Report Title:

Appropriation; Primary Health Care


Appropriates $2,000,000 in FY 2003-2004 and $3,000,000 in FY 2004-2005 to DOH to pay for primary health services for uninsured Hawaii residents through nonprofit, community-based primary health care. (SD1)


S.B. NO.



S.D. 1






making an appropriation for primary health care for the uninsured.



SECTION 1. The legislature finds that the estimated number of Hawaii residents who do not have health insurance has doubled -- growing from 68,200 in 1996 to 135,900 in 2001. This makes lack of health insurance a serious concern for the State. This increase generates a considerable economic impact on the State's hospitals, community health centers, and other participants in the health care industry and threatens their ability to effectively serve the whole community.

According to the Kaiser Commission on Medicaid and the Uninsured:

(1) Four out of five uninsured persons belong to working families;

(2) Uninsured persons are more likely than those with insurance to be hospitalized for conditions that could have been avoided;

(3) Uninsured persons with various forms of cancer are more likely to be diagnosed with late-stage cancer resulting in higher rates of death and disability; and

(4) Nearly forty per cent of uninsured adults skipped a recommended medical test or treatment, and twenty per cent say they needed but did not get care for a serious problem in the past year.

The legislature further finds that it is in the best interests of the State to ensure access to primary and preventive health care for its residents. In addition to giving rise to a healthier population, providing access to care reduces state expenditures attributable to hospital and emergency room services for preventable injuries or illnesses.

The most effective means to encourage access to primary health care for residents who do not have health insurance is through Hawaii's system of community health centers that:

(1) Are nonprofit, community-based organizations whose purpose and expertise lie in serving people who otherwise have limited access to care;

(2) Provide culturally and linguistically appropriate health care, including a broad range of primary care and preventive services, and are located in areas where people have limited access to other health care providers because of geographic and socioeconomic barriers;

(3) Contribute greatly to the economies and livability of the communities they serve; and

(4) Are cost-effective providers whose care results in healthier patients and decreased emergency, specialty, and in-patient services.

The legislature further finds that, while community health centers represent the best system of community-based primary care for uninsured people, financial support for community health centers is inadequate to meet increasing demands. More specifically, community health centers have experienced a forty-one per cent increase in uninsured visits since 1997.

The purpose of this Act is to provide cost-effective care for Hawaii residents who are uninsured, while at the same time ensuring that the community health center system remains financially viable and stable in the face of a growing population of uninsured.

SECTION 2. There is appropriated out of the general revenues of the State of Hawaii the sum of $2,000,000, or so much thereof as may be necessary for fiscal year 2003-2004, and the sum of $3,000,000, or so much thereof as may be necessary for fiscal year 2004-2005, to the department of health to provide resources to nonprofit, community-based health-care providers to care for the uninsured. This appropriation shall pay for providing direct care, which includes primary medical, dental, and mental health care, and may pay for the purchase of prescription drugs. The department of health may distribute moneys on a per-visit basis, taking into consideration need on all islands.

SECTION 3. The sums appropriated shall be expended by the department of health for the purposes of this Act.

SECTION 4. This Act shall take effect July 1, 2003.