EDITORIAL: Hawaii can't afford Affordable Care Act war fallout

The federal shutdown, now in its 40th day barring a weekend miracle, began after Senate Democrats refused to approve continued government funding — an unprecedented (for Democrats) move aimed at pressuring Republicans into renewing federal tax credits that help workers pay for health insurance, and reversing cuts made to Medicaid, insurance for Americans who cannot otherwise afford health care.

If these reductions in health care subsidies and supports are allowed to take effect, the impact on Hawaii, and other states, will be devastating.

Gov. Josh Green and Hawaii's congressional team are aligned in calling to preserve health care supports — and rightly so. As Green has stated, "We have 25,000 individuals that rely on some of those subsidy supports to be able to afford insurance. Otherwise, that falls to the state. It will hurt rural hospitals. It will hurt families. "

People with health care insurance see doctors when needed and receive preventative care to avoid or manage disabling conditions, such as heart or kidney disease. Individual who have no access to such benefits end up in the state's emergency rooms. Here in Hawaii, the state continues to fund public hospitals that are the only source of health care for many rural residents; reductions in the numbers of people insured or in reimbursements for care from Medicaid inflicts a direct blow on Hawaii in this way, too.

Green flew to Washington to urge a congressional compromise last month — "We need this shutdown to end" — and emphasized the importance of federal health care supports. The loss of subsidies for insurance coverage "hurts everyone, in red states and blue states," he rightly said. An estimated 24 million people in the U.S. receive the direct help with health care costs that's at stake in this fight.

On Friday, Senate Minority Leader Chuck Schumer said Democrats would vote to end the government shutdown if Republicans agree to extend health care tax credits for one year and to open broader talks on the health issues. That failed — but U.S. senators are working this weekend for the first time since the shutdown began Oct. 1, raising hopes for an end to the impasse.

Americans want the stalemate resolved and shutdown ended; they also want help with affording health care. Hawaii's citizens certainly do. Our state was a leader in expanding access to health insurance, with its 1974 law requiring most employers to offer it: the Hawaii Prepaid Health Care Act. The benefits to Hawaii in better health and longevity for islanders have been clear — and it's why Hawaii has one of the lowest uninsured health rates in the U.S., at about 3.5%.

Further, most people in Hawaii who receive the disputed subsidies under the Affordable Care Act are classic American model citizens — self-employed entrepreneurs, running their own businesses, such as plumbers, real estate agents, Uber and Lyft drivers, or artists and musicians.

Extended insurance subsidies will likely become more expensive, but also more highly valued, in the coming year. We see the stakes rise as the cost of insurance rises, across the board. Nationwide, employer-sponsored health insurance costs hiked for a third year in a row in 2025 — up by 6%, with workers paying an average $6,850 toward premiums out of their paychecks. Rising drug prices are a factor, too.

For uninsured people, health care costs have risen to unreachable heights. But the more widely people are insured, the better insurance costs can be buffered — and even reduced, if citizens become more healthy. That's a potential benefit of health care for all.

Democrats may have initiated the shutdown stand-off, but majority-party Republicans can quickly and easily end it; surely, further negotiations to recalibrate health care subsidies are needed, for the good of people's health in both red and blue states.

"We need to end this shutdown now," said Hawaii Congresswoman Jill Tokuda. "This is a choice that [Republicans] are making to shut down government, to not even talk about how we save health care in districts across the country — in their own districts."

As earlier noted, the health care tax credits at stake are issued via the ACA — Hawaii-born former President Barack Obama's signature achievement as chief executive. And while a majority of Republicans have opposed and criticized the ACA and its manifestations from the beginning, Americans have taken to "Obamacare" robustly, showing the demand and need for relatively affordable health coverage.

A majority of Americans have come to approve of Obamacare, and the federal supports that Republicans are trying to strip away. Perhaps the subsidy levels need readjustment — but negotiations can't even happen if the sides are entrenched in shutdown mode.