Hawaii's Broken Health Care System Needs Urgent Reform, Voters Say

Hawaii's health care system faces growing pressure as residents demand major reforms. Over 80% of voters want changes, with many struggling to access care and afford rising costs. A new proposal suggests shifting from treating illness to preventing it, aiming for better coordination and efficiency across the islands.

The current system is under strain from multiple challenges. Rising premiums, workforce shortages, and limited access for vulnerable groups have left many residents frustrated. Nearly 40% of emergency visits could be managed in cheaper, non-emergency settings, yet the system still pays more for expensive care. This inefficiency drives up costs and wastes resources.

Financial troubles are also evident. Major health systems and insurers have reported operating losses, signalling deeper instability. Emergency department visits have slightly declined—from around 650,000 in 2021 to about 600,000 in 2025—due to factors like telehealth expansion and preventive care efforts. However, the 2023 Maui wildfires briefly spiked visits by 15% before numbers settled again.

A proposed solution, One Health Hawai'i, aims to improve quality, affordability, and access. The nonprofit affiliation would keep patient choice intact while guiding people to the right care settings. The focus would shift toward prevention, reducing unnecessary emergency visits and easing financial burdens.

The plan seeks to address long-standing issues by making care more efficient and patient-focused. If implemented, it could lower costs, reduce strain on hospitals, and improve access for residents. The success of the reform will depend on coordination between providers, insurers, and policymakers.