The proposed consolidation of healthcare providers in Hawaii is a pressing issue that demands immediate attention from Governor Josh Green. The integration of Hawaiʻi Pacific Health and HMSA could exacerbate the existing problem of limited access to healthcare services, particularly on Maui. This is not merely a policy debate; it's a matter of real and painful consequences for residents. Dialysis patients face long hours at night, cancer patients endure months-long waits for biopsies, and families are forced to leave the island for care that should be available locally. These issues are not due to geography or bad luck but rather the predictable outcome of policy choices, including consolidation, supply-restricting regulations, low reimbursement rates in a high-cost state, and market structures that favor large institutions over competition. The human toll on health, families, and livelihoods is real and growing. To understand the root cause, we must examine the forces shaping Hawaii's healthcare system, particularly the Certificate of Need laws, increasing consolidation of hospitals and insurers, and the emergence of a two-tier healthcare system. The Certificate of Need laws, intended to prevent unnecessary duplication and protect communities, have instead restricted the development of essential services like imaging centers, dialysis facilities, surgical centers, and operating rooms, even when demand is urgent. This has led to measurable consequences, with Maui having only one major hospital system compared to four in Little Rock, Arkansas, resulting in rationed care, longer waitlists, and services like emergency care being prioritized over community-based diagnostics and elective procedures. The consolidation of healthcare providers compounds the problem, creating a two-tier system where Kaiser, a vertically integrated model, tightly controls access and routes patients to Oahu for even simple studies. Meanwhile, the dominant hospital ecosystem lacks competition and incentives to expand community-based services. This dynamic leads to delays, substitutions, and denials for patients, with colonoscopies replaced by stool tests and imaging deferred. The proposed integration between Hawaiʻi Pacific Health and HMSA would intensify this dynamic, concentrating pricing power, reducing transparency, and squeezing independent providers out of the market. This is not just speculation; it's basic economics. Research consistently shows that consolidation in healthcare markets leads to higher prices and slower innovation, while quality improvements rarely materialize for patients. The ripple effects of healthcare consolidation impact the entire economy, affecting small businesses and trades. When healthcare costs rise and access shrinks, small employers are forced to cut staff, limit growth, or close, pushing independent operators and workers into corporate employment. This consolidation accelerates across the economy, straining even large employers like hotels. The Affordable Care Act's market-driven framework, while intended to expand coverage, has shifted healthcare away from a relational model towards a transactional subscription model, where control shifts upward and local-led care weakens. The governor has the authority to take meaningful action, including imposing enforceable guardrails on healthcare consolidation, opening Hawaii's insurance market to competition, ending 'paper capacity' by requiring approved projects to be built, enforcing network adequacy laws, and pursuing a higher Medicare Geographic Practice Cost Index to ensure physicians can afford to practice in Hawaii, especially on neighbor islands. This is not an ideological argument but an outcomes-based one. Maui's healthcare system, like those on other neighbor islands, is failing to meet basic community needs. Consolidation has reduced choice, Certificate of Need has restricted supply, and vertical integration has shifted control away from patients, doctors, and small businesses. Governor Josh Green has expressed a commitment to saving lives and improving healthcare, and it's time for that commitment to be reflected in urgent action at home. Healthcare consolidation is a powerful driver of rising costs, impacting not just healthcare but the survival of families, private practitioners, tradespeople, and small businesses. It threatens our sovereignty and control over our daily lives and means of making a living. The affordability of goods and services is at stake, as healthcare consolidation sends a tsunami through the cost of living, affecting housing, food, safety, and ownership over one's life.
