THE SENATE	S.R. NO.	109
THIRTY-THIRD LEGISLATURE, 2025
STATE OF HAWAII

SENATE 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 Trump administration and the Republican majority in the United States Congress are threatening deep cuts to federal Medicaid funding; and

WHEREAS, Hawaii may soon be in urgent need for a more cost-effective health care financing system if cuts to Medicaid are implemented; 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 simplified, standardized fee-for-service based on time and required training for a given procedure, rather than assigning a relative value to each of 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 cost 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 under-paid 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 2025, 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 2026; 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:

Hawaii Health Authority; Single-Payer Health Care System