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2018 LEGISLATIVE RECAP 2 Hawai‘i Public Health Institute 2018 Legislative Recap UNITED BY THE SPIRIT OF aloha Hawai‘i has been hit hard by several disasters this year including a false ballistic missile alert that sent residents and visitors into a panic. Then, in April and May, back-to-back events caused widespread damage and displacement from flash flooding in Kaua‘i and East Honolulu and from the lava outbreaks on the Big Island. Although many are facing tremendous emotional and financial challenges as a result of these events, one thing is evident: our island state continues to be united by the spirit of aloha. At the Hawai‘i Public Health Institute, we are driven by our mission to improve the quality of life for the people of Hawai‘i. Inspired by the tireless commitment of our advocates and partners, we will continue to fight for solutions that advance health and health equity in our state. Much of that fight happens at the state legislature. While news outlets focused their attention on a few big and sometimes controversial issues, our 2018 Legislative Recap shines the light on a number of major health and health-related issues that you may not have heard about. We hope you find this piece informative and that it inspires you to be an engaged, active participant in the legislative process. 2018 alohaLegislative Recap Hawai‘i Public Health Institute 3 NATIONAL & LOCAL HEALTH LANDSCAPE Less than two months after passage of President Trump’s signature tax cut bill that largely benefits the wealthiest Americans, the president proposed a 2019 budget that cuts basic resources which help millions of struggling families obtain health care, put food on the table, and assist with rent. To make matters worse, the administration has used its authority to tighten Medicaid eligibility by allowing states to impose work requirements for low-income people in order to qualify for the federal health program. Taken together, these changes deepen inequity and hardship, while driving up uninsured rates across the nation. If the president’s proposed cuts are enacted, states will be expected to pick up the tab, resulting in massive new costs that states cannot afford. In Hawai‘i, public health leaders and healthcare providers have worked on legislation to bend the cost curve through prevention, addressing workforce shortages and access to care, preserving health coverage, and making significant investments in affordable housing and homelessness. Find more about these bills in the health legislation section. 4 Hawai‘i Public Health Institute 2018 Legislative Recap TRUMP’S PROPOSED 2019 BUDGET CUTS $763 billion in Medicaid cuts over the next 10 years. $7 billion in cuts to the Children’s Health Insurance Program (CHIP). $213 billion in Supplemental Nutrition Assistance Program (SNAP) cuts over the next 10 years. $6.8 billion in immediate cuts to low-income housing programs. $72 billion in cuts to disability programs, including Social Security Disability Insurance, over 10 years. $21 billion in cuts over 10 years to the Temporary Assistance for Needy Families block grant, which provides short-term income and work assistance to low-income families with children. $800 million in immediate cuts to Affordable Care Act (ACA) programs that test innovative payment service delivery models. 2018 Legislative Recap Hawai‘i Public Health Institute 5 THE 2018 ELECTION The 2018 Hawai‘i elections will take place on November 6, 2018. The primaries will be on August 11, 2018. The following pages highlight a few key races to watch and some of the candidates who have filed or expressed intent to run. For a full up-to-date list, please visit the Hawai‘i Office of Elections website. GOVERNOR Mr. Carroll previously served in the State House for four terms and State Senate for one term. He owns a ranch in Hamakua, Hawai‘i and is a war veteran John Carroll (R) and former commercial pilot for Hawaiian Airlines. Health platform from campaign page: None found as of May 15, 2018. Congresswoman Hanabusa returned to serve Hawaii’s 1st Congressional District after a special election to fill the remainder of the the late U.S. Rep. Colleen Hanabusa (D) Mark Takai’s seat. Health platform from campaign page: Protect Prepaid Healthcare Act, improve healthcare for kupuna, and fund senior programs. Mr. Hee is a former state senator and Office of Hawaiian Affairs Board Chair. Clayton Hee (D) He owns a farm in Ahuimanu. Health platform from campaign page: Address healthcare crisis and legalize recreational marijuana. Gov. Ige is seeking re-election. Health platform from campaign page: A 21st century health system that improves access, treatment, and affordability; David Ige (D) dedicated funding and increased treatment for mental health; improve care for homeless and kupuna; and fight opioid abuse and youth tobacco use. Ms. Tupola was first elected into the House of Representatives in 2014 and Andria Tupola (R) currently serves as House Minority Leader. Health platform from campaign page: None found as of May 15, 2018. 6 Hawai‘i Public Health Institute 2018 Legislative Recap LIEUTENANT GOVERNOR U.S. HOUSE OF REPRESENTATIVES Although much of the public’s attention will be on the With several candidates pulling papers for office, the write-up gubernatorial race this year, the lieutenant governor’s seat is below focuses on the only open seat, Congressional District 1, also up for election. Despite having no constitutional which is being vacated by Rep. Colleen Hanabusa. responsibilities, the office has been used for various special projects that can help advance policy. Doug Chin, current Lieutenant Governor and previous Attorney General (D). Health platform from campaign website: None found. Bernard Carvalho, current Kaua‘i Mayor (D). Health platform from campaign website: Address homelessness, mental health, improving Beth Fukumoto, current House Representative in Mililani and roads for pedestrians and bicyclists, complete streets, safe routes previous Republican-turned-Democrat (D). Health platform from to schools, and food sustainability. campaign website: None found. Kim Coco Iwamoto, previous member of Board of Education (D). Kaniela Ing, current House Representative in South Maui (D). Health platform from campaign website: Address homelessness. Health platform from campaign website: Medicare-for-all, protect reproductive rights, enact paid family leave, strengthen mental Will Espero, current State Senator, Ewa Beach (D). Health health services, gun control, legalize adult-use cannabis, restore platform from campaign website: Address homelessness, Medicaid benefits for COFA migrants, and kupuna care. complete streets, food sustainability, drug treatment for all, kupuna care and caregiver support, and medical cannabis research Donna Kim, current State Senator, Kalihi, Moanalua, and Halawa and development. (D). Health platform from campaign website: Affordable and accessible healthcare, expand Medicare, kupuna care, reproductive Josh Green, current State Senator, Kona (D). Health platform from care, and care for low-income women and children. campaign website: Affordable healthcare and investing in hospitals. Ernie Martin, current City and County of Honolulu Councilmember (D). Health platform from campaign website: None found. Jill Tokuda, current State Senator, Kailua and Kaneohe (D). Health platform from campaign website: Address homelessness. 2018 Legislative Recap Hawai‘i Public Health Institute 7 THE 2018-2019 BUDGET The Legislature’s budget for the year beginning July 1, 2018 authorizes spending for $14.4 billion, a combination of both general and federal funds. The following chart includes our analysis of $7.2 billion in operating costs as it relates to general funds, not including federal funds. Funding for health includes $142 million for health programs, $149 million for hospital care (HHSC), $283 million for behavioral health, $18 million for environmental health, and $13 million for overall program support, totaling $597.5 million. (Economic development, employment, transportation, culture & recreation, public safety, individual rights, and government-wide support.) HB 1900 CD1 appropriations by program area category, totaling $7.2 billion for FY 2018-19 in general funds, not including federal funds. 8 Hawai‘i Public Health Institute 2018 Legislative Recap THE BUDGET: WHAT MADE THE CUT & WHAT DIDN’T A snapshot of public health funding based on our analysis of HB 1900 and various appropriations bills. FUNDED NOT FUNDED − $200M for Rental Housing Trust Fund − $4.4M Medicaid adult dental benefit − $360M over a 12-year period to provide GET restoration exemption for construction of affordable housing − $4.1M DOE workers’ compensation and − $125M for flood relief to Kaua‘i and other areas benefits − $4.5M for 3 new ambulances in Kaua‘i, Hawai‘i, and O‘ahu − $2M English language learners classroom − $500,000 additional funds for chronic disease supplies prevention and health promotion − $1.1M DOE data governance and analysis − $180,000 funds for oral health telehealth pilot project − $700,000 UH Promise Scholarship − $1M Family Medicine Practice center Program − $4.6M increased rates for foster care payments − $500,000 UH staffing and support for − $15M various homeless programs and services Native Hawaiian programs − $3.8M Kupuna Care and $1.2M for Kupuna Caregivers − $1.1M liver cancer research − $2.8M Hawai‘i Keiki Program − $17M security fence for the Hawai‘i State − $260,000 UH Apprenticeship Program Hospital − $703,980 staffing & funding for Med-QUEST health analytics − $1M family medicine office for JABSOM − $5.2M to Med-QUEST to support online enrollment for Medicaid family medicine residency program 2018 Legislative Recap Hawai‘i Public Health Institute 9 The 2018 session was the second year of the legislative biennium, where bills that did not make it through the 2017 session are “carried over” and considered again for passage into law. Nearly 5,000 bills were considered by the legislature between these carry-over bills and new bills that were introduced in 2018 (2,688 and 2,260 bills, respectively). At the end of the legislative session, 230 bills (8.9 percent of those introduced in 2018) were passed and sent to the governor’s desk.
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