanie Craddock in support. Anybody else wishing to testify on SB 3045? Members, any questions? Okay. I do. HMSA, come on up. My understanding is that it's already being provided, and if so, why can't we just pass this and ensure continuous?

I'm sorry. One second, Senator. So right now, it's provided for members that are on injectable insulin, but if the bill is passed, it would cover Type II--

Type II also.

And there is a question of the acute need and the supply that, if available to everyone, the people who need it the most, which are typically the Type I diabetic that has the injectable insulin, may not have access to it on a constraint or a strain supply stream.

Okay.

Thank you.

Thank you very much. Anybody else? Okay. Moving on. SB 2843.

First up, relating to domestic violence. First up, we have Darcia Forester in support.

Aloha. Today, I'm testifying in my capacity as the supervisor of the family court division at the office of the public defender. We strongly support extending the pilot program for our domestic violence misdemeanor cases that is currently in effect. We believe it has made a significant impact on reducing backlogs and getting the 8th Floor, basically, to run smoothly. We really don't have dysfunctional backlog.

Things are moving, trials are happening, but definitely at a lower level than we did in the past. And it's my opinion that the calendars are really efficient. I really also just want to separately say that we strongly oppose Senate Bill 2254 and House Bill 2087. I know. But those talk about getting rid of the deferral.

I understand. That's something hard. Okay. Next up, we have Hawaii State Commission and Status of Women in support.

I stand on my written testimony. Thank you.

Thank you very much. Crime Victim Compensation Commission in support. Maui County Department of Prosecuting Attorney in support. County Hawaii Office of Prosecuting Attorney in support. Rainbow Family 808 in support.

Marnessa Rea in support. Marnessa, are you present?

Yes. I stand on my written testimony.

Thank you very much. Dennis Dunn in support. Dennis, are you present on Zoom?

Not present on Zoom, chair.

Okay. Next, we have Mina Burden in support. Tanya Puri in support. Judith Mills Wong in support. Georgette Yandel in support, and Annallese Wolf, Hawaii County prosecuting office in support. Are you present on Zoom, Annallese?

I am.

Annallese. Sorry. Please proceed. You have one minute.

Thank you. Good afternoon, committee. Yes. As a prosecutor for the County of Hawaii, I prosecute a great number of the domestic violence cases, and our office strongly supports continuing the deferrals for abuse charges. They are some of the most useful tools in providing a resolution for a case, both quickly and also making sure that we have somebody marked appropriately with an abuse charge, so it does credit to the actions that actually occurred.

We also support continuing the petty misdemeanor offense, including the one for coercive control. Although it is a petty misdemeanor, it is not necessarily charged often alone, but it is charged as part of big picture felony cases where you need to paint an entire picture of the domestic violence that occurs throughout a relationship. And we have successfully used it to do so. So we urge you to support SB 2843. Thank you.

Thank you very much. And by the way, it is gratifying to know that Hawaii County Office of the Prosecuting Attorney supports this because when I first pursued this five years ago, I was attacked by the Hawaii County Prosecuting Attorney's Office. So thank you for your change of mind. Okay. Anybody else wishing to testify in SB 2843?

Okay. Members, any questions? Okay. Moving on. Next up, SB 2845.

Oh, my goodness. Lots of testimony. Relating to health care. First up, Trisha Nakamatsu, Deputy AG, providing comments. Trisha.

Oh, you're not Trisha. I'm not.

Sorry. But I'm here on behalf of the Department of the Attorney General. Lauren Chun, Deputy Attorney General. Good afternoon, Chair and Vice Chair.

The department submitted comments on this bill. The comments were intended to address and correct potential First Amendment issues, and also to provide some clarifying amendments. I am available for any questions.

Okay. Thank you very much. Next, we have Department of Health providing comments. Okay. Next we have Jack Lewin in support.

Chair, Vice Chair, we stand on our written testimony.

Thank you. Hawaii Commission on the Status of Women in support.

Yes. Thank you. We stand on our written testimony.

Hoku PAC in support. Okay. Hawaii State LGBTQ Commission in support. Are you present? I see Michael Golojuch Jr.

Please proceed.

Oh, no. I'm here on behalf of Pride at Work. Sorry.

Okay. Sorry. Okay. Is Sandy Livingston present on Zoom?

Not present, Chair.

Okay. Hoku PAC in support. You already said that you're in Pride at Work. I see you now. Mike Golojuch, please proceed.

You have one minute in support.

Good afternoon. Michael Golojuch Jr. He, him pronouns, president of Pride at Work Hawaii. We stand in strong support of this bill. I know the hour is late.

So it's just a sad state of affairs that we actually need this bill. Being able to go see a doctor without being harassed, physically assaulted, or berated is a human right. So we encourage you to pass this bill, protect people just trying to seek health care.

Okay. Thank you very much. Next, we have Healthcare Association of Hawaii in support. Hawaii Primary Care Association in support. Indivisible Hawaii Healthcare Team in support.

AAUW in support. Stonewall Caucus, Democratic Party of Hawaii in support. Hawaii Women Lawyers in support. Visibility Brigade Honolulu in support.

Indivisible Leeward Oahu in support. Planned Parenthood Alliance Advocates in support. ACOG, American College of Obstetrics and Gynecology Hawaii Section in support. Hawaii Nurses Association Local 50 in support. Hawaii Family Forum in opposition.

Next, we have Marnessa Rhea. Are you present? Yes. In support.

Thank you very much. Michael Lopez in support. Michael, are you present on Zoom?

Present, Chair.

Please proceed. You have one minute.

Aloha, Chair. Aloha, Vice Chair, members of the committee. My name is Michael Lopez, and I'm a student in the UH Manoa bachelor's social work program.

And I'm testifying in favor of bill SB 2845. Bill SB 2845 protects access to health care by prohibiting intentional or reckless interference with health care facilities, including blocking entrances, making disruptive noise, trespassing, or threatening patients and staff. It establishes consequences for repeat offenses and allows individuals and facilities to seek legal relief for harm caused, while still preserving the right to lawful labor demonstrations.

During my time as a social services intern in a skilled nursing facility, I have witnessed how vulnerable residents can be affected by disruptions in care. Many of the residents I work with are older adults or living with disabilities, and they rely on a calm, stable, and secure environment. I respectfully urge your support. Mahalo.

Thank you very much. Okay. No one else having registered to testify, we have over 110 people all in support. Hawaii Health and Harm Reduction Center in support. Hawaii State Democratic Women's Caucus in support.

YWCA of Kauai in support. Greta Colbus in opposition. Greta. Brett, please proceed. You have one minute.

Thank you, Chair. My name is Brett. Chair San Buenaventura, committee members, my name is Brett Colbus. I'm testifying in strong opposition to SB 2845. I stand firmly by my written testimony submitted to this committee.

As a twenty-six-year veteran, I took an oath to support and defend the Constitution of the United States. That oath did not expire when I retired and continues to guide me today.

Peaceful praying, sign holding, quiet conversations on public sidewalks. This bill chills lawful free speech and is unbalanced, and imposes mandatory jail and powerful civil penalties on some advocates while expressly exempting labor demonstrations and strikes, giving one favored type of protest special protection that others do not have. I urge you to defer SB 2845 indefinitely. Mahalo.

Thank you very much. Anybody else wishing to testify on SB 2845? Members, any questions? Okay. Seeing none. Moving on. SB 2854, relating to health. First up, Department of Health in support. Okay. Next we have DCCA Hawaii Board of Dentistry in support. Comments. Okay. Comments. Thank you very much. Next, we have AlohaCare in support. AlohaCare, are you present on Zoom? Mike Nguyen?

Not present, Chair.

Okay. Next, we have University of Hawaii, Kelly Whitby, in support. Okay. Not present. Hawaii Oral Health Coalition, Hawaii Public Health Institute in support. Patrick Donnelly, are you present on Zoom?

Yes, present, Chair.

Okay, you have one minute.

Thank you very kindly. Aloha, Chair, Vice Chair, and Members of the Committee. Patrick Donnelly with Hawaii Oral Health Coalition and Hawaii Public Health Institute. I stand on our written testimony in strong support, and thank you very much for the time.

Okay. Thank you very much. Next, we have Kokua Kalihi Valley Comprehensive Family Services in support. Hawaii Dental Service in support. Hawaii Dental Hygiene Association in support. Grassroots Institute of Hawaii in support. Hawaii Dental Association providing comments. Hawaii Dental Association, Melissa Pavlicek, providing comments. Nine other individuals all in support and one in opposition. Anybody else wishing to testify on SB 2854 relating to health? Okay. Moving on. Members, any questions? Okay.

Thank you. SB 2307. Okay. Relating to healthcare. First up, we have Dr. Lewin in support. Thank you very much. Hawaii State Council Mental Health in support. Department of Health providing comments. Department of Health. Thank you very much. DCCA Hawaii Medical Board in opposition. Hawaii Medical Association provide... Are you standing for? Providing comments. Yeah. Excuse me, opposition or comments? In opposition.

Oh, yes. That's right. And I see it. Young-Im Wilson. Hawaii Medical Association providing comments. Dr. Ignacio, State Council on Mental Health in support. AlohaCare, Mike Nguyen. Are you present on Zoom, Mike?

Not present, Chair.

Anybody else wishing to testify on SB 2307? Okay. Members, any questions? DCCA. Which one?

The only one here. Medical Board, guys.

Medical Board. Come on up.

It'll be fast, Chair. I know you're not gonna be a big agenda. Just real fast question here. So if this bill to pass, would these active retired physicians be paying into the fee structure for the other physicians that are licensed pay into?

Well, the way bill is written, we don't have inactive or expired license status at this point. So nobody is actually qualified to get this license.

But if this bill were to pass, you would be able to have this kind of license. But would you, would fees be assessed like it is to people who have licenses now?

That if what we mentioned in our testimony is all applied to amend the bill, then yes.

Okay. Alright. Thank you, Chair.

I have a question. Come on. So this bill basically allows for retirees, retired physicians to do volunteer work. And like the 988 board, when we did the warm line, they really could use a retired physician to volunteer there. You're saying that the reason you folks oppose is that there is no, like, volunteer license. Right? So if we create this, then maybe your position might change?

Oh, that depending on the language.

On the language?

Yes. And then because when it says volunteer, it is a temporary, but this license sounds like it make a volunteer license as a permanent license. So it's monitoring that qualification for that volunteer license require same amount of the monitoring we have over the full license.

So if we... Because it sounds like it we we have a super shortage of medical providers, and we have this great need for to have this expertise available. If the liability insurance of, like, Department of Health covers these volunteer physicians, shouldn't that, shouldn't we allow them to be able to give their knowledge to help out, like, in the warm lines, the 988 calls?

Well, Hawaii Medical Board always focusing on quality over quantities. So these retirees, we'll reduce the CE requirement, and then there's no requirement we can check their... Yeah. Disciplinary action convictions. And on the other hand, this remote area, people can be easily taken advantage by this.

Thank you. Okay. Any other questions?

Okay. Seeing none, moving on. SB 3202, relating to health care. First up, Department of Health in support.

Thank you. Amy Chin, DCCA, Board of Nursing in support.

Yes. The Board of Nursing stands on its written testimony in support.

Laura Reichardt, Hawaii State Center for Nursing, in support. Hawaii Department of Taxation providing comments. Thank you. DCCA Hawaii Medical Board providing comments.

Okay. University of Hawaii in support. Robin Arndt.

Yes, Chair. This is Robin Arndt, coordinator of field education at UH Manoa. I stand in support of the, our testimony, and I am available for any questions.

Okay. Thank you very much. Hawaii Pharmacists Association in support, Carrie Sanders. She's left. Hawaii affiliate of nurse, College of Nurse Midwives.

Is somebody here there for nurse midwives? Please identify yourself.

Aloha. Honorable Chair and Vice Chair. Mahalo for the opportunity to testify. My name is Margaret Reagan. I am the affiliate legislative contact for the American College of Nurse Midwives of the, of Hawaii.

We stand by our written testimony and requestfully request consideration of an addendum that we supplied today with line suggested line amendments. It's within the late section. It's towards the end. And the reason why this is important is what we are asking is for the addition of the advanced midwifery practice credential. Other specialties have been included within this bill.

Since last year, we've been advocating for the inclusion of midwives. Not only do midwives provide maternal care, they also act as primary care providers. And, although currently there are no masters of science midwifery programs in Hawaii, advanced practice midwives serve in 24 locations across the state, 14 of which have active pre active preceptor programs. Not only have.

Thank you very much. I have a 20 bill hearing. Sorry. Next, we have Jonathan Chang, Kaiser Permanente in support. Are you present?

Jonathan Chang, please proceed.

We'll stand on our testimony in support.

Thank you. Hawaii Academy of Physicians Assistant, Leocadia Conlon. Are you present? Leocadia Conlon on Zoom.

Yes, Chair. I'm present.

Okay. You have one minute.

Thank you, Chair and Vice Chair. I am representing the Hawaii Academy of PAs. We sent in our testimony, and I just wanna add that the importance of the preceptor tax credit is to support the healthcare workforce development. To date, PAs have not been included in the preceptor tax credit, but we now have PA students from Hawaii attending Hawaii-based institutions for PA school. It's important to support these students so they can have clinical education experiences in Hawaii and stay in Hawaii.

Also, adding PAs to the preceptor tax credit matches the growth and collaboration of advanced practice providers, which are in both PAs and APRNs. We embrace this model that's being fostered and embraced across all of our healthcare organizations to ensure high-quality, comprehensive care. Thank you for your time. We support all elements of the proposed changes to the preceptor tax credit.

Thank you very much. Hawaii Public Health Institute in support. Chris Cofield. Okay. Not present.

Waianae Coast Comprehensive Health Center, Ian Voss. Are you present on Zoom, Ian?

Not present, Chair.

Okay. Aloha Care, Mike Wynne. Are you present on Zoom, Mike?

Not present either, Chair.

Okay. Hawaii Healthcare Association of Hawaii in support. Hawaii Primary Care Association in support. Hawaii Substance Abuse Coalition in support. Hawaii Pacific Health in support.

Hinamauka in support. Hawaii Medical Association in support. Healthy Mothers Healthy Babies in support, Hawaii, American Nurse Association in support, Tax Foundation Hawaii, Tom Yamachika, you're present on Zoom. Tom.

Aloha. Tom is not present. I'm Colleen with the Tax Foundation on his behalf, and he stands on his written testimony. Thank you.

Okay. Thank you very much. JC Mikulanek of Queen's Health Systems in support. Chaminade University of Honolulu School of Nursing and Health Professions in support. Hawaii Association of Professional Nurses in support.

Stacy Haumea, are you present, Stacy?

Not present, Chair.

Okay. Mickey Miura in support. Alan Novak in support. Excuse me. Okay.

Tynesha Ly, is that you? You're the only other person who registered. Please proceed. You have one minute.

Thank you, Chair and Vice Chair. My name is Tynesha Ly, and I am a social work student at Manoa. While I do strongly support SB 33202 relating to health care, removing limited access to practice and primary care, there are some challenges addressed in Hawaii's health work workforce, naming the critical shortage of high and demanding jobs, ultimately lacking the quality services, especially in neighbor islands.

Students like myself have the perseverance to make the required hours with the amount of experience, but are limited to clinical education sites and opportunities. However, if this bill passed, this if this bill passes, this would benefit the next generation, especially in the Hawaii health care industry.

Mahalo for your time. Thank you.

Thank you very much. Hawaii affiliate of the American College of Nurse Midwives in support. Three, four, five, six, seven, eight, nine, ten, eleven. And 13 other individuals all in support.

Anybody else wishing to testify on SB 3202? Okay. Come on up. Identify yourself.

Yasmine Cheney for the Commission on the Status of Women. We stand in support. Thank you.

Okay. Thank you very much. Anybody else wishing to testify on SB 3202? Okay. Members, any questions?

Okay. Thank you very much. Anybody else wishing to testify on SB 3202? Okay. Members, any questions? Okay, seeing none. SB 3272, relating to Child Welfare Service. Tia Hartsock, Office of Wellness and Resilience, in support.

I'll stand on our written testimony. Thank you.

Thank you very much. DHS in support. Director Yamane, you present on Zoom?

Not present, Chair.

Thank you. Hawaii State Planning and Development Agency, Dr. Lewin, in support.

Chair, Vice Chair, yeah. We stand stand on our written testimony in support.

Thank you very much. Early Childhood Action Strategy in support, Hawaii Children's Action Network in support, HI H.O.P.E.S. Initiative EPIC 'Ohana in support. Judith Clark, are you present on Zoom?

Not present, Chair.

Tilani Hunkin, are you present on Zoom? Okay. Please proceed. You have one minute.

Thank you, Chair and Vice Chair. My name is Tilani Hunkin. I'm a social work and public health student at UH Manoa. I believe that this pilot program will emphasize diversion and intervention for families and children at risk of involvement or re-involvement with the Child Welfare system. Families continue to come into contact with the Child Welfare system due to unmet basic needs.

I believe this program will help families meet those needs through support and services. Social work and public health research shows that early intervention leads to better outcomes for our children <unintelligible>. In summary, this bill offers stability and well-being to our community. Thank you for your time and consideration.

Thank you very much. Next, we have Julia Ricci in support, Karen Worthington in support, Christi Keliikoa in support. Anybody else wishing to testify on SB 3272? Seeing none, moving on. SB 3204, relating to Family Resilience Pilot Program. Director Yamane, DHS in support. Are you present?

Okay. Thank you very much. Tia Hartsock, Office of Wellness and Resilience, in support. Thank you. Dr. Lewin, State Health Planning and Development Agency, in support. Thank you. Hawaii Youth Services Network in support. Judith Clark, are you present on Zoom?

Not present, Chair.

Okay. Early Childhood Action Strategy in support. Catholic Charities in support. Shellie Niles of Catholic Charities support. Hawaii Children's Action Network support. HI H.O.P.E.S. Initiative, EPIC Ohana in support. Mareva Nopuente in support. Stepfenie Keohokalole in support. Anybody else wishing to testify in SB 3204? Members, any questions? Seeing none. Thank you very much. SB 2934. First up, we have, relating to ambulances. I see Garrett Hall there. Yeah.

First up, we have relating to ambulances. I see Garrett Hall here. State Health Planning and Development Agency in support.

In support, Chair, Vice Chair.

Thank you. Department of Health in support.

In support. Stand on our written testimony.

Thank you. AMR Maui in support, AMR Response in support, AMR support, and various Hawaii County paramedic in support. Maui County EMS in support. And three-- over 20 individuals, all in support. Nobody in opposition. Anybody else wishing to testify on SB 2934? Members, any questions? Okay. Good bill for Maui.

Great bill. Fantastic.

Okay. That's my Vice Chair's bill. So, moving on.

I really want to thank you folks for being so efficient, okay? Next up, SB 3203, American Medical Services. Department of Health in support. Garrett Hall?

We stand on our written testimony in support.

Thank you very much. SHPDA in support.

Stand on our written testimony in support.

Thank you very much. AlohaCare in support. Mike Nguyen, are you present on Zoom?

Not present, Chair.

Hawaii Medical Association in support, and we have four other individuals all in support. Nobody in opposition. Anybody else wishing to testify on SB 3203? Okay.

Seeing none. Moving on. SB 2803, relating to homelessness. First up, Department of Human Services providing comments.

Okay. Thank you, director. Yes. State Office of Homelessness and Housing Solution providing comments. Please identify yourself, Emma.

Thank you, chair, vice chair, members of the committee. Emma Brahaski, here on behalf of the statewide Office on Homelessness and Housing Solutions. We stand on our written testimony. Thank you.

Thank you very much. Rainbow Family 808, in support. Michael Golojuch, Sr. in support. City and County of Honolulu in support. Anton Cookie, I don't see him here.

Alright. Edward Otton, Deputy Director, Department of Human Services...testimony in strong support.

Thank you very much. Okay. We have Lerishane Enriquez in support, Garrison Gamil in support. Anybody else wishing to testify on SB 2803? Members, any questions? Seeing none, moving on. SB 3254, relating to the state budget. First up, Climate Change Mitigation Adaptation Commission in support. Mike Nguyen, AlohaCare in support, Hana Health, in support.

He's outside.

Okay. Have him come on in. But I'll just go to Mike. Collective Energy, on behalf of-- Mike Nguyen, are you in support? Relating to the state budget. Primary Care Association.

We stand on our written testimony in support. Thank you.

Thank you very much. Okay. Collective Energy, on behalf of Hawaii Primary Care Association, providing comments.

Hello.

Please proceed.

Aloha.

All right. Erik Abe, Public Affairs and Policy Director for the Hawaii Primary Care Association. The HPCA supports this bill and offers a friendly amendment for your consideration. With me is Cindy Kan from Collective Energy to answer any technical questions you may have on this project.

This project is vital for the financial stability of participating FQHCs. Enactment of the One Big Beautiful Act has fundamentally changed our Medicaid system. We anticipate that in the worst-case scenario, Hawaii's uninsured population will at least double within the next three years. Most of the new uninsured will be former Medicaid enrollees who will lose their coverage. FQHCs are required by law to provide services to all patients regardless of their ability to pay.

For the uninsured, federal law prescribes a sliding fee schedule we can charge based on a patient's income. Most of the time, the amount received does not cover the cost of the services provided. When there is no insurance reimbursement, the FQHC must rely on their operational funds to offset the losses. Under the worst-case scenario, if availability and level of services are kept to what we provide today, FQHCs will have less than three months of resources before we would have to shut down.

I think your one minute is up there. Thank you very much. I need my decision-making notes for this one.

We'll be happy to answer any questions.

Yes, I see that and I see your proposed amendment.

Thanks.

Okay. Thank you very much. Beverly Harbin in support and Collective Energy on behalf-- well, that's you folks. Anybody else? And Waimanalo Health Center in support. Anybody else wishing to testify on SB 3254? Okay. Members, any questions?

Quick question of Collective.

The Primary Care--

Primary Care.

--Association. Okay.

This looks like a grant-in-aid. Shouldn't you guys be putting in for a grant-in-aid application instead of doing it through a bill?

We did.

You did? Okay.

We have two applications.

I'm a little concerned because I think to pass a bill for an application that's competing against other worthy applications could set up a bad precedent. So I appreciate the goal of it but I'm just concerned about the methodology. So, okay. Thank you, guys. Appreciate the clarification.

Thank you.

Thank you.

Okay. Thank you very much. Thank you. Anybody else wishing to testify on SB 3254? Members, any questions?

Okay. Moving on. I believe SB—okay. SB 2804. First up, we have—relating to commerce.

First up, Insurance Division providing comments.

Insurance Division stands on its testimony.

HMSA providing comments.

Walden Au on behalf of HMSA. We, we stand on our written testimony offering comments. HMSA appreciates and shares the legislature's commitment to maintaining a health care system where consumers benefit from choice access and innovation. However, we believe that regulating market outcomes, such as access levels or insurance rates, may unintentionally hinder, not strengthen, competition.

There are broad examples throughout the health care industry where this type of regulation could prove to have unintentional consequences or even prove to be challenging to quantify. Hawaii's existing antitrust laws are already robust and give regulators flexibility to consider all factors in deciding when conduct is anti-competitive. It should be noted that current statute intentionally tracks nearly verbatim its federal analog, and the stated intention of the chapter is to be interpreted consistent with federal antitrust law.

As written, the measure could potentially deprive regulators of that flexibility to weigh all relevant circumstances and impair, rather than protect, the competitive marketplace. We appreciate the opportunity to provide this testimony.

Thank you.

Thank you very much. Anybody else wishing to testify on SB 2804? Walden, stick around. I have questions. Walden, come on back up.

This is really helpful.

That's—exactly. Okay. So, this base—this bill basically qualifies what I, what was stated at the informational briefing prior, right?

Which is that everyone's concerns about you folks' vertical integration does not increase premiums. Why are folks opposing something where basically it was laid out to us that your cost will actually lessen, which means premiums should not increase if your costs have lessened?

I think when we look at the discussion of premiums increasing, I mean, just year over year, right, whether it be through inflation or other expenses, premiums may go up. I think the hope of this would be to slow down the increased rate if there could be cost savings eventually, but I can't imagine that it would go down.

Okay. Well, that was the way it was presented to us. So, thank you very much.

Thank you.

Any other questions? Okay. Moving on. SB 3246, relating to hospital discharge data.

Dr. Lewin in support.

Good afternoon, chair, vice chair. I do need to—this is a, a bill that's a little bit complex, so I just wanna make a few comments. We didn't author the bill. We find it interesting.

We strongly support the intent of having hospital discharge and ED data, which should be useful in a lot of ways, particularly for the AHEAD Grant, also for helping neighbor islands keep care on the neighbor islands through the—through some of this data and some of the work out there. We wanna point out that we soon will have a really functioning APCD which will provide similar—very close to that same data. We don't have it for all the state right now. We're missing it for Medicare Advantage.

We haven't ingested that data, and we haven't gotten a lot of the commercial data.

We have the EUTF. So, this would give us some additional data that we might not have for a few years. I wanna point out though that, and so, there'd be some appropriation need to obtain the data. I, I point out that the, the Healthcare Association of Hawaii already collects this data in an excellent fashion. It's called Laulima.

So, so, possibly, I mean, I think the, the thing with offline, between this and the next committee is to figure out whether we can—that is the best way to acquire the data.

The Laulima.

And, and if not, then we can keep the bill alive and look for a way to fund that research.

Thank you very much.

Thank you.

Okay. Next up, we have, Office of Information Practices providing comments. Navion Hawaii in support.

Navion, Richard Luzer. I see Hilton Bethel of healthcare...