As the Legislature continues to work with stakeholders to develop short-term and long-range solutions to the fiscal crisis facing the Hawaii Health Systems Corp., it is important to note that there are no solutions available to the Legislature that could immediately transform the fiscal health of our state hospital system. Systemic reform requires thoughtful consideration, input from a variety of stakeholders and perspectives, and time for implementation before we see results.

The Legislature is doing its part to help bring about systemic reform of the state hospital system by working with the HHSC regional and corporate boards, the health care industry, public employee unions, our communities, the administration and others to develop long-range solutions for the HHSC's fiscal health. At the same time, the administration must do its part by helping HHSC hospitals in the short term. It is critical that the administration be willing to use all of the resources available to the executive branch to assist HHSC with its immediate needs in the current fiscal year.

Unfortunately, state Department of Health Deputy Director Susan Jackson, in her Sept. 18 op-ed, does not tell the full story regarding efforts to move HHSC to greater fiscal health.

For example, Jackson notes that the administration provided HHSC with an $11.8 million second-quarter allotment advance. Although this will help our state hospitals maintain services over the next few months, the advance does nothing to help alleviate the $62 million projected funding gap in the current fiscal year. The advance simply buys HHSC a little more time.

As Jackson knows, the HHSC regional boards have already made tough decisions to address their funding gap by realigning staffing and services to bring expenditures more in line with revenues. Still, these changes may not make up their entire shortfall.

What HHSC might need is an emergency appropriation to help with any remaining shortfall they might have after the regional board changes are implemented. (An “;emergency appropriation”; is an appropriation into the current fiscal year, which can be done only if the governor issues a proclamation requesting that the Legislature immediately consider and pass a bill making an emergency appropriation.) It is our understanding, however, that HHSC has been informally told by the administration that an emergency appropriation for HHSC is not an option at this time.

Jackson acknowledges that the governor can move funds if there is an emergency declaration for HHSC, but goes on to say that doing so affects other programs. However, if the governor is unwilling to provide the necessary funding for HHSC by reallocating funds, she is effectively saying that the state's health safety net is not a priority of the Lingle-Aiona administration.

  Jackson states that the current law limits the executive branch's oversight of HHSC. I am not sure what limitations she is referring to. The executive branch can reallocate funds from other agencies, request an emergency appropriation for, loan funds to and advance funds to HHSC. These are all oversight functions that the executive branch can and should exercise immediately. HHSC is no different from other state agencies with regard to these executive branch functions and powers.

Jackson urges the Legislature to make “;fundamental reforms”; to the operating structure of HHSC, including independence from the state's civil service system and procurement rules. However, she utterly fails to mention that the administration fought proposals to exempt HHSC from the Hawaii Public Procurement Code two years ago, when the Legislature was considering and passing Senate Bill 1792 (enacted as Act 290, Session Laws of Hawaii 2007).

  Finally, Jackson implies that because a $14 million loan provided to HHSC by the Department of Budget and Finance in 2002 was never repaid, they should not receive further loans until HHSC regains a solid financial footing and is able to pay loans back. This conveniently ignores HHSC's fiscal history. When HHSC took over the state hospital system, it inherited existing debt of approximately $140 million, as well as aging facilities with a huge deferred maintenance backlog - currently requiring an estimated $1 billion for deferred maintenance and facilities replacement. Furthermore, state hospital systems throughout the country require regular assistance from county, state or federal governments.

The Legislature welcomes the opportunity to work with all stakeholders in charting a fiscally sound second decade for the HHSC. We need the cooperation of the administration to help HHSC in the short term, and look forward to working with the administration on long term systemic reform of the state hospital system. Otherwise, the continued delivery of quality health care primarily on the neighbor islands is at risk.