Health care in America is at a breaking point. Rising costs, workforce shortages, hospital closures and increasing demand from aging populations are squeezing the system. Nowhere is this crisis felt more acutely than in rural communities, and here on Hawaii Island, we are on the frontlines.
Hawaii is often praised for its relatively high insurance coverage rates and commitment to public health. But peel back the surface, and a more fragile picture emerges. Rural communities like ours face geographic isolation, limited medical infrastructure and an alarming shortage of health care professionals. We rely heavily on federal policies and funding streams that support programs like Medicare, Medicaid and rural health clinics. Any shifts at the federal level will have considerable negative effects here.
Since 2010, over 150 rural hospitals in the U.S. have shut down. Here on Hawaii Island, we could face the same risk.
From Ka‘u to Kohala, from Hilo to Kona, the island is wide and spread out, and so is our access to health care. We have only a few hospitals across this large island, and some people have to drive hours just to see a specialist — if one is even available.
We face persistent shortages of primary care physicians, specialists and behavioral health providers. Care is too often delayed, many waiting months to get an appointment. Recruiting and retaining health care workers here is challenging, compounded by Hawaii’s high cost of living and limited housing.
Meanwhile, federal funding sources that help bridge these gaps hang in the balance. Proposed changes to Medicaid and policy shifts impacting Medicare reimbursements could significantly destabilize the safety net that more than half our population relies on.
Many of Hawaii Island’s health care providers rely on these reimbursements to stay afloat. Cuts at the federal level could force hospitals and clinics to reduce services or shut their doors, leaving patients stranded.
Additionally, Hawaii’s unique geography makes us more vulnerable to supply chain disruptions and health care workforce trends. National shortages of nurses and physicians are felt even more keenly here, as we compete with mainland systems for scarce human resources. Any reduction in federal programs supporting workforce development, such as student loan forgiveness for rural service, will further strain our ability to staff clinics and hospitals.
At the same time, the population of kupuna (seniors) is growing rapidly, with increasing rates of chronic conditions like diabetes, hypertension and heart disease. Without robust federal support, the infrastructure to care for our aging population will be insufficient, especially in rural areas.
The uncertainty at the federal level leaves local leaders scrambling to fill the gaps. Philanthropy, private health care systems and state programs alone cannot sustain rural health care. We need consistent, reliable federal support and thoughtful policies that reflect the realities of rural communities.
This is not just a rural issue; it’s a statewide and national concern. The health of Hawaii’s rural communities affects the broader health care system, economy and quality of life.
As federal policymakers debate changes to health care programs, they must recognize the unique challenges faced by rural communities like Hawaii Island. We urge them to prioritize stable funding, protect access to care for vulnerable populations, and invest in workforce development tailored to rural needs. Without this, the fragile health care infrastructure in rural Hawaii and across America may not survive.
Health care is not a luxury. For rural Hawaii, it is a lifeline. We cannot afford to lose it.
Randy Kurohara is executive director of Community First Hawaii. Lisa Rantz is executive director for Hilo Benioff Medical Center Foundation.
This editorial is brought to you by Community First Hawaii, a nonprofit serving as a convener and catalyst for solutions to improve health and access to health care. For more information, please visit www.communityfirsthawaii.org or Facebook and Instagram pages at @communityfirsthawaii.
