Save money on your next flight

Skyscanner is the world’s leading flight search engine, helping you find the cheapest flights to destinations all over the world.

With its tropical beaches, lush rainforests, and vibrant culture, Hawaii is often seen as a paradise. But behind the picture postcard scenes lurk serious healthcare challenges for the state’s residents. So does Hawaii have universal healthcare to ensure all its people can access the medical services they need? Let’s take a look.

If you’re short on time, here’s a quick answer to your question: No, Hawaii does not have universal healthcare. But it does have healthcare programs that work to expand access and cover more of the population.

In this comprehensive guide, we’ll cover the current state of healthcare and health insurance in Hawaii. We’ll look at the programs in place, who they cover, and the gaps that still remain. We’ll also explore some of the reasons why Hawaii hasn’t established universal coverage yet. By the end, you’ll have a full understanding of whether Hawaii provides healthcare for all.

An Overview of Healthcare in Hawaii

Hawaii is known for its beautiful beaches, stunning landscapes, and aloha spirit. But when it comes to healthcare, does this tropical paradise have universal coverage? Let’s take a closer look at the current healthcare system in Hawaii and how it compares to other states.

The Current System

Hawaii has a unique healthcare system that sets it apart from the rest of the United States. The state has had a mandatory employer-based health insurance law since 1974, known as the Hawaii Prepaid Health Care Act. Under this law, employers are required to provide health insurance to employees who work at least 20 hours per week.

This employer-based system has resulted in a high rate of health insurance coverage in Hawaii. According to the Hawaii Health Information Corporation, as of 2019, the uninsured rate in the state was only 3.5%. This is significantly lower than the national uninsured rate of 8.5%, as reported by the U.S. Census Bureau.

Uninsured Rates in Hawaii

Hawaii’s low uninsured rate can be attributed to several factors. First, the mandatory employer-based system ensures that a large portion of the population has access to health insurance through their jobs. Additionally, the state has implemented various programs to help individuals and families afford health insurance, such as the Hawaii Employer-Union Health Benefits Trust Fund and the Keiki Care program, which provides coverage for children.

Furthermore, Hawaii has expanded Medicaid under the Affordable Care Act, providing coverage to low-income individuals and families who may not qualify for employer-sponsored insurance. This expansion has played a significant role in reducing the uninsured rate in the state.

How Hawaii Compares to Other States

When comparing Hawaii to other states, it becomes clear that the Aloha State is leading the way in terms of healthcare coverage. According to the Commonwealth Fund’s Scorecard on State Health System Performance, Hawaii ranked first in the nation for access to healthcare and second overall for healthcare outcomes in their 2020 report.

It’s important to note that while Hawaii has achieved high levels of coverage, there are still challenges that need to be addressed. The cost of healthcare in Hawaii remains a concern, with high premiums and out-of-pocket expenses. Additionally, access to healthcare services, especially in rural areas, can be limited.

Hawaii’s Major Healthcare Programs

Medicaid in Hawaii (Med-QUEST)

Hawaii’s Medicaid program, known as Med-QUEST, provides free or low-cost health coverage to low-income individuals and families. Med-QUEST is administered by the Hawaii Department of Human Services and is funded jointly by the state and federal governments. It covers a wide range of medical services, including doctor visits, hospital stays, prescription medications, and more. Eligibility for Med-QUEST is based on income and other factors, and individuals can apply online or through their local Med-QUEST office.

Hawaii’s Prepaid Health Care Act

Hawaii’s Prepaid Health Care Act (PHCA) is a unique healthcare program that requires employers to provide health insurance to their employees. Under the PHCA, employers must offer health insurance to employees who work at least 20 hours per week and have been employed for at least four consecutive weeks. The PHCA aims to ensure that all working individuals in Hawaii have access to affordable healthcare coverage. It has been in place since 1974, making Hawaii the first state to enact such legislation.

Hawaii’s Medicare Program

Hawaii’s Medicare program provides health insurance to individuals aged 65 and older, as well as certain younger individuals with disabilities. Medicare is a federal program that helps cover the cost of healthcare services, including hospital stays, doctor visits, and prescription drugs. In Hawaii, the program is administered by the Centers for Medicare and Medicaid Services (CMS) and provides coverage to over 250,000 residents. Individuals who are eligible for Medicare can enroll through the Social Security Administration.

Remaining Gaps in Hawaii’s Healthcare System

While Hawaii has made significant strides in providing access to healthcare for its residents, there are still some gaps in the system that need to be addressed. These gaps primarily revolve around high costs, limited options, coverage limitations for legal immigrants, and a lack of coverage for dental, vision, and long-term care.

High Costs and Limited Options on the Individual Market

One of the main challenges in Hawaii’s healthcare system is the high costs and limited options available on the individual market. Many individuals and families who do not qualify for government-funded healthcare programs are left to purchase insurance plans on their own. However, the cost of these plans can be prohibitively expensive, especially for those with pre-existing conditions. Additionally, the options for coverage may be limited, leaving individuals with fewer choices to find a plan that meets their needs and budget.

Coverage Limitations for Legal Immigrants

Another gap in Hawaii’s healthcare system is the coverage limitations for legal immigrants. While the state has made efforts to provide healthcare access to its residents, there are still restrictions in place for legal immigrants who are not yet eligible for government-funded programs. This can leave individuals and families in a vulnerable position, as they may not have access to affordable healthcare options. It is important to address these limitations and ensure that all residents, regardless of immigration status, have access to necessary healthcare services.

Lack of Dental, Vision, and Long-Term Care

In addition to the aforementioned gaps, Hawaii’s healthcare system also lacks coverage for dental, vision, and long-term care. These essential services are often not included in basic healthcare plans, leaving individuals to bear the full cost of these expenses. This can be particularly burdensome for those who require ongoing dental or vision care, as well as for individuals in need of long-term care services. Addressing this gap and expanding coverage to include these important services is crucial for ensuring the overall well-being of Hawaii’s residents.

It is important to recognize that while Hawaii has made progress in providing access to healthcare, there are still areas that require attention. By addressing the high costs and limited options on the individual market, expanding coverage for legal immigrants, and including dental, vision, and long-term care in healthcare plans, Hawaii can move closer to achieving universal healthcare for all of its residents.

Efforts Toward Universal Healthcare in Hawaii

Previous Attempts at Reform

In Hawaii, the journey towards achieving universal healthcare has been marked by several notable initiatives. One significant milestone occurred in 1974, when the state implemented the Hawaii Prepaid Health Care Act (HPHCA). The HPHCA requires employers to provide health insurance to employees working more than 20 hours per week, making Hawaii the first state in the United States to mandate employer-provided healthcare. This groundbreaking legislation was a crucial step towards expanding access to healthcare for Hawaii’s residents.

Another noteworthy effort aimed at achieving universal healthcare was the Hawaii Health Authority (HHA), established in 2009. The HHA was tasked with developing a plan to provide comprehensive healthcare coverage to all residents of Hawaii. However, due to various challenges and complexities, the plan was ultimately abandoned in 2013.

Despite these setbacks, the state of Hawaii remains committed to finding viable solutions for universal healthcare coverage.

The Path Forward: Possibilities and Challenges

As Hawaii continues its pursuit of universal healthcare, several possibilities and challenges must be considered. One potential avenue is the exploration of a single-payer system, where the government would be the sole provider of healthcare services. This approach has been successful in countries like Canada and the United Kingdom. However, implementing such a system in Hawaii would require careful consideration of funding mechanisms and potential impacts on the healthcare industry.

Another avenue for universal healthcare in Hawaii is the expansion of existing public health programs, such as Medicaid. By increasing eligibility criteria and coverage options, more individuals could access affordable healthcare services. Additionally, leveraging technological advancements, such as telehealth, could help improve healthcare access for remote and underserved communities in the state.

However, achieving universal healthcare in Hawaii also comes with challenges. One significant hurdle is the high cost of healthcare. According to data from the Centers for Medicare and Medicaid Services, Hawaii has some of the highest healthcare costs in the nation. Addressing these cost challenges would require innovative approaches that prioritize cost containment without compromising the quality of care.

It is important to note that the path towards universal healthcare in Hawaii is complex and multifaceted. It requires collaboration between policymakers, healthcare providers, and the community at large. By learning from previous attempts at reform and considering various possibilities, Hawaii can continue to make progress towards achieving the goal of universal healthcare for all its residents.


In the end, while Hawaii has made significant strides in expanding healthcare access, gaps remain and the state has yet to achieve universal coverage. Programs like Medicaid and the Prepaid Health Care Act have extended coverage to many, but limitations around affordability, eligibility, and services covered prevent Hawaii from providing healthcare to all residents. While bold reform attempts have stalled in the past, Hawaii continues to grapple with how to best build on its existing programs to further close coverage gaps. With strong grassroots momentum, political will, and innovative policy solutions, the dream of universal healthcare may someday become a reality in Hawaii.

Sharing is caring!

Similar Posts