Hawaii has been awarded nearly $190 million in federal funding to augment rural health care under President Donald Trump’s “Big Beautiful Bill” through a plan co-written by Democratic Gov. Josh Green.
Green told the Honolulu Star-Advertiser Monday that the amount of funding means Hawaii now ranks sixth in the country per capita in federal rural health care funding. He said it’s the result of working with fellow Pennsylvania native and physician Dr. Mehmet Oz, administrator for the federal Centers for Medicare &
Medicaid Services.
Green started his Hawaii medical career treating
rural, low-income patients at Hawaii island’s Kau Hospital &Rural Health Clinic.
Hawaii’s initial $188,892 million in rural health care funding for the current fiscal year is scheduled to be followed by additional awards through 2030.
Green serves as vice chair of the Western Governors’ Association and said rural health care needs affect both red and blue states.
“The whole country’s dealing with this,” he said.
For the last three years, Green has won state legislative support for $30 million in annual state funding to pay down student loans for a wide range of Hawaii health care workers, not just physicians and nurses.
Green hopes the new federal Rural Health Transformation Program funding, the ongoing Hawaii Education Loan Repayment Program, called HELP, and his ongoing push to develop affordable housing for first responders, teachers, health care workers and other necessary workers combine to erase Hawaii’s shortage of 50,000 health care by 2030.
The new, rural health care funding through the Centers for Medicare &Medicaid Services “comes at a perfect time,” Green said. “This could level the playing field.”
For a country divided along partisan political lines, Green said the rural health care funding serves as “a tool to bridge that gap between red and blue states.”
Despite political differences over Trump Administration policies — especially Green’s opposition to Health and Human Services Secretary Robert F. Kennedy Jr.’s vaccination policies — Green said he continues to work with Trump and Trumps’ cabinet and administration officials to reduce the impact of federal funding cuts to Hawaii.
Green previously told the Star-Advertiser that his current state budget proposal was drafted to respond to the likelihood that more federal funding cuts will occur this year, including the possibility of tapping into the state’s $1.6 billion rainy day fund as tourism and the overall Hawaii economy continue to slow.
The Council on Revenues is scheduled to make its
latest economic forecast on Wednesday, which will give Green and legislators more guidance on how to prepare for what might lie ahead as the legislative session begins on Jan. 21.
Hawaii and Utah remain the only states with no legal gambling but efforts to legalize some form of gambling — from a lottery to Las
Vegas-style casinos — are
introduced every year at the Legislature.
This year likely will be no exception but Green said any gambling proposals, in his mind, “have got to be part of solving our social ills,” such as housing and health care.
Recruiting and retaining health care workers — especially in rural areas — remains a national problem and in July Green’s administration began organizing health care officials to come up with
recommendations for:
>> A state digital network linking hospitals, clinics and health centers called the
Rural Health Information Network to access health records and other data.
>> A statewide Pili Ola Teleheath Network for rural communities to connect to with health care providers and access telehealth training.
>> Expand emergency medical services, mobile health care, community paramedicine and behavioral health in rural areas through Rural Infrastructure for Care Access.
>> A pipeline to provide workforce training, residencies, scholarships and mentoring to recruit and retain rural health care workers through a Hawai‘i Outreach for Medical Education in
Rural Under-resources Neighborhoods program called HOME RUN.
>> Expand Green’s homeless “medical respite” kauhale village concept to the neighbor islands that has proven to reduce medical costs, emergency room visits and health care worker time treating homeless
patients who rely on paramedics and ambulances to transport them to Oahu
hospitals.
Housing people with medical issues in kauhale, where they can receive treatment, “is better than having people on the street or in the E.R.,” Green said. “We’ve saved
tens of millions of dollars.”
>> Dedicate a fund to help rural health care providers develop new models to ensure quality and access to rural health care.
At the same time, Green has not given up that Congress could still vote to extend health care subsidies for people who receive their health care through the
Affordable Care Act.
Congress failed to extend the subsidies at the end of 2025, leading Affordable Care Act costs to double in many instances.
For Republicans seeking re-election this year, Green said failing to extend the subsidies “is like dropping a nuclear bomb on the mid-term elections.”
For low-income patients, in particular, Green said, “That’s how you go bankrupt. This will be the ultimate game changer in the mid-terms if they don’t extend the Affordable Care Act subsidies.”
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