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HR 172

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.

2025 Regular Session Introduced by Terez Amato and 3 co-sponsors

Hawaii bill urges appointing members to plan transition to state-administered single-payer healthcare by consolidating Medicare, Medicaid, and TRICARE funding through federal waivers.

Referred to HLT/HSH, FIN, referral sheet 22
#hawaiihealthauthority #single-payerhealthcaresystem
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Bill Summary · HR 172

Legislative bill overview

HR 172 calls for reactivating Hawaii's Health Authority and directing the governor to appoint members who would develop a transition plan toward a single-payer healthcare system for the state. The bill explicitly seeks to consolidate Medicare, Medicaid, and TRICARE funding under state administration through federal waivers.

Why is this important

Hawaii would become one of the first states attempting to comprehensively replace the current multi-payer system with state-administered coverage, potentially affecting healthcare access and costs for hundreds of thousands of residents. Success would require significant federal cooperation and waivers that have rarely been granted, making this both pioneering policy and administratively complex.

Potential points of contention

  • Federal authority challenges: Medicare and TRICARE are federally administered programs; consolidating them under state control faces substantial legal and political barriers that the bill doesn't address
  • Implementation uncertainty: The bill provides no funding mechanism, timeline, or cost projections for transition planning or system operation
  • Healthcare provider impact: Consolidating all payer streams could dramatically reduce provider payment autonomy and require negotiating entirely new reimbursement structures, raising concerns about physician participation and care quality
  • Risk allocation: The state would assume financial risk currently distributed across federal programs, creating potential budget exposure during economic downturns or demographic shifts

Compiled from official sources — confirm details with the bill’s official record.

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