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.”

As 2025 came to an
end, a climate report released by the Council on Strategic Risks outlined how climate change could threaten both Hawaii’s civilian and military communities, and how cuts to programs that monitor weather and other environmental threats could leave both more vulnerable.

The report by CSR — a non-partisan security policy institute based in Washington, D.C. — warns that “with its diverse landscapes and geographic isolation, Hawai‘i is exceptionally vulnerable to the impacts of climate change. Shifting rainfall and seasonal patterns affect local food security and biodiversity; heat and drought stress water supplies, impacting human health and increasing wildfire risk; and coastal flooding and inundation threaten economic security, including infrastructure, agriculture, and tourism.”

The report noted that under a high-emissions scenario in which the world does nothing to reduce current green gas emissions, coral reef loss in the islands is projected to result in an economic loss of up to $1.3 billion per year by 2050. It also noted that Hawaii is the third-most vulnerable U.S. state to temperature-related deaths, and that greater heat wave intensity is straining energy and water infrastructure across the islands.

Rainfall and stream flow have declined across Hawaii since the 1990s, with 90% of the state receiving less rainfall than it did a century ago.

Over the last three decades military leaders in
Hawaii, which is the nerve center for military operations across the Pacific, have tracked how changing climate is altering the strategic landscape of the region, calling it a potential “threat multiplier.”

Security analysts have warned that droughts, sea level rise and other changes risk fueling displacement of communities and competition over resources, potentially destabilizing countries or entire regions. More recently, melting arctic ice caps have been opening up new waterways that China and Russia seek to take advantage of, while strategic U.S. facilities on Guam and in the Marshall islands have been hit by storms and rogue waves that have disrupted operations.

But in the White House’s National Security Strategy released last month, the administration of President Donald Trump said it “reject the disastrous ‘climate change’ and ‘Net Zero’ ideologies that have so greatly harmed Europe, threaten the United States, and subsidize our adversaries.” The document also said the administration considers “restoring American energy dominance” with oil, gas and coal to be a top priority in order to fuel the growth of artificial intelligence and data centers.

At the same time, the administration also has sought deep cuts to environmental monitoring and research programs, including partnerships in Hawaii. Hawaii has made plans for $6 billion in climate adaptation projects to compensate for sea level rise, including port renovations, dredging and wetland restoration.

“I think every administration gets to set its priorities, but they don’t always match what states want,” said Jessica Kehaulani Wong, a fellow at the Pacific Islands Climate Adaptation Science Center who authored the CSR’s study.
“Local governments and communities want to address climate hazards that are not just theoretical, but are from lived experiences. So I think federal funding cuts have spurred conversations around diversifying funding sources for local adaptation projects.”

Among the programs the Trump administration is looking to eliminate is the Pacific Islands Ocean Observing System, which provides real-time observations of wave height, current strength, wind speed, shoreline inundation and other ocean conditions. In Hawaii that data is used by commerical freighters and other civilian mariners as well as the U.S. Navy and Coast Guard to plot courses around storms and safely navigate harbors.

That’s part of a $1.3 billion reduction in the budget of the National Oceanic and Atmospheric Administration that the CSR report said would “would also dismantle regional climate adaptation partnerships that help Hawai‘i plan for rising sea levels, and reduce the accuracy of hurricane forecasting by limiting investments in satellite data.”

There is also a $558 million — or 38% — reduction in funding across the U.S. Geological Survey, which the report said “would impact its ability to provide scientific information that supports the management of water, ecosystems, and land resources in Hawai’i and mitigate risks from natural hazards. It could end collaborations in Hawai‘i that monitor invasive species, sea level rise, and wildfire risks.”

Fire-prone invasive grasses and other vegetation have become prevalent throughout the islands and played a central role in the deadly 2023 Lahaina wildfire, Hawaii’s deadliest disaster. These plants thrive in hot, dry environments, crowding out and replacing native species and spreading further.

These grasses and other invasive species have spread across military bases, already impacting operations. Fires have disrupted training, and in some cases been caused by military training. Wong said “let’s say that a wildfire reaches infrastructure where weapons caches or explosive are stored, that would not be good.”

“Military installations and service members, they don’t exist in a vacuum, they pull from the same resources — food, water, energy — as the communities that they’re in,” Wong said. “And so any climate or ecological hazards that impact communities are also going to impact service members and national security
operations.”

A Pentagon study in 2018 — during the first Trump
administration — found that nearly half of all U.S. military sites were threatened by weather linked to climate change, especially coastal bases in Hawaii like Pearl Harbor, Marine Corps Base Kaneohe and the Pacific
Missile Range Facility.

But current Defense Secretary Pete Hegseth has said that he intends to put an end to “climate change worship” in the military. He has aggressively worked to shut down environmental programs and his team has largely prohibited military personnel from discussing the possibility that climate change could impact their operations.

In April, Navy Secretary John Phelan scrapped the service’s climate action program, declaring in a video posted to the social media platform X that “we need to focus on having a lethal and ready naval force, unimpeded by ideologically motivated regulations.”

“If these projects aren’t able to continue due to loss of funding, simply put, it will leave us all unprepared — governments, local communities and military — for the climate hazards that will come if global cooperation to reduce emissions is not achieved,” Wong said. “And there’s a cost whether you pay for it upfront before a natural disaster hits, or you pay for it after to recover from it. And post disaster recovery usually costs a lot more.”