Healthcare need not come with a dose of financial ruin; 50,000 Hawaiʻi residents may qualify for relief

As many as 50,000 Hawaiʻi residents may qualify for as much as $91 million in medical debt relief under a bill signed into law Thursday by Gov. Josh Green, a medical doctor.

Senate Bill 3025, now Act 220, establishes a medical debt relief framework for thousands of residents who qualify. The legislation requires the Office of Wellness and Resilience, now under state Department of Human Services, to establish and administer a Medical Debt Acquisition and Forgiveness Program to purchase and eliminate outstanding medical debt for state residents, contingent on available program funds.

According to an announcement from the Governor’s Office, an estimated one in 20 Hawaiʻi residents have outstanding medical debt on their credit report.

“This burden delays necessary medical treatments, creates barriers to obtaining housing or employment and worsens mental distress, thus intensifying the cycle of poverty,” the announcement says. “With ever-rising living costs and a for-profit healthcare system, Hawaiʻi is further disadvantaged as one of the most costly states in the nation.”

Twenty-seven other cities and states in the United States have developed similar programs, the Governor’s Office reported. The Office of Wellness and Resilience will partner with a nonprofit organization that will purchase the debt from healthcare providers for a fraction of the total cost, then abolish the debt.

“This system is beneficial for all involved, as participating providers are able to receive revenue from otherwise dormant accounts,” the Governor’s Office said.

“Medical debt is one of the biggest drivers of financial ruin in Hawaiʻi,” said Sen. Jarrett Keohokalole, chair of the Senate Commerce and Consumer Protection Committee and co-introducer of the bill. “SB 3025 ensures that thousands of families in Hawaiʻi don’t have to choose between paying rent and paying off a hospital bill.”

“No one chooses medical debt—and medical emergencies can suddenly bankrupt families with even the best insurance,” said Sen. Chris Lee, co-introducer of SB 3025 and chair of the Senate Committee on Water, Land, Culture and the Arts. “This is probably the best return on investment ever — $500,000 to cancel $91 million in medical debt for 50,000 local families struggling to pay their bills. It will save taxpayer money by making it easier for people to see doctors again instead of ending up in the emergency room on the taxpayer dime.”

“Fear of medical debt should never stand in the way of someone getting needed care—and actual medical debt should not be part of a downward financial spiral linked to bad credit or bankruptcy,” said Rep. Lisa Marten, chair of the House Committee on Human Services & Homelessness. “With willing partners like The Queen’s Health Systems, the state can erase medical debt and the anxiety and depression often associated with it for just pennies on the dollar. People cannot actually apply for this program, rather, tens of thousands of qualified candidates will simply receive a notice with the good news that their medical debt has been erased.”

“Medical debt is unlike other forms of debt because no one chooses to become ill or injured, yet a single unexpected health crisis can result in an inescapable financial burden,” said Holomua Collaborative Policy and Communications Director Matt Prellberg. “By establishing the Medical Debt Acquisition and Forgiveness Program, we propel Hawai‘i forward and help provide working families in desperate situations with the economic breathing room they need to stay and thrive in Hawai‘i.”

In other bills signed into law, Green enacted House Bill 1864, now Act 218. It requires insurers, mutual benefit societies and health maintenance organizations to cover standard fertility preservation services for individuals undergoing medically necessary treatment that may cause iatrogenic infertility. This requirement applies to all policies, contracts, plans and agreements issued or renewed after Dec. 31, 2026.

Because chemotherapy and radiation can damage reproductive organs and impact future fertility, many patients must grapple not only with the challenges of a serious diagnosis, but also with the possibility that life-saving treatment may compromise their ability to build a family. House Bill 1864 ensures that Hawai‘i residents facing this dilemma will have coverage options for preserving their fertility prior to undergoing surgery or initiation of cancer therapy.

This measure makes Hawai‘i the 22nd state to ensure that residents do not have to forgo the opportunity to conceive in order to receive life-saving medical treatment.

Green also signed into law House Bill 1969, now Act 219. This measure expands access to screenings for colorectal cancer, the second-leading cause of cancer-related deaths in Hawai‘i, taking the lives of roughly 260 residents each year. The key to survival is early detection through timely and equitable screening.

The legislation requires the Department of Human Services to provide financial assistance to eligible Hawaiʻi residents who are uninsured, underinsured or otherwise ineligible for Medicaid. The measure also requires certain health insurance plans to cover medically necessary follow-up colonoscopies after a positive colorectal cancer screening test without deductibles, copayments, coinsurance or other cost-sharing.

“Governor Green’s signing of HB 1969 into law makes Hawaiʻi an innovative leader for colorectal cancer screening and treatment,” said Dr. Shane Morita, surgical oncologist, American Cancer Society medical officer and American Cancer Society Cancer Action Network volunteer. “Colorectal cancer is often curable when detected early, yet it remains a major cause of cancer-related death in Hawaiʻi. Expanding access will reduce the burden on local families and improve survival for our patients.”