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On the Hook for Uninsured Residents, Counties Now Wonder How They’ll Pay

Hawaii faces doubled healthcare costs after ACA subsidy lapse and seeks funding and policy solutions to address shortages and support rural health programs, officials said.

  • Following the lapse in federal subsidies, Congress failed to extend Affordable Care Act marketplace subsidies, doubling ACA costs and prompting Governor Josh Green to draft a state budget before the Jan. 21 session.
  • The federal law signed this past summer by President Donald Trump is expected to reduce Medicaid spending by more than $900 billion, contributing to coverage gaps, as analysts estimate 10 million newly uninsured patients from Republicans' One Big Beautiful Bill Act.
  • The new Rural Health Transformation Program awarded Hawaii $188,892 million in federal rural health funding through a plan co-written by Green and Dr. Mehmet Oz, a timely boost, Green said.
  • Local governments are preparing for a rise in uninsured residents and some county health officials have asked to join statewide associations to manage expected demand.
  • The Council on Revenues' Wednesday forecast will guide Green and legislators as the legislative session begins Jan. 21, amid federal subsidy lapses and workforce efforts.
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kffhealthnews.org broke the news in on Tuesday, January 6, 2026.
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