Hawaii is famous for our beautiful beaches, tropical climate and the “aloha spirit” of our people. But we’re also a leader in health care, setting an example with public health innovations that other states can adopt and adapt for their own populations and circumstances.
Hawaii’s pioneering efforts in public health trace back to 1974, when the state enacted Hawaii’s Prepaid Health Care Act, which guarantees employer-supported health insurance for anyone working at least 20 hours per week for four weeks or more. That’s even more inclusive than the Affordable Care Act, which requires employers to offer health care to those who work 30 hours or more a week.
Half a century later after passing this landmark legislation, we are still building on that foundation. I’m proud that we ranked as the best state for health care in the nation in the latest U.S. News Best States rankings, and in U.S. News’ latest Healthiest Communities rankings, released in August, Hawaii’s most-populous counties were all rated highly.
So how have we excelled? One reason is that Hawaii has one of the lowest rates of uninsured people in the country, at less than 4% of our population. We’re consistently ranked highly for access to care, quality of care and public health outcomes.
This issue is especially close to my heart, because I began my life’s work as a family and emergency room doctor. Straight out of medical school, I joined the National Health Service Corps and was stationed in a large rural district on Hawaii’s Big Island, where I had the privilege to hear directly about the struggles and learn from the people I treated.
As lieutenant governor and the state’s COVID liaison during the pandemic, I relied on my experience as an ER doctor to lead our state’s public health effort – using the latest in science, data and communications to fight the spread of the virus and protect our people. Hawaii’s innovative response to the COVID emergency helped us achieve some of the best results in the country, including ranking first in preventing deaths from COVID, according to the Commonwealth Fund, a foundation that supports research on health care.
Embracing a policy of full transparency, we provided real-time data and risk assessments to our citizens – with continuous updates and advisories through social and traditional media. We also created the Safe Travels program, which implemented mandatory testing for all visitors to our state, helping us achieve one of the lowest transmission rates in the country.
Our commitment to open communication and rapid, data-driven responses to the emergency also helped us reach one of the nation’s highest vaccination rates, at over 80%, and one of the lowest mortality rates in the country – saving an estimated 10,000 lives in our state.
Last year, when we suffered the devastating wildfires on Maui that killed more than 100 people and destroyed or damaged more than 3,000 homes, we applied the same analytical approach to our disaster response and recovery efforts that we developed during COVID. This approach allowed us to deliver vital relief, housing and services more quickly to families displaced by the fire to help them recover and heal.
Hawaii is also addressing the challenge of homelessness in a new way – by treating it as a public health issue. Housing is health care – and a housed population is a healthy one. As one of only a limited number of states with federal approval to utilize some of our Medicaid funds for housing, Hawaii is investing health care resources in reducing homelessness – not only improving health care outcomes for this vulnerable community, but also driving down costs.
We also have begun initiatives like building kauhale villages, which are already showing unprecedented results in reducing homelessness and improving health outcomes. These communities of tiny houses have achieved a remarkable reduction of up to 73% in health care costs per person housed.
We are committed to building 12 kauhale villages by the end of this year, towards a total of 20 in 2025. These innovative communities will help us achieve our ambitious goal of cutting unsheltered homelessness in half in Hawaii by 2026.
This new approach of “housing is health care” reflects Hawaii’s values of compassion and aloha, helping ensure that everyone in our state gets the care and support they need to thrive.
This year, we launched the Healthcare Education Loan Repayment Program, a state-funded initiative to provide $30 million in educational debt repayment to health care professionals, including primary care physicians, behavioral health specialists and individuals practicing in rural areas. Eligible individuals qualify for between $12,500 and $50,000 in support. Within five years, we hope this initiative will help Hawaii become an outlier when it comes to our nation’s shortage of doctors or nurses.
Hawaii has also been a pioneer in protecting the reproductive rights of women. In 1970, three years before the Supreme Court’s Roe v. Wade ruling established a federal right to abortion, our state made history by decriminalizing abortion, demonstrating our commitment to defend the right of women to make their own reproductive health care choices. This right to choice is one we continue to reaffirm despite the repeal of Roe in 2022 and pushback elsewhere in the country. Under my tenure as governor, we enacted legislation to safeguard women’s reproductive rights.
By implementing solutions like these – driven by the latest data and rooted in our oldest values – Hawaii will keep leading on issues like providing access to health care, protecting reproductive rights and ending homelessness in our state.
We have made equitable access to health care a human right, and other states can do the same.
Josh Green, M.D., is the governor of Hawaii.
