As halftime approaches in what is sure to be the Legislature's most difficult session in years, it's encouraging to see that leaders have placed considerable effort on what has to be the No. 1 concern in tough economic times: the health of Hawai'i's neediest citizens.

In the raft of bills moved along Friday by the Senate Ways and Means Committee, the largest number concerned healthcare. Fixing the strained delivery system for health services should be a top priority; this part of Hawai'i social safety net was under duress even before the global economy fell into severe recession.

One encouraging measure that the committee will continue work on is Senate Bill 1673, which targets weaknesses in the Hawai'i Health Systems Corp. This agency manages the network of public hospitals and long-term care facilities that operate primarily in rural communities, especially on the Neighbor Islands.

Like public hospital systems nationally, the HHSC has struggled under the financial burden of serving a disproportionate number of uninsured patients and in general receiving low reimbursements for expenses. SB 1673 cites the "constraints and inefficiencies inherent in operating as a governmental agency" among the reasons why nationally, many public hospitals privatize, reorganize as a nonprofit or take another corporate form.

These are options the Senate wants to extend to the hospitals now under the state umbrella. It is studying ways to give greater autonomy — if not full independence — to the corporation's constituent facilities.

The idea is a good one, and has drawn acclaim.

Wesley Lo, Maui regional chief executive officer, said that the bill would allow Maui Memorial Medical Center and other publicly funded institutions in the corporation to tap alternative sources of money and partner with other healthcare organizations.

The Hawai'i Primary Care Association also supports the bill, particularly the section calling on the corporation to collaborate with federally qualified health centers (FHQCs) that provide the bulk of healthcare services to rural residents. The association cites the higher Medicaid and Medicare reimbursements the centers could bring to a partnership.

Some employee unions have voiced opposition to transitioning away from state operations. Their concern has some foundation: This will be a complex transition, and lawmakers need to make sure the restructuring and spinning off of new management entities take place without putting access to care at risk.

But ultimately it's clear the state will no longer be able to underwrite all the expense of rural healthcare services, especially under current fiscal constraints. New financial arrangements should be sought, dictated by the economic conditions of each locale. The Senate needs to move this bill and work with House members to hammer out the kinks.

Among the other bills that deserve further consideration for making inroads toward healthcare goals:

• House Bill 989, which would extend coverage to uninsured children for three more years, resuscitating the "Keiki Care" program the Lingle administration recently shuttered for budgetary reasons.

• Senate Bill 1205, providing temporary health insurance for unemployed people who lost their health insurance.

• Senate Bill 423, which appropriates state funds to secure matching federal dollars for Medicaid reimbursements, a one-time allotment to help healthcare providers underfunded for this service.

• Senate Bill 1140, boosting reimbursement rates to providers at critical access hospitals and FHQCs.

• Senate Bill 1094, to create a pilot program aimed at providing more integrated care for patients at FHQCs.

This last measure is among those that would use money from federal stimulus legislation, but it's unclear how much money will be available or how many budgetary holes those funds will cover. But the Legislature seems at least to have developed the start of a plan for delivering whatever resources are available.

The public that depends so desperately on a functioning healthcare system should monitor to see that these needs remain top of mind at the Capitol.