Rural health care needs “transformation,” in Hawaii and throughout the U.S. That’s something Democrats, Republicans and the officials they elect agree on, though significant differences exist over how much public money should be deployed to get it right.
Given the need, which is only expected to grow with the impacts of federal cuts to Medicaid and Affordable Care Act (ACA) funding, Hawaii must pursue any and all assistance available. The state has properly and actively chased down opportunities offered by the current federal administration, organizing its own programs to match federal guidelines. And a measured win was reported Monday, when Gov. Josh Green announced that Hawaii had been awarded $58 million from the new federal Rural Health Transformation Program (RHTP).
Glaring deficiencies exist in rural health care services nationwide, and are especially prominent in “red” or Republican- represented states. RHTP addresses this. In, Hawaii, the funding will support “quality care, closer to home” for rural residents, the governor said.
The University of Hawaii John A. Burns School of Medicine (JABSOM) and the Hawaii Department of Health partnered with the state in planning, applying for and allocating the assistance. The money will be leveraged to train health care providers, upgrade facilities and update technology.
JABSOM will receive $45 million for workforce development — locally based training for health-care professionals who then, it’s hoped, will pursue lifelong health care careers in the islands. An additional $13 million goes to the Department of Health for new ambulances in each county, and to upgrade emergency communications systems.
Hawaii sought out the funding, preparing a five-year “Rural Health Transformation Plan” that meshes with federal goals and requirements, and establishing the Hawaii Outreach for Medical Education in Rural Under-resourced Neighborhoods (“HOME RUN”) initiative to administer grants.
In January, the state was allocated first-year funding of $188,892,440, including the $58 million. Per rural resident, that funding is among the highest in the nation. It can be used for:
>> Training, recruitment and retention of health care workforce, including general practitioners, nurses and technicians
>> Up-to-date facilities, with adequate infrastructure and technology to provide care under varied conditions
>> Improved access to care for rural residents who may face isolation-related or economic barriers
It remains to be seen whether the assistance is enough to keep Hawaii healthy. In 2025, legislation dubbed “One Big Beautiful Bill” by Pres. Donald Trump, who set its priorities, reduced Medicaid, Affordable Care Act (ACA) and Supplemental Nutrition Assistance Program funding by about $1.3 trillion, nationwide. The $50 billion allocated for the RHTP is a fraction of that. Additionally, ACA tax credits that helped working people pay for heath insurance were allowed to expire on Jan. 1.
The effect of these cutbacks hasn’t fully hit Hawaii yet. In the meantime, funding to support making rural health care less expensive and more efficient takes on outsized importance.
The state’s emergency healthcare assistance for Hawaii island’s Kau region following Hurricane Lala offers a window into some of the issues involved. Kau is always isolated, but Lala led to additional communication, transportation and power outages. Flooding, mudslides and high winds damaged roads, homes and health facilities, ramping up the need for medical attention and hurdles to providing it.
A mobile medical healthcare team had already been established in Hawaii County, enabling a quick response. At a temporary clinic at the Naalehu Gym shelter, the team treated offered wound care, general medical attention and access to medication, with a “priority” placed on mental and behavioral health services.
The team of five to seven people includes private physicians who volunteer services. After Lala, Hawaii public health nurses and Medical Reserve Corps members joined, at times bringing staffing up to about 10.
As disaster needs ease, persistent problems will return to focus. For patients in rural areas such as Kau, few doctors are available for routine care, and access to mobile health care is limited. At the same time, an aging population increases need, and doctors are increasingly retiring or turning to more lucrative practice models.
Federal cutbacks threaten to widen an access gap for rural or economically insecure patients, who must confront provider shortages, price and access barriers, and often require more intensive services by the time they get help. Mobile clinics, healthcare hubs, upgraded technologies and more providers must all be part of the response — and stat.
