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.

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

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.

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

By Keli‘i Akina

Through the years, each of my weekly letters to you has concluded with the Hawaiian phrase “E hana kākou” (“Let’s work together”) as a reminder of how important it is for us to find common ground as we work toward establishing a more free and prosperous Hawaii for all.

Recently, that’s been happening in spades, especially on the housing issue.

Over the past few months, my colleagues and I at the Grassroot Institute of Hawaii have joined with many state and county lawmakers and community organizations to promote research-backed proposals that could help end what our governor elevated last July to emergency status: the state’s housing shortage and high home prices.

Recommended policies have included streamlining homebuilding permitting procedures and reforming zoning laws to allow more homes in Hawaii’s urban cores, where residential housing and infrastructure already exist.

Two bills in particular at the 2024 Legislature that have gained wide support, HB1630 and SB3202, would legalize smaller homes on smaller lots.

But sometimes it’s hard to get absolutely everyone on board for a specific program, no matter how good the goal, and all of that encouraging collaboration I was talking about now is at risk.

“Not in my backyard” advocates, or NIMBYs as they are called, turned up on Thursday at a meeting of the Honolulu City Council’s Committee on Planning and the Economy to voice strong support for a proposed county resolution that would urge the state Legislature to reject those two bills.

Sad to say, the committee approved Resolution 24-65, which contains most of the usual anti-housing rhetoric, and even claims that making it easier to create smaller, more affordable homes would somehow result in more so-called monster homes.

This unfortunate campaign of misinformation and scare tactics has emerged at the eleventh hour to discredit the very zoning strategies that cities across the country, and even around the world, have implemented with great success.

As I wrote to you five weeks ago — in a letter optimistically titled “True housing reform seems a strong possibility” — NPR reported that “changing zoning rules to allow more housing” is “the hottest trend in U.S. cities.”

And that’s where the two bills HB1630 and SB3202 come into the picture. As Kealii Lopez of AARP Hawaii and Sterling Higa of Housing Hawaii’s Future wrote in Honolulu Civil Beat on Wednesday, Hawaii needs more housing options for young professionals, families and kupuna, and enacting either of these two bills would help make that happen.

Opponents of such reforms claim that their neighborhoods will change. But change will happen anyway. The only questions are how slowly and at what cost?

The current cost is that our friends and family are leaving the islands in record numbers for more affordable lives on the mainland.

I understand the nostalgia for the past, but it is time for us to acknowledge that the Hawaii of 30, 40, 50 years ago cannot be the Hawaii of today — and that the status quo our NIMBY friends demand is simply not sustainable.

I hope our state lawmakers will be courageous enough to do the right thing for Hawaii and open the door to change.
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Keli‘i Akina is president and CEO of the Grassroot Institute of Hawaii.