On June 14 the State Mental Health Advisory Council voted unanimously to ask Gov. David Ige to veto House Bill 1980, citing the likelihood of completed suicides if this bill is signed into law.

Beyond matters of life and death, two of the most disturbing questions raised by HB 1980 are: 1) Should our federal taxpayer-funded health insurance plans provide greater access to health care than Hawaii’s private insurance? And 2) Should Hawaii’s telehealth law allow for audio-only veterinary care of pets, but prohibit it for people?

During the Covid-19 lockdown, the tried-and-true landline was the only lifeline available for so many, particularly patients in rural and isolated communities lacking broadband coverage, the poor who didn’t have access to smartphones, and several kupuna intimidated by newer technologies.

The federal government understood this, and Congress and President Biden made sure public health insurance would reimburse for audio-only telehealth services under both Medicare (65 and older), and Medicaid (low-income). Governor Ige agreed and issued an emergency proclamation to require private insurers to do the same.

Hawaii’s Emergency Proclamation expired in August 2021.

Despite multiple legislative proposals to make these recent advancements in telehealth policy permanent, ensuring audio-only telehealth services would continue to be available through private insurance, HB 1980 actually takes us backwards — restricting access to care in ways that are worse than before the pandemic.

While claiming to embrace audio-only health care as the wave of the future, certain health insurers testified in strong support of HB 1980, but also asserted that audio-only “telehealth” treatment is inferior. They project concerns that mental health providers will exploit audio-only as a modality, commit fraud, and slack on their care.

The language in HB 1980 favored by insurers (in contrast to the nine other bills which authorized audio-only “telehealth”) puts unreasonable and burdensome conditions on vulnerable patients before their mental health care can qualify for reimbursement:

• the telehealth technology must be unavailable;
• the patient must first see the provider in-person within the preceding year; and
• the telephonic treatment must be a “covered health care service.”

HB 1980 also adds a new definition of “telephonic service” rendering it ineligible for coverage until new insurance codes are issued (which may take six months or longer).

Talk Therapy Works

All this is particularly harmful to neighbor island patients who rely on telephonic treatment with Oahu providers.

Explain this to the isolated and overwhelmed mother in Laupahoehoe, Kaunakakai, or Hana; or the depressed father struggling to stretch his paycheck the entire week; or the confused grandfather who uses his cell phone as a paper weight because he gets nervous when it rings.

What happens if they get sick? Or we go into another Covid lockdown?

Will patients have to wait until they need to visit the ER or call an ambulance? Won’t that be more expensive? And what if, by then, it’s too late?

Talk therapy via landline literally saves lives. Otherwise, what’s the point to launching the new 988 suicide prevention hotline in a few weeks?

Moreover, mental health professionals are ethically bound to provide care via telephone, regardless of whether this therapy is covered by insurance. Unlike insurance executives, mental health providers did not go into this work for the money, but to heal people. We need support — especially when the demand for mental health care is so great.

Talk therapy via landline literally saves lives.

Legislators were led to believe by the insurance industry that HB 1980 creates a legal authority for reimbursement that didn’t exist before. But Kaiser made clear in a hearing they’ve been providing reimbursement for telephonic care well before the pandemic — and rightfully asked for flexibility that did not end up in the bill.

What some health insurers and hospitals really want is the language in HB 1980 emphasizing “telephonic service” does not constitute telehealth.”

Why? Because the law currently requires “telehealth” be reimbursed in parity with in-person visits.

HB 1980 protects health insurers’ profits, but leaves us again with these questions:

Why should hard-working families with employer-based insurance have to pay out-of-pocket for audio-only telehealth while those with Medicare or Medicaid don’t?

And why does Senate Bill 2798 include telephonic treatment in the definition of veterinary telehealth, giving dogs better access to health care than people?

There is no question HB 1980 will harm people — and increase profits for insurers.

Please urge this veto. Otherwise, Gov. David Ige will join the legislators who clandestinely pushed this through.

If telephonic telehealth is good enough for Medicare — and dogs — it’s good enough for private insurance.

Editor’s note: This Community Voice was authored in collaboration with the Hawaii Psychological Association, National Association of Social Workers Hawaii Chapter, Hawaiian Islands Association of Marriage and Family Therapy, and several public health organizations, providers, and advocates.