Hawaii-2012-SB2638-Introduced

SECTION 1. The legislature finds that Hawaii currently has an estimated shortfall of approximately 600 physicians, as compared with a community of comparable size on the United States mainland. At minimum, Hawaii needs over 200 additional adult primary care providers and is particularly underserved by neurosurgeons, cardiologists, infectious disease specialists, and general surgeons. Geographically, although the problem is most acute on Hawaii island, residents in rural areas throughout the State are beginning to experience problems accessing physician services.

The legislature further finds that physician statistical supply-demand models indicate that if significant changes are not made soon in the medical care delivery system, recruitment and retention effectiveness, and the number of doctors that are trained in the State, Hawaii will have a shortage of over 1,600 physicians by 2020. These imbalances are driven principally by population growth and aging, and the anticipated loss of over 40 per cent of currently practicing physicians to retirement.

One means of expanding recruitment and retention of primary care physicians is the enhancement of incentives for physicians to practice on neighbor islands and rural Oahu, including the creation of a medical loan forgiveness program.

The purpose of this Act is to increase the excise tax on cigarettes and small cigars and use cigarette tax revenue, among other funding sources, to establish a medical loan forgiveness program.

SECTION 2. Chapter 304A, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§304A- John A. Burns school of medicine medical loan forgiveness program special fund. (a) There is established the John A. Burns school of medicine medical loan forgiveness program special fund, to be administered and expended by the University of Hawaii.

(b) The following shall be deposited into the special fund:

(1) Appropriations by the legislature;

(2) Cigarette tax revenues pursuant to section 245‑15(6);

(3) Sugar-sweetened beverages tax revenues pursuant to section -14(3) as enacted by Act , Session Laws of Hawaii 2012;

(4) Liquor tax revenues pursuant to section 244D-17(3) as enacted by Act , Session Laws of Hawaii 2012;

(5) Grants, donations, gifts, or other income received for the purposes of the special fund; and

(6) Interest earned or accrued on moneys in the special fund.

(c) Moneys in the special fund shall be used to support the John A. Burns school of medicine medical loan forgiveness program for medical students graduating after May 1, 2013.

(d) The John A. Burns school of medicine shall submit an annual report to the governor and the legislature accounting for the income, expenditures, and fund balance of the John A. Burns school of medicine medical loan forgiveness program special fund."

SECTION 3. Section 245-3, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"(a) Every wholesaler or dealer, in addition to any other taxes provided by law, shall pay for the privilege of conducting business and other activities in the State:

(1) An excise tax equal to 5.00 cents for each cigarette sold, used, or possessed by a wholesaler or dealer after June 30, 1998, whether or not sold at wholesale, or if not sold then at the same rate upon the use by the wholesaler or dealer;

(2) An excise tax equal to 6.00 cents for each cigarette sold, used, or possessed by a wholesaler or dealer after September 30, 2002, whether or not sold at wholesale, or if not sold then at the same rate upon the use by the wholesaler or dealer;

(3) An excise tax equal to 6.50 cents for each cigarette sold, used, or possessed by a wholesaler or dealer after June 30, 2003, whether or not sold at wholesale, or if not sold then at the same rate upon the use by the wholesaler or dealer;

(4) An excise tax equal to 7.00 cents for each cigarette sold, used, or possessed by a wholesaler or dealer after June 30, 2004, whether or not sold at wholesale, or if not sold then at the same rate upon the use by the wholesaler or dealer;

(5) An excise tax equal to 8.00 cents for each cigarette sold, used, or possessed by a wholesaler or dealer on and after September 30, 2006, whether or not sold at wholesale, or if not sold then at the same rate upon the use by the wholesaler or dealer;

(6) An excise tax equal to 9.00 cents for each cigarette sold, used, or possessed by a wholesaler or dealer on and after September 30, 2007, whether or not sold at wholesale, or if not sold then at the same rate upon the use by the wholesaler or dealer;

(7) An excise tax equal to 10.00 cents for each cigarette sold, used, or possessed by a wholesaler or dealer on and after September 30, 2008, whether or not sold at wholesale, or if not sold then at the same rate upon the use by the wholesaler or dealer;

(8) An excise tax equal to 13.00 cents for each cigarette sold, used, or possessed by a wholesaler or dealer on and after July 1, 2009, whether or not sold at wholesale, or if not sold then at the same rate upon the use by the wholesaler or dealer;

(9) An excise tax equal to 11.00 cents for each little cigar sold, used, or possessed by a wholesaler or dealer on and after October 1, 2009, whether or not sold at wholesale, or if not sold then at the same rate upon the use by the wholesaler or dealer;

(10) An excise tax equal to 15.00 cents for each cigarette or little cigar sold, used, or possessed by a wholesaler or dealer on and after July 1, 2010, whether or not sold at wholesale, or if not sold then at the same rate upon the use by the wholesaler or dealer;

(11) An excise tax equal to 16.00 cents for each cigarette or little cigar sold, used, or possessed by a wholesaler or dealer on and after July 1, 2011, whether or not sold at wholesale, or if not sold then at the same rate upon the use by the wholesaler or dealer;

(12) An excise tax equal to cents for each cigarette or little cigar sold, used, or possessed by a wholesaler or dealer on and after July 1, 2012, whether or not sold at wholesale, or if not sold then at the same rate upon the use by the wholesaler or dealer;

[~~(12)~~] (13) An excise tax equal to seventy per cent of the wholesale price of each article or item of tobacco products, other than large cigars, sold by the wholesaler or dealer on and after September 30, 2009, whether or not sold at wholesale, or if not sold then at the same rate upon the use by the wholesaler or dealer; and

[~~(13)~~] (14) An excise tax equal to fifty per cent of the wholesale price of each large cigar of any length, sold, used, or possessed by a wholesaler or dealer on and after September 30, 2009, whether or not sold at wholesale, or if not sold then at the same rate upon the use by the wholesaler or dealer.

Where the tax imposed has been paid on cigarettes, little cigars, or tobacco products that thereafter become the subject of a casualty loss deduction allowable under chapter 235, the tax paid shall be refunded or credited to the account of the wholesaler or dealer. The tax shall be applied to cigarettes through the use of stamps."

SECTION 4. Section 245-15, Hawaii Revised Statutes, is amended to read as follows:

"§245-15 Disposition of revenues. All moneys collected pursuant to this chapter shall be paid into the state treasury as state realizations to be kept and accounted for as provided by law; provided that, of the moneys collected under the tax imposed pursuant to:

(1) Section 245-3(a)(5), after September 30, 2006, and prior to October 1, 2007, 1.0 cent per cigarette shall be deposited to the credit of the Hawaii cancer research special fund, established pursuant to section 304A-2168, for research and operating expenses and for capital expenditures;

(2) Section 245-3(a)(6), after September 30, 2007, and prior to October 1, 2008:

(A) 1.5 cents per cigarette shall be deposited to the credit of the Hawaii cancer research special fund, established pursuant to section 304A-2168, for research and operating expenses and for capital expenditures;

(B) 0.25 cents per cigarette shall be deposited to the credit of the trauma system special fund established pursuant to section 321-22.5; and

(C) 0.25 cents per cigarette shall be deposited to the credit of the emergency medical services special fund established pursuant to section 321‑234;

(3) Section 245-3(a)(7), after September 30, 2008, and prior to July 1, 2009:

(A) 2.0 cents per cigarette shall be deposited to the credit of the Hawaii cancer research special fund, established pursuant to section 304A-2168, for research and operating expenses and for capital expenditures;

(B) 0.5 cents per cigarette shall be deposited to the credit of the trauma system special fund established pursuant to section 321-22.5;

(C) 0.25 cents per cigarette shall be deposited to the credit of the community health centers special fund established pursuant to section 321‑1.65; and

(D) 0.25 cents per cigarette shall be deposited to the credit of the emergency medical services special fund established pursuant to section 321‑234;

(4) Section 245-3(a)(8), after June 30, 2009, and prior to July 1, 2013:

(B) 0.75 cents per cigarette shall be deposited to the credit of the trauma system special fund established pursuant to section 321-22.5;

(C) 0.75 cents per cigarette shall be deposited to the credit of the community health centers special fund established pursuant to section 321‑1.65; and

(D) 0.5 cents per cigarette shall be deposited to the credit of the emergency medical services special fund established pursuant to section 321-234; [~~and~~]

(5) Section 245-3(a)(11), after June 30, 2013, and thereafter:

(B) [~~1.5~~] cents per cigarette shall be deposited to the credit of the trauma system special fund established pursuant to section 321-22.5;

(C) [~~1.25~~] cents per cigarette shall be deposited to the credit of the community health centers special fund established pursuant to section 321‑1.65; and

(D) 1.25 cents per cigarette shall be deposited to the credit of the emergency medical services special fund established pursuant to section 321‑234[.]; and

(6) Section 245-3(a)(12), after June 30, 2013, and thereafter, cents per cigarette shall be deposited to the credit of the John A. Burns school of medicine medical loan forgiveness program special fund, established pursuant to section 304A- .

The department shall provide an annual accounting of these dispositions to the legislature."

SECTION 5. The John A. Burns school of medicine shall establish a medical loan forgiveness program as an incentive for physicians to practice on the neighbor islands and in rural Oahu communities. In establishing the program, the John A. Burns school of medicine shall determine the requirements for physician participation in the program, the minimum and maximum amounts available per participant, and any other requirements that may be necessary to ensure a successful program.

SECTION 6. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 7. This Act shall take effect on July 1, 2012.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	2638
TWENTY-SIXTH LEGISLATURE, 2012
STATE OF HAWAII