Saturday, July 27, 2024
More
    Home Blog Page 5

    The Also-Rans

    News has been piling up about many of the bills that made it through this year’s legislative session.  We will be discussing some of those in the weeks ahead.  But this week we will be focusing on some of those bills that almost made it to the end but fell off just before the finish line. Some of us will be saying, “Good riddance!” while others, perhaps, will be bemoaning the loss.

    HB 2504, for example, would have bumped up the cigarette tax another $0.02 per cigarette to $0.18. The University of Hawaii sponsored it, primarily because earmarks off the cigarette tax go to special funds that are used to benefit the UH School of Medicine. Disagreements quickly arose as to where the extra funds were going to go and the uses to which they would or could be put. The bill went to a House-Senate conference committee, but they were unable to reconcile differences in the bill versions.

    SB 3176 was sponsored by the Department of Taxation. It would have provided that when a taxpayer is under audit, the auditor requests documents, and the documents aren’t produced by a certain deadline after the request, then, unless the department allows more time, the documents can’t be used in any appeal from the auditor’s assessment. Many tax practitioners strongly opposed the bill, saying among other reasons that the courts make their own rules on when to exclude evidence. Ultimately, House and Senate conferees couldn’t work out their differences.

    HB 2653 would have amended the Hawaii estate tax to allow interests in successful family-owned businesses to pass to next generation family members tax-free. The businesses launched a considerable public relations campaign, including several op-eds, in support of the bill.  However, some in the progressive wing of the Democratic Party were outraged at the prospect of tax breaks being given to the wealthiest of the wealthy. In the end, the bill was set to go to conference committee but the House failed to appoint conferees.

    HB 2686 and SB 3234 would have increased the transient accommodations tax on vacation rentals and the conveyance tax on all property sales by unspecified amounts, with the new money raised to establish funds to stabilize property insurance. The new funds would be conceptually similar to the Hawaii Hurricane Relief Fund and would provide insurance of last resort for hurricane damage and lava inundation. One problem was that as the bill was going through the process, people couldn’t figure out exactly how much money needed to be raised. The sections of the bill calling for tax increases kept moving through the session without the blanks being filled in.  In the Senate, the Ways and Means Committee turned the bill into one requiring a study to be conducted by the insurance commissioner. Ultimately, no agreement was reached on how to proceed.

    And, last but not least, HB 2570 would have required out-of-state attorneys appearing in a local court or arbitration to have a GET license number and agree to pay tax. Apparently, a number of such firms came in, left, either didn’t know or didn’t care about our local tax, and didn’t pay it.  This bill went to conference committee and the Senate did not appoint conferees. But that doesn’t mean that out-of-state law firms are going to get a free pass. The Hawaii state judiciary testified that they will impose the same requirements using the courts’ regulatory powers over attorneys.

    In the coming weeks, we’ll be highlighting some of the bills that did pass and are making their way to the governor’s desk.

    The Home Stretch at the Legislature

    Those of you watching the Legislature probably know that we are now in the home stretch.  Both the House and the Senate have had a chance to consider bills, and this is the stage of the legislative session where differences get worked out between House and Senate versions of bills.  It also has little public involvement.  No more testimony is allowed, and the meetings that conference committees have are held either to stall for more time or simply announce the results.  Here are three of the more consequential bills that are still alive.

    HB 2404, a “Green Affordability Plan” bill, seeks some reform for our income tax brackets, many of which haven’t been touched since the 1960’s.  The current version, the Senate draft, bumps up the standard deduction, personal exemption amounts, and all of the tax brackets.  It also contains language automatically adjusting those brackets for cost-of-living increases, just as the federal tax code does.  The latest House version of the bill contains no cost-of-living adjustments and replaces all of the current income tax brackets with blanks.  The House version also amends the current household and dependent care services tax credit to—no surprise here—a formula with blank amounts in key places, and it also contains language saying that if the taxpayer’s credit claim is disallowed, the taxpayer is barred from claiming the credit again for two years (ten years if the disallowance was due to fraud).  The Senate version leaves the credit alone.

    SB 1035, a bill from last year that was pulled from the dumpster when this year’s versions died, exempts health care professionals from the general excise tax when Medicare, Medicaid, or TRICARE is paying for the care.  This year’s bill, HB 1675, would have exempted health care professionals from the GET when acting in the capacity of a primary care provider.  Most of the testifiers, including some state agencies, came out in favor of the bill because they believe the tax contributes to the acute physician shortage that we are facing.  Also, as the Foundation testified, the current system has some unfairness because health care delivered by the state’s major hospitals is exempt from the tax while smaller clinics and sole practitioners, which are the lifelines for those in rural areas and some Neighbor Islands, get hit with GET at the full rate.  Some of our prior coverage on this issue can be found here.

    Then, there is HB 2653, relating to the estate tax.  This bill was being pushed by a coalition of family-owned businesses, who argued that the Hawaii estate tax, which kicks in at a much smaller dollar amount in Hawaii than the federal estate tax, could have the effect of breaking up successful family-owned businesses, closing them, or causing them to be sold to persons outside of Hawaii.  The current version of the bill would create a deduction for “qualified family-owned business interests” that are inherited.  It would also double the “applicable exclusion amount” so it is the same as under the federal tax code.  This bill is a bit more controversial; some organizations and individuals have strongly objected to it, calling it tax relief for the wealthiest of the wealthy at a time when we have many unmet revenue needs, such as Maui wildfire relief.  Our prior coverage on this bill can be found here.

    At the end of this month, the Legislature wraps up and we see what gets sent to Gov. Green’s desk for signature or veto.

    2024 Legislature poised to take big steps toward lower cost of living

    By Keli‘i Akina

    Every once in a while, something happens that makes you proud to have worked so hard for so many years.

    For me, that something happened yesterday at the Legislature, where at least five bills strongly supported by my colleagues and I at the Grassroot Institute of Hawaii were passed out of conference committees and now will go for final votes at the House and Senate floor sessions.

    Keli’i Akina

    If approved, they then will go to the desk of Gov. Josh Green, where they have an excellent chance of being signed into law.

    First among those bills is SB1035, which, if enacted, will exempt from the state general excise tax medical and dental services paid for by Medicare, Medicaid and TRICARE.

    If you are a regular reader of my weekly columns, you know this bill stands to improve healthcare access in Hawaii by easing the tax burden of so many private practice doctors and dentists who have been struggling to cope with the state’s extraordinarily high cost of living.

    Then there’s the groundbreaking SB3202, which by requiring the counties to allow at least two accessory dwelling units on all qualifying residential lots could significantly increase the availability of affordable housing options in Hawaii.

    Another potential housing game-changer is HB2090, which would make it easier for homebuilders to convert underutilized commercial spaces into residential units. This would enable greater mixed-use housing options, with all their financial, environmental and health-related benefits.

    Next, SB63 could be a lifeline to our healthcare system by authorizing temporary six-month licenses for out-of-state nurses, addressing our critical nursing shortage.

    And finally, HB2404 — put forth by the governor himself and known as the “Green Affordability Plan” — promises historic state income tax relief for Hawaii’s working families by, among other things, significantly increasing the standard deduction over the next six years and increasing the tax bracket thresholds to drop taxpayers back into lower tax brackets.

    Together, these five bills offer hope for a brighter future for Hawaii, with increased access to healthcare, housing and economic opportunity — and a lower cost of living.

    As they head for final votes next week, I am optimistic that the positive potential of these bills will be recognized and embraced.

    Of course, at the moment I am still not counting them as “wins.” Anything is still possible, after all.

    But the fact that they have made it this far in this year’s Legislature is a testament to what can be accomplished with a positive attitude and by working together.
    __________

    Keli‘i Akina is president and CEO of the Grassroot Institute of Hawaii.

    Hawaii is odd state out when it comes to taxing medical services

    By Keli‘i Akina

    Testimony at this year’s Hawaii State Legislature has made it pretty clear why medical services in Hawaii should be exempted from the state general excise tax.

    At a recent legislative hearing on a bill that would do just that, dozens of doctors and healthcare advocates explained how the GET makes practicing in Hawaii so financially challenging, causing many Hawaii doctors to retire or move away, or dissuade mainland doctors from moving here in the first place.

    For instance, Maui resident Josie Mallott testified that she has been trying for years to find some doctors who can take over her husband’s medical practice in North Kihei once he’s ready to retire. But potential recruits decline to move here after they find out about Hawaii’s tax on medical services, its low medical reimbursement rates and its high cost of living.

    Keli’i Akina

    The bill that could help change that is SB1035, which proposes lifting the state’s 4% general excise tax that doctors have to pay on reimbursements from the Medicare, Mediaid and TRICARE programs.

    Hawaii doctors still would have to pay the GET on income received from other sources, but exempting care covered by government insurance programs would be better than nothing.

    It’s actually kind of embarrassing that Hawaii is the only state left in the country that taxes patient copayments and deductibles, as well as the only state that taxes Medicare, Medicaid and TRICARE reimbursements.

    Until recently, Hawaii was joined by New Mexico in taxing medical services — but that state apparently thought better of the practice, and now it’s just us.

    Hawaii does exempt nonprofit facilities such as hospitals from the GET. So extending that exemption to private practice providers would not only help mitigate Hawaii’s doctor shortage, but also simply be the fair thing to do.

    Some people might say this is the wrong time to ask for a tax exemption because the state needs every penny it can get to help rebuild Lahaina. But a medical services exemption to the GET would not be expensive.

    The Hawaii Department of Taxation estimated last year that enacting SB1035 would cost only $50 million to $65 million in tax revenues. Given how much our lawmakers like to spend money, perhaps they could think of the exemption as a $50 million spending program to keep more doctors in Hawaii. It seems to me like that would be money well spent.

    In addition, a 2020 study commissioned by the Grassroot Institue of Hawaii found that more doctors would generate more employment and thus more taxes, so in the end it could be close to a wash.

    So what happens next?

    Currently, SB1035 is heading to conference committee. And if legislators can agree on the details of the bill and the governor signs it, Hawaii would join the rest of the nation in exempting Medicare, Medicaid and TRICARE payments from sales and excise taxes.

    But anything can happen between now and the end of this year’s legislative session, which is just a couple of weeks away.

    If you want to make your voice heard on this issue, be sure to visit Grassroot’s action page, where you can easily send a message about the bill to your legislators.

    Reducing the tax burden on our physicians would improve healthcare access in our state. Need I say more?
    __________

    Keli‘i Akina is president and CEO of the Grassroot Institute of Hawaii.

    Nurse agreement could help heal Hawaii’s healthcare ills

    By Keli‘i Akina

    We must give credit where it’s due: Hawaii lawmakers seem to be getting serious about solving our healthcare shortages.

    Problems such as Hawaii’s doctor and nursing shortages existed before the COVID-19 crisis, but facing such a healthcare emergency without enough healthcare workers made it clear that the issue couldn’t be ignored any longer.

    State lawmakers took an important first step last year by passing legislation that allowed Hawaii to join the Interstate Medical Licensure Compact, which streamlines the licensure process for doctors to practice in Hawaii as long as they hold a license in good standing from another IMLC state.

    Keli’i Akina

    I am proud to say that the Grassroot Institute of Hawaii, of which I am president, was instrumental in pushing for Hawaii to join the IMLC and other interstate licensure compacts for healthcare workers.

    As we explained in our policy brief, “How changing Hawaii’s licensing laws could improve healthcare access,” there is a point at which local regulations on licensed out-of-state professionals become redundant and unnecessarily burdensome. Rather than protect the public, such provisions instead serve as barriers to medical professionals practicing here

    I mean, let’s face it: You wouldn’t hesitate to accept care from any licensed doctor or nurse while visiting another state, so why should those same doctors and nurses have to jump through bureaucratic hoops in order to care for patients in Hawaii?

    Fortunately, this common sense approach to bringing more medical professionals to Hawaii appears to have taken hold at the Legislature. After green-lighting the IMLC last year, state lawmakers now are are considering a bill, HB2415, that would allow Hawaii to also join the Nurse Licensure Compact.

    The NLC allows nurses to apply for a multi-state license, which means that nurses who hold a multi-state license can practice in other NLC states and territories without having to obtain another license. It’s basically like a driver’s license for nursing.

    Admittedly, joining the NLC probably wouldn’t end Hawaii’s nursing shortage — according to a report from the Hawaii State Center for Nursing, we need 300 to 400 additional nurses in order to meet demand. It would, however, remove barriers for some out-of-state nurses to practice in Hawaii, regardless of whether they want to work here temporarily or permanently.

    Joining the NLC would also make it easier for nurses who are military spouses to work at Hawaii facilities, which is why the U.S. Department of Defense testified in support of HB2415.

    The compact model has become an effective way for states to streamline cross-state medical licensure, and Hawaii cannot afford to be left behind. There are currently 41 states and territories participating in the NLC, with Hawaii and eight other states having introduced bills to also join.

    So what’s next for the Nurse Licensure Compact bill?

    Lawmakers might still need to hash out some of the details, but if that process goes well, it will head to the governor’s desk.

    If you want to add your voice to the many others who are urging Hawaii lawmakers to bring more nurses to our state, you can reach out to your legislators through the Grassroot Institute’s “Take Action” portal.

    Enacting this bill would be another step toward improving our healthcare access in Hawaii, but there’s still much more to do.

    In the coming year, my colleagues and I at Grassroot will be urging policymakers to keep up the momentum by also reforming the state’s medical certificate-of-need laws, improving telehealth access and eliminating the general excise tax on all medical services.

    For now, we should applaud our lawmakers Legislature for embracing the Nurse Licensure Compact.

    And let’s encourage them to improve our healthcare access even further by passing more laws that will attract healthcare workers to Hawaii.
    __________

    Keli‘i Akina is president and CEO of the Grassroot Institute of Hawaii.

    And Now the Big Guns Come Out

    Those of you who like to watch the legislative process unfold have probably wandered through (virtually, perhaps) a number of committee hearings.  Seeing these, you have probably gotten a taste of the power that legislative committee chairs wield.  The more bills that need to go through the committee, the more powerful that committee is.  For that reason, the Senate Ways & Means Committee and the House Finance Committee are usually held out as two of the most powerful committees in our Legislature.

    The House Finance Committee heard and passed out SB 3289, relating to the estate tax.  We recently profiled three bills that would fundamentally change how our estate tax works.  This bill was one of them. 

    SB 3289 was placed on the calendar for Third Reading on April 9.  The House Order of the Day, summarizing which bills were up for vote, listed that the bill would be up for passage on Third Reading.

    But then something else happened.

    When the bill number was called, Rep. Nadine Nakamura, House Majority Leader, moved to recommit the bill to the Finance Committee, essentially killing it.  The motion was seconded by Rep. Kyle Yamashita, who happens to be chairman of the Finance Committee.  A voice vote was taken on the motion (although the House Republicans asked for a roll call vote, which would result in a list of all members and how they voted, there were not sufficient votes to order a roll call) and the motion passed without further discussion or comment.  The bill’s status on the Legislature’s website was then updated to add the line:  “Recommitted to FIN with none voting no and none excused.”  (This seems a tad misleading because there were indeed some “No” voices when the vote was taken, as one lawmaker pointed out immediately after the vote.)

    Although the nature of the vote was somewhat unusual, nobody at all seemed surprised, especially the Finance Committee chair, even though his committee’s approval was being swatted down.  After watching the drama, or lack thereof, play out on YouTube, I became convinced that the proceedings, or at least this part of them, were prearranged.

    What was shown here, ladies and gentlemen, were the big guns — a shadowy cabal known as “leadership” — making their presence known.  The House Finance committee is one of the most powerful committees at the legislature, but its work can be quietly and efficiently undone, as we’ve just seen. When the big guns come out, even the mighty submit.

    In this part of the legislative session, where no public sessions are held except perhaps to announce the resolution agreed upon, the influence of the big guns is outsized. Conferees who are appointed by the House Speaker or the Senate President to work out differences with the other house can be discharged without notice or explanation, immediately catapulting the bill involved to its death.

    We bring up these considerations not because we like SB 3289 (actually, we have concerns with it because it would essentially wipe out the estate tax) but because we wanted to illustrate how “leadership” works its magic in a way that is very difficult for the public to see and to hold any specific people accountable. 

    Aloha ThinkTech

    For those of you who care about citizen journalism and the free flow of ideas here in Hawaii Nei, you probably should know about ThinkTech Hawaii.  For many years it has been providing a platform for people to broadcast about all sorts of issues important to society and government in Hawaii.

    My first appearance on one of ThinkTech’s podcasts was on February 24, 2014, on a show hosted by Dr. Keli’i Akina, then and now the president of the Grassroot Institute of Hawaii. At the time his show was called “E Hana Kakou,” roughly translated as “us working together.”  “Hawaii Together” is the current title of that show.

    After a one-year break, Dr. Akina had me back on show four times in 2016, and a couple more times in the first quarter of 2017.  At around that time, one of ThinkTech’s founders, Jay Fidell, brought me on his show, “Community Matters,” on May 5, 2017. After a few more episodes on both shows that year and the next, a new show, “Talking Tax,” hosted by Jay Fidell and co-hosted by me, debuted on January 31, 2019, in the thick of that year’s legislative session.

    “Talking Tax,” a show focusing on tax and public finance, ran approximately every two weeks since then, a five-year run.  Many of the shows can be viewed on YouTube or Vimeo, and the websites of Tax Foundation of Hawaii, Grassroot Institute, and ThinkTech have links to those shows.  I can’t say that Talking Tax dominated in viewership—some people would rather get a root canal than hear about taxes—but we did make enough impact so that ThinkTech awarded me the Cohost of the Year award for 2023.

    Now, it pains me to report, ThinkTech has fallen victim to a phenomenon that has plagued many nonprofits including the Tax Foundation of Hawaii:  a drop in donor funding.  Because of this new reality, ThinkTech has announced that it will produce no more video broadcasts after April 2024.  The last “talking Tax” show on ThinkTech will be taped this month.

    We extend our heartfelt gratitude to ThinkTech for helping us at the Foundation to get our educational messages out to Hawaii, and beyond, for the ten years that we have been working with them.

    We sincerely hope that our programming has had a positive effect on you, the citizens of Hawaii, and has helped you to understand the government that we have here. We also hope that at least some of you have been empowered to give our lawmakers constructive feedback about taxes, public finance, and the laws that they are considering.

    After “Talking Tax” stops being produced in May, we at the Foundation have no plans to acquire broadcast facilities. But we will be looking for other ways to get our information out.  And, as we have done for decades, we will still be sending out our Weekly Commentary through email and on the Foundation’s website.

    ThinkTech, we are assured, is not dead.  It will continue its YouTube channel and website and will accept and post content on an ad hoc basis on and after May 30.  It has just put the brakes on video production.   We will say aloha to the show “Talking Tax,” and hope that good things will come to ThinkTech and further the ideals it represents.

    The PTE (Passthrough Entity) Problem

    There are a couple of measures moving in this year’s Legislature that are important for the many small businesses here that do business in passthrough entities (partnerships or S Corporations, mostly). 

    So, here’s the problem.  The Tax Cuts and Jobs Act of 2016 put a $10,000 hard cap on individual taxpayer deductions for state and local taxes.  No limit is placed on other entities like corporations.

    If an individual conducts business as an S corporation or a partnership (most small businesses are in that form), the state income taxes of the business aren’t paid by the business itself, but are instead paid by its owners according to their respective shares in the business; a 30% owner, for example, would include 30% of the business’s net income on the owner’s individual tax return.  But if state tax on that amount goes over $10,000, then the owner involved winds up with a non-deductible expense. This is an issue here in Hawaii because our individual income tax rates can go up to 11%, second highest in the nation.

    Last year, lawmakers enacted a workaround.  They passed a bill providing a “passthrough entity election” (PTE election).  An electing company would pay 11% (because 11% is the highest individual tax rate) on its net income. The company, not the owners, would be able to deduct the 11% without limit, and the owners would get credited with their proportionate shares of the tax payment.  The Internal Revenue Service came out with some guidance, Notice 2020-75, that says this works.  So far, so good.

    Hawaii’s bill, however, also had a feature that wasn’t so great. The credit was provided on a “use it now or lose it” basis; it couldn’t be refunded or carried to any other year. If it wasn’t used in the current year, any excess was lost.  This was harsh because the credit wasn’t for magic money that the State gives people for doing certain things that it considers socially desirable; it was for real money that the business paid to the State on behalf of its owners.

    Most normal business owners don’t make nearly enough to drop into the 11% tax bracket.  For those people, the benefit from the federal deduction was often outweighed by the state tax forfeiture that would result from the “lose it” portion of the credit.

    Put another way, the benefit from the PTE election was greatest when the taxpayer was wealthy enough to have income from sources other than the passthrough.  The excess credits would offset the tax from those other income sources and wouldn’t be lost.

    Well, that is a screwed-up situation, probably not at all what our lawmakers intended.

    The bills moving through the Legislature, HB 1803 and SB 2725, would help to solve the problem by allowing the excess credit to be carried forward to future years (both bills), or reducing the rate from 11% to 9% (House bill only).  Both changes appear to help with the problem presented.  Hopefully, lawmakers will consider these bills seriously as the legislative session advances.

    Lift rules holding back conversion of office buildings to housing

    By Keli‘i Akina

    I have said many times that there is no single solution to Hawaii’s housing crisis. We need a variety of approaches to improve the situation.

    One promising option is so-called adaptive reuse — that is, turning older office or commercial buildings into residential apartments or condominiums.

    Keli’i Akina

    In the wake of the COVID-19 lockdowns, technological changes and other social changes, there are more and more underused buildings throughout Hawaii’s urban areas that could be repurposed to help address Hawaii’s housing crisis.

    Examples include the former Walmart building at the corner of King and Bethel streets, the nearby Davies Pacific Center, and the former Bishop Building at 1132 Bishop St., now called The Residences at Bishop Place.

    The new owner of the Walmart building, Avalon Group, is envisioning a site that could feature up to 100 new residences, conveniently located near stores, offices and transit stops.

    The same company has been working to transform the Davies Pacific Center into a 352-unit residential project to be called “Modea.”

    But it hasn’t all been smooth sailing for the developers.

    For example, last year I wrote about how the Davies Pacific Center conversion was being held up by a zoning rule that requires residential spaces to have windows that open.

    The rule doesn’t make allowances for air conditioning and ventilation systems, and refitting every window in an office building is expensive, if not financially unfeasible.

    The developer requested a waiver for the project, but a year later, the permit is still pending.

    In lieu of action by the city, two state legislative bills could help speed up adaptive reuse projects — HB2090 and SB2948 — which would allow residential uses in areas zoned for commercial use, and require that Hawaii’s four counties allow adaptive reuse in their county building codes.

    The point of the bills is that it is highly inefficient to force homebuilders to lobby for a change in the law every time a new zoning challenge arises.

    It would be far better for the counties to address these barriers ahead of time by adapting their building and zoning rules to encourage adaptive reuse.

    Then Hawaii’s deteriorating city centers could blossom once again, while also providing islanders with something they desperately need — new housing.
    __________

    Keli‘i Akina is president and CEO of the Grassroot Institute of Hawaii.

    GET on Health Care, Revisited

    We’ve passed the halfway point in this year’s legislative session.  The mood at the Capitol is kind of somber, as there is a growing realization that the amount of state resources that wildfire recoveries are going to consume has destroyed even the most pessimistic projections.  “There’s not a whole lot of extra money this year, folks, so deal with it,” is what they are saying.

    As a result of this bleak fiscal picture, many of the proposals made at the beginning of the session for a general excise tax (GET) exemption here, or an income tax credit there, have already fallen to the cutting room floor.  This week we’ll be discussing one of the survivors.

    The bill is HB 1675.  As introduced, it would provide an exemption to the GET for doctors and nurses in primary care practice.  As it reads now, it would provide a GET exemption for medical services paid for by Medicare, Medicaid, and TRICARE.  The current version is similar to a bill that was in play in last year’s Legislature, which we wrote about here.

    Why is this bill worthy in our current time of financial need?  To start, there is a fairness issue. As we explained in our previous article, individual or small group physician practices are subject to the GET while hospitals organized as nonprofits (and all of them are) do not pay GET on medical services.  The medical practitioners who are taxed can’t do much about it because insurance companies and government parties like Medicare will pay the same amount to either the doctor or the hospital for the same service, and then the government providers, and perhaps some of the insurance companies, forbid the doctors from billing the extra tax, to the patients or anyone else.  So, the individual or small group practitioners, which are the only practitioners that rural areas have, are at a significant disadvantage. Either they absorb the additional tax themselves, or they get the heck out of Hawaii and move their practice to a place where they can make ends meet.  Studies show that the doctors have been doing the latter, plunging our state into a continually deepening shortage of health care professionals.

    Maybe you have no sympathy for health care professionals who are getting paid lots more than you are.  But look — if there are no doctors around, who are you going to call if you’re sick?

    Typically, the free market takes care of this kind of problem. Prices go up and the tax is taken care of.  That’s what happens with most other businesses here.  But with the dominance of insurers and government payers in the medical services market, the rules are different.

    Even the State Health Planning and Development Agency (SHPDA), the agency that regulates how many health care facilities can be set up and where, weighed in.  Its testimony presented to the Senate Health and Human Services and Commerce and Consumer Protection Committees, said:  “Hawai’i must exempt independent clinical practices for [GET] or face increasing shortages and serious health consequences for our population, and particularly our neighbor islands.  This is not exaggerated.”  SHPDA further observed that only two States tax healthcare services, Hawaii and New Mexico; it concluded its testimony by saying those two states “have yet to recognize this is ineffective public policy and a detriment to public health.”

    Now let’s see if the Legislature can get its act together and agree upon the contours of a GET exemption for health care.