It means making sure every Hawaiʻi resident has access to reliable, complete healthcare, regardless of income, job, or island. It means removing financial barriers so no one has to choose between medical treatment and other basic needs.

Every day in Hawaiʻi, the most vulnerable go without care because of a complicated healthcare system. Kūpuna, keiki, and people with disabilities face income limits, paperwork barriers, and gaps in coverage that make it harder to get the care they need. Many residents, including those with serious health risks, delay or forgo treatment because of soaring costs, recently worsened by federal cuts. Universal healthcare establishes a single-payer system to ensure full coverage statewide. By advocating for healthcare for all, we help build a system where preventive care is accessible, chronic conditions are managed effectively, and everyone has the opportunity to live their healthiest life. Health equity strengthens families, supports the local economy, and reflects Hawaiʻi’s values of care and community.

A single-payer healthcare system is one in which a single public or government program pays for healthcare services for everyone, rather than relying on multiple private insurance companies. It prioritizes patient care over profit and reduces administrative costs by eliminating the paperwork, billing complexities, and coverage barriers that come with private insurers. In a single-payer system, everyone has access to necessary medical care based on their needs, not their income, job, or insurance approval. For Hawaiʻi residents, this could mean more transparent, affordable, and equitable access to healthcare, fewer coverage gaps, and a stronger focus on preventive care and overall public health.

A single-payer healthcare system is one in which one public program pays for healthcare services for everyone, rather than relying on multiple private insurance companies. It prioritizes patient care over profit, unlike traditional insurers that often focus on maximizing financial returns. In a single-payer system, a single public or governmental entity manages healthcare funding, reducing administrative costs and eliminating the paperwork, complexity, and barriers associated with multiple private insurers. Universal and single-payer systems can also lower overall healthcare costs by cutting administrative waste, simplifying billing, negotiating lower drug prices, and efficiently pooling risk across the population. This approach helps ensure that patients receive care based on their medical needs, not their income, job status, or insurance approval. For Hawaiʻi residents, this could mean more transparent, equitable access to healthcare, fewer coverage gaps, stronger negotiating power to lower costs such as prescription drugs, and greater stability so people do not lose coverage when they change jobs or experience life transitions.

Healthcare policy involves funding decisions at both the state and federal levels. Different policy proposals take different approaches to funding. Our focus is on ensuring accessible and sustainable care that supports Hawaiʻi families and small businesses. A review of 22 economic models of single‑payer (Medicare‑for‑All) scenarios found that 19 (86 %) predicted net savings in the first year of operation, with a median overall reduction of around 3.5 % in total national health spending due primarily to lower administrative and drug costs. This suggests that simplifying financing and reducing overhead can meaningfully reduce overall healthcare expenses.

Small businesses often struggle with the high cost of providing health insurance for employees, which can limit hiring, wages, and growth. Research shows that thoughtful healthcare reform can reduce the costs small businesses pay for employee coverage, saving owners money they can reinvest in their business and supporting jobs and wages. For example, analyses of healthcare reform scenarios found that reforms could cut small employer healthcare costs by up to 36 % over ten years, helping preserve jobs and boost profits compared with continuing the current system.

Hawaiʻi’s Prepaid Health Care Act (PHCA), passed in 1974, requires most employers to provide health insurance to employees who work at least 20 hours per week for 30 or more days. It was the first law of its kind in the U.S. and ensures that many full-time workers in Hawaiʻi have basic health coverage. However, the PHCA does not cover everyone. Part-time workers, many small business employees, freelancers, and their families may still struggle to access affordable care. Costs for premiums, deductibles, and co-pays can still be high, and some residents who do not qualify may delay or forgo necessary healthcare. A broader system like Med-QUEST expansion or a single-payer approach, would fill these gaps and provide coverage for all Hawaiʻi residents, not just employees of covered businesses.

While Hawaiʻi has one of the highest health insurance rates in the U.S. thanks to programs like Med-QUEST and the Prepaid Health Care Act, not everyone is fully covered. Many residents — including part-time workers, freelancers, low-income families, and some seniors or disabled individuals — either don’t qualify for public programs or face high costs for private insurance. As a result, some people delay care, skip treatment, or go without insurance altogether, leaving gaps in coverage. Coverage alone isn’t enough. It must be affordable, reliable, and accessible so everyone can get the care they need without financial strain.

Hawaiʻi faces unique challenges, including a high cost of living, provider shortages on the neighbor islands, and heavy reliance on federal healthcare funding. It has become clear that federal options are becoming less reliable, and we must come together to develop local solutions that work for Hawaiʻi. Historically, Hawaiʻi had universal healthcare before colonization, as Native Hawaiians understood the value of a healthy society and caring for all its people. Building on that tradition, we can create a system that ensures everyone has access to the care they need.

Med-QUEST is Hawaiʻi’s Medicaid program. It provides free or low-cost health coverage to eligible adults, children, seniors, and people with disabilities.

Eligibility depends on income, household size, age, and other factors. Children qualify at higher income levels than adults. Income limits change each year based on federal guidelines. About 68% of Hawaiʻi residents are not enrolled in Med-QUEST, and many families who do not qualify struggle with high premiums, deductibles, and out-of-pocket costs. Some delay care or go without treatment because they cannot afford it.

People already pay for healthcare through premiums, deductibles, co-pays, and out-of-pocket costs. A universal system would restructure these costs, reduce administrative waste, and negotiate lower prices for drugs and services. Studies show that single-payer systems can actually lower total healthcare spending while ensuring everyone has coverage.

A cost analysis shows that if hospitals were funded under a single-payer system with global budgeting, U.S. non-federal hospital operating costs could decrease by about $2.5 trillion between 2021 and 2030 compared with current law. These savings come from lower administrative costs, simplified billing, and reduced profit extraction, allowing hospitals to focus more resources on patient care rather than paperwork and complex insurance processes.

Universal coverage ensures everyone can see a doctor when they need care, but people can still supplement coverage if they want extra services or private insurance. The goal is not to remove choice, but to guarantee that basic, necessary care is available for everyone.

Evidence from other countries with single-payer systems shows that care can be delivered efficiently, with less paperwork and fewer administrative hurdles. By simplifying billing and insurance processes, healthcare providers can spend more time caring for patients instead of dealing with complex insurance forms. Policies can also include safeguards against inefficiency or corruption, such as regular audits and mandatory efficiency, quality, and financial reporting, ensuring the system remains transparent and accountable.

Any change would be carefully planned and phased in to ensure continuous coverage. Models from other states and countries show that it’s possible to move to universal coverage without major disruptions while maintaining quality care for everyone.

While individuals play a role in maintaining their health, healthcare is also a community and societal concern. Hawaiʻi has a long history, pre-colonization, of valuing a healthy society and caring for all people. Universal healthcare reflects that tradition, ensuring that no one is forced to choose between treatment and basic needs.

A bill is a proposal for a new law or a change to an existing law. Bills must go through committees and votes before becoming law.

Testimony means sharing your comments or opinion with lawmakers about a bill. You can submit testimony in writing online or speak at a hearing, either virtually or in person.

Yes. Lawmakers and their staff review testimony before hearings and votes. Even short, simple messages help show public support or concern.

In Hawaiʻi, the State House of Representatives and the State Senate make state laws that affect Hawaiʻi residents. State House Representative: A State Representative is an elected official who represents a specific district in the state. Hawaiʻi has 51 House districts, and Representatives serve two-year terms. They propose, debate, and vote on laws that impact your community and the state. State Senator: A State Senator is an elected official who represents a larger district than a House member. Hawaiʻi has 25 Senate districts, and Senators serve four-year terms. They also draft and vote on state laws, and work alongside House members to approve the state budget and policies. Both State Representatives and Senators are your local lawmakers. You can contact them to share your opinions, submit testimony, or request support on issues like healthcare, education, and housing. Find yours here.

You can send a short email, submit written testimony, share information on social media, or talk with friends and family. Even small actions make a difference.

Most actions, like sending an email or submitting testimony, take just a few minutes