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Gov. Green introduces kauhale concept to a global audience

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Governor Josh Green discusses the kauhale concept at the 2023 global conference. PC: Office of Gov. Josh Green.

Governor Josh Green, M.D. shared the kauhale concept with influential attendees of the 26th Annual Milken Institute Global Conference, taking place in Los Angeles, California.

The event brings together leaders from around the globe to tackle critical issues facing society.

Gov. Green the only physician governor in the country, spoke on the importance of treating behavioral health as primary healthcare, as well as addressing homelessness through humane methods such as developing tiny homes. He also emphasized the need for healthcare reform to increase efficiency and accessibility for all.


“Housing is health care,” he announced during a live interview, and shared with the audience the medical respite kauhale plan he previously revealed to the state. 

Average spending on emergency room care for a homeless person in Hawaiʻi is $82,000 per person per year. Putting people in tiny homes following discharge from the hospital for follow-up care will reduce that cost from between 43% to 73%, depending on the severity of the patient’s illness, according to Gov. Green. These follow-up services will dramatically reduce ER visits and bring the average cost down to $21,000 a year, he said. The savings can be reinvested in our communities, according to the governor.

Gov. Green encouraged willing attendees at the conference to examine investment opportunities in health systems that have workforce shortages, and many house patients in need of long-term care for whom spaces in long-term-care homes are not available.


“People who invest in that way are really investing in something that’s more efficient than probably the heart pills we’re putting into people’s bodies,” Gov. Green said.

Gov. Green emphasized the need to bridge political gaps across the nation to “focus less on bickering and more on leading with compassion and helping people in need across red and blue states.”

He discussed a planned pitch to President Joe Biden for pilot housing projects, three for blue states and three for red, to test reduction in Medicaid costs and promote better housing and health care options using the kauhale model.


Kauhale is a new approach to offering housing for neighbors who have experienced persistent homelessness. As a community-centered model, various forms of kauhale can provide previously houseless people an opportunity to thrive in a community they can call home.

Gov. Green received applause at numerous points of his live, on-stage interview, including for his announcement that his loan forgiveness legislation for health care professionals had been approved.

Gov. Green returns to Hawaiʻi on Wednesday.

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