If you or a loved one is still waiting in long lines for dialysis, you can blame embattled former state Rep. Ryan Yamane and the system that allows Hawai‘i’s culture of corruption to flourish.
A recent Civil Beat article revealed that Yamane seems to have used his position as chairman of the House Health, Human Services and Homelessness Committee to influence the passage and defeat of bills affecting the clients of lobbyist Tobi Solidum. Yamane has been charged with receiving bribes from Solidum and others.
Committee chairs hold an inordinate amount of power in the Hawaiʻi Legislature. It’s an unspoken rule that a bill will pass through a committee only if the chair supports it. They can also quietly kill a bill by simply refusing to hear it. In Hawai‘i’s non-adversarial, one-party government, there isn’t much anyone can do if a committee chair is determined to kill or pass a bill.
One of the bills Yamane allegedly killed at the behest of Solidum is HB224 (2021), which Yamane himself introduced. The bill in part proposed carving out exemptions from the state’s restrictive Certificate of Need requirements for dialysis and psychiatric services. Had it passed, new dialysis facilities would no longer need to obtain state Department of Health approval before opening, bypassing a lengthy and expensive process that has been shown to restrict healthcare access.
As I explained in a Grassroot Institute of Hawai‘i policy brief about reforming Hawai‘i’s Certificate of Need laws, CON requirements are often referred to as a “competitor’s veto” because they give potential competitors the ability to stop a new service before it even begins
It’s very much like giving McDonald’s a say in whether a new Burger King can open in the same neighborhood. Naturally, McDonald’s would claim it already meets local burger needs and that another burger restaurant would threaten the area’s entire burger delivery market.
Likewise, the CON approval process allows healthcare competitors to block new facilities from opening — which is why studies on CON laws find that access to care improves after they are repealed.
This also explains why established health organizations tend to strongly oppose CON reform. Intentional or not, the CON system protects their commercial interests by making it difficult for new companies to enter the market.
Thus, Solidum worked both publicly and behind the scenes on behalf of Liberty Dialysis to kill HB224. Although the measure made it all the way to conference committee, where House and Senate lawmakers agreed on a final version, Yamane used a technical maneuver to block it from passing — a move that phone records show earned him praise from Solidum, who is now accused of bribing Yamane to torpedo the reform.
In other words, it appears the state did not make it easier to open new dialysis and psychiatric centers because a lobbyist for a dialysis company allegedly paid a legislator to kill that bill. It is hard enough to address Hawai‘i’s healthcare challenges without having to confront a system that allows bribery and self-dealing to defeat even the smallest improvements.
Ultimately, unethical behavior does more harm than simply undermining public trust. Hawai‘i residents are literally suffering from reduced healthcare access because of the state’s culture of corruption.
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