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.

HR87

HOUSE OF REPRESENTATIVES

H.R. NO.

87

THIRTY-THIRD LEGISLATURE, 2026

STATE OF HAWAII

HOUSE 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 House of Representatives of the Thirty-third Legislature of the
State of Hawaii, Regular Session of 2026, 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 Resolution be transmitted to the
Governor, Director of Finance, and Director of Human Services.

OFFERED BY:

_____________________________

Report Title:
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Hawaii
Health Authority; Reactivation; Single-Payer Health Care System