SB2997

SECTION 1. The legislature finds that increasing the water supply's concentration of fluoride, a naturally occurring mineral, to an optimal level promotes good oral health is an extremely effective means of stopping, preventing, or even reversing tooth decay. The practice of community water fluoridation benefits all people who drink from the public water supply of a community.

The legislature recognizes that according to the United States Centers for Disease Control and Prevention, the nation's premier public health agency, water fluoridation is both safe and the most cost-effective way of preventing tooth decay. This method of fluoride delivery's success in decreasing rates of tooth decay has led the Centers for Disease Control and Prevention to name community water fluoridation as one of ten great public health achievements of the twentieth century. Since 1945, hundreds of cities have implemented community water fluoridation. As of 2012, more than 210,000,000 people, or three out of every four Americans who used public water supplies, drank water with enough fluoride to prevent tooth decay. Drinking fluoridated water keeps teeth strong and reduces tooth decay by approximately twenty-five per cent in both children and adults. The value of water fluoridation has been recognized internationally and is used in many countries, including Australia, Canada, Chile, Colombia, Ireland, Malaysia, New Zealand, Singapore, and the United Kingdom.

The legislature further finds that Hawaii's public water systems have no added fluoride, except on military bases. Consequently, only eleven per cent of individuals in the State

have access to the benefits of fluoridated drinking water. This is lowest percentage of any state in nation, and the corresponding national average is seventy-five per cent. According to "Hawaii Smiles 2015: The Oral Health of Hawaii's Children", a report from the state department of health, Hawaii has the highest prevalence of tooth decay among third graders in the United States. More than seven out of ten third graders in the State are affected by tooth decay, which is a substantially higher rate than the national average of fifty-two per cent. Hawaii also received a failing grade in three recent oral health report cards published by the Pew Center on the States, a division of the Pew Charitable Trusts.

The legislature also finds that many state residents do not have dental care insurance. Among those on medicaid/QUEST, children generally receive dental services as a covered benefit, but adults do not. According to "Hawaii Oral Health: Key Findings", another 2015 report from the state department of health, the number of emergency room visits for preventable dental problems has increased. For example, in 2012, there were more than three thousand visits to Hawaii emergency room for preventable dental problems. This represented an increase of sixty-seven per cent compared to 2006. For comparison, according to the same report, emergency room visits for preventable dental problems increased nationwide by twenty-two per cent from 2006 to 2009.

The legislature concludes that the benefits of fluoridation outweigh the risks. Notably, the State's drinking water already has additional chlorine, which is chemically similar to fluoride, in its water supply for the purpose of reducing exposure to water borne illnesses. Notwithstanding the benefits of fluoridation, residents who have dental care insurance will have better opportunities to take preventative measures for their own and their children's dental care.

The purpose of this Act is to ensure good dental health by:

(1) Requiring all suppliers of public water throughout the State, including privately owned public water systems as well as county entities with jurisdiction over water supplies, to fluoridate the water under their respective jurisdictions, with the amount of fluoride in the water to be managed and adjusted by the respective county entities based on optimal fluoride levels for community water fluoridation that are established by the United States Department of Health and Human Services;

(2) Voiding the fluoridation requirement upon verification by the department of health and a proclamation issued by the governor that one hundred per cent of residents in the state either have obtained dental care insurance or affirmatively rejected insurance; and

(3) Expressly superseding any contrary state or county law on fluoridation of the public water supply.

SECTION 2. Chapter 321, Hawaii Revised Statutes, is amended by adding a new section to part I to be appropriately designated and to read as follows:

"§321- Fluoridation. (a) Each supplier of water in the State, whether the supplier is a privately-owned or governmental entity, that has one thousand or more service connections shall adjust the level of fluoride it its public water system, with the amount of fluoride in the water to be managed and adjusted by the county entity having jurisdiction over the water supply, the optimal fluoride level for community water fluoridation, pursuant to the most recent standard established by the United States Department of Health and Human Services; provided that this section shall not apply to any federal agency operating a public water system in the State.

(b) The department of health shall provide each supplier of water subject to this section with technical assistance and training relating to community water fluoridation and the management of fluoridation systems. The department may reimburse each supplier of water for expenses necessarily incurred to comply with this section.

(c) The department of health, with the cooperation of the boards of water supply and all other suppliers of water subject to this section, shall submit a status report to the legislature on compliance with this section and the procurement of dental care insurance by residents of this State no later than forty days prior to the convening of each regular session.

(d) The department of health shall monitor and verify to the governor when one hundred per cent of the residents of this State have either obtained or affirmatively rejected dental care insurance. The governor shall immediately issue a proclamation declaring the date that all residents have either obtained or affirmatively rejected dental care insurance, and shall submit a certified copy of the proclamation to the revisor of statutes. This section shall be void on the date of low-cost dental care insurance availability, as stated in the proclamation.

(e) This section shall supersede any state or county law to the contrary, until this section is made void pursuant to subsection (d)."

SECTION 3. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

SECTION 4. New statutory material is underscored.

SECTION 5. This Act shall take effect upon its approval.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	2997
THIRTIETH LEGISLATURE, 2020
STATE OF HAWAII