Committees adopt amendment and advance HB1875 to protect reproductive and gender-affirming care

The House Committees on Health and on Consumer Protection & Commerce advanced HB1875 on Feb. 11, a measure the committees described as intended to protect access to reproductive and gender-affirming health care and to shield providers from retaliation by out-of-state actors or insurers.

Testimony was dominated by proponents — medical associations, public-health groups, LGBTQ+ commissions, community organizations and dozens of individual residents — who said gender-affirming care is evidence-based and life-saving. "Gender affirming care is evidence based, medically necessary, and life saving," Chris Caulfield of the Hawaii Public Health Institute told the committees. The committees heard that roughly 180 submitted written testimonies supported the bill, with about 26 in opposition.

Justin Chu of the Insurance Division, Department of Commerce and Consumer Affairs, outlined a specific concern in the bill's drafting: a clause would prohibit medical-malpractice insurers from taking "sanctions, fines, penalties, rate increases, or other type of unfavorable change," language he described as vague and potentially in conflict with state insurance law that requires rates to be "actuarially sound." "The term... 'other type of unfavorable change' is pretty broad, pretty vague," Chu said. He added that an absolute ban on rate increases could conflict with actuarial rules that require rates to reflect risk.

The insurance division proposed an amendment to preserve actuarial standards, and committees accepted modified language. The amendment — adopted during decision-making — narrowed the prohibition to actions "that are not based on sound actuarial principles," retaining the bill's intent to prevent penalties targeted at providers for providing lawful care while allowing insurers to set rates consistent with actuarial practice.

Supporters said the bill is narrowly drawn to protect lawful, standards-based care rather than to shield unlawful or negligent conduct. Dr. Malero Bravo, representing the American College of Obstetricians and Gynecologists, told the committees the bill does not change standards of medical practice and "doesn't shield unlawful or negligent conduct." Opponents said the bill could limit legal recourse for harmed patients; one opponent argued a shield could remove rights to malpractice protections. Committee members pressed clinicians on pediatric cases; witnesses said minor patients do sometimes seek care, typically with parental involvement and after deliberation.

In decision-making the committee voted to pass HB1875 with amendments, including the insurance-division language and an effective (defective) date to keep the measure moving. Committee leaders noted several members were excused and recorded a small number of no votes and reservations. The bill will move forward with the adopted changes.