Hawaii Healthcare Still Hurting; Here’s What We Can Do

by Keli‘i Akina

We have known for years that Hawaii’s healthcare system is in bad shape, but recent events have shown just how much of a crisis medical providers and patients are experiencing.

Lahaina’s suffering has been unfathomable. The wildfires that destroyed much of the historic town claimed over 100 lives, and possibly many more.

Many survivors who experienced severe burns had to be transported to Oahu’s Straub Medical Center, which has the only burn unit in the North Pacific between Asia and California.

Three medical clinics were among the thousands of buildings that burned down, throwing into question how long West Maui might suffer from a lack of basic medical care. Even before the fires, area residents had to drive more than an hour to visit the island’s only hospital in Kahului.

Meanwhile, on Kauai, the nonprofit Kauai Community Health Alliance finally called it quits, announcing it would be closing its two clinics in Kilauea by this month.

James Winkler, Alliance president and CEO, told reporter Emma Grunwald of The Garden Island that the finances of the Alliance “have always been tenuous, but the last few years have pushed us over the edge.” He cited the state’s low Medicare and Medicaid reimbursement rates and its high cost of living.

At a forum last fall, Winkler also cited the state’s 4% general excise tax. Hawaii is one of only two states that tax healthcare services, and Hawaii’s private practice physicians may not pass on that cost to their Medicare, Medicaid, or TRICARE patients, who typically comprise a large portion of their patients.“Taxing medical care is criminal,” Winkler said, expressing his frustration with Hawaii’s current healthcare system.

The Legislature did consider a bill to exempt medical services from the GET earlier this year, but it was killed before its last hearing.

Another contributor to Hawaii’s healthcare woes is the requirement to obtain a “certificate of need” before building a new medical facility or offering a new healthcare service.

Not only is the process time-consuming and costly, but it even lets existing clinics that could be competitors have a say. It would be like asking Wendy’s or McDonald’s if Burger King should be allowed to open a new restaurant nearby.

It might be a good idea for the existing restaurants, which might say a new restaurant would be a wasteful duplication of their service, or that allowing a new restaurant could harm them financially and threaten their ability to provide reliable service. And in fact, those are the types of arguments that CON law advocates make for medical services. Unfortunately for patients, however, studies show that medical CON requirements result in fewer hospital beds, fewer healthcare professionals, and worse treatment and higher costs for patients.

Which is to say, state lawmakers should reform the state’s medical CON process to make it easier to build new healthcare facilities or offer new medical services.

To its credit, the Legislature this year did allow Hawaii to join the Interstate Medical Licensure Compact, which will let licensed physicians from the compact’s 40-plus member states and territories to practice in Hawaii without having to waste time and spend large amounts of money obtaining a Hawaii license.

Once the compact goes into effect, this will go a long way toward relieving the state’s acute doctor shortage, estimated at almost 800.

I urge the state legislators to build on this good move and enable Hawaii to join interstate agreements for nurses, physical therapists, occupational therapists, and other licensed medical professionals. Doing so would further improve Hawaii’s healthcare situation.

However, Winkler on Kauai told The Garden Island that it’s “highly unlikely” he will continue in the medical field, and more medical professionals are bound to follow his lead if conditions for medical professionals in Hawaii do not significantly improve soon.

And it’s not just burdensome healthcare regulations that are the problem. Hawaii has the highest cost of living with the highest median home prices in the nation, which are concerns for medical workers just like anyone else.

Hawaii lawmakers should work overtime to address these conditions too, if we really want to improve healthcare access in our state.

KELI‘I AKINA is president and CEO of the Grassroot Institute of Hawaii.