SCR 186: supporting the reactivation of, and urging the governor to appoint members to, the Hawaii Health Authority to plan for a transition to a maximally cost-effective single-payer health care system for the State, to be implemented as soon as possible after waivers have been obtained to capture all major sources of federal funding flowing to the State through Medicare, Medicaid, and Tricare.

SENATE CONCURRENT

RESOLUTION

supporting the reactivation of, and urging the governor to appoint members to, the Hawaii Health Authority to plan for a transition to a maximally cost-effective single-payer health care system for the State, to be implemented as soon as possible after waivers have been obtained to capture all major sources of federal funding flowing to the State through Medicare, Medicaid, and Tricare.

     WHEREAS, the Budget Reconciliation Act, signed into law in July 2025, cuts over $1,000,000,000,000 in Medicaid over ten years, with estimates suggesting that it will result in fifteen million more people without health insurance by 2034; and

     WHEREAS, these cuts will have a significant impact on Hawaii's healthcare system, with more than four hundred thousand residents participating in Medicaid; and

     WHEREAS, the University of Hawaii Economic Research Organization estimates that the cuts would create a loss of $400,000,000 in Medicaid spending in Hawaii; and

     WHEREAS, these developments further necessitate the establishment of a more cost-effective health care financing system; and

     WHEREAS, a Hawaii single-payer health care financing system could achieve large savings from reduced administrative costs without cuts to care delivery by doctors and hospitals; and

     WHEREAS, global budgets based on the cost of operations could eliminate about fifteen percent of total hospital budgets that would otherwise be apportioned for billing and collection costs; and

     WHEREAS, independent doctors paid with a simplified, standardized fee-for-service structure based on time and required training for a given procedure, rather than assigning a relative value to thousands of procedure codes, could markedly reduce billing and collections costs that now consume around fifteen percent of physician practice revenue; and

     WHEREAS, similar savings in the fifteen percent range could be achieved from reduced administrative costs for a Hawaii single-payer administrator; and

     WHEREAS, some of these savings could be used to fund community-based programs for high-risk and special needs patients and specialist consultations to primary care to save the cost of preventable emergency room visits and hospitalizations; and

     WHEREAS, some of these savings could be used to improve take-home pay for primary care specialties and psychiatry so that doctors in underpaid specialties could afford Hawaii's high cost of living, reversing the State's severe physician shortage; and

     WHEREAS, health care costs for Medicaid and state and county employee and retiree benefits now consume around thirty percent of the total state budget; and

     WHEREAS, all the above administrative cost savings could add up to a reduction in Hawaii health care costs in the range of thirty percent or more, reducing the total state budget by around nine percent; and

     WHEREAS, the Hawaii Health Authority is already established in state law with a mission of planning for a universal health care system covering all residents of the State, but the Authority is currently inactive; now, therefore,

     BE IT RESOLVED by the Senate of the Thirty-third Legislature of the State of Hawaii, Regular Session of 2026, the House of Representatives concurring, that this body supports the reactivation of, and the Governor is urged to appoint members to, the Hawaii Health Authority to plan for a transition to a maximally cost-effective single-payer health care system for the State, to be implemented as soon as possible after waivers have been obtained to capture all major sources of federal funding flowing to the State through Medicare, Medicaid, and TRICARE; and

     BE IT FURTHER RESOLVED that the Hawaii Health Authority is requested to submit a report of its progress and recommendations, including any proposed legislation,

to the Legislature no later than twenty days prior to the convening of the Regular Session of 2027; and

     BE IT FURTHER RESOLVED that certified copies of this Concurrent Resolution be transmitted to the Governor, Director of Finance, and Director of Human Services.

Report Title: 

Hawaii Health Authority; Reactivation; Single-Payer Health Care System