When Healthcare Feels Like an Ocean Away - Ka Wai Ola

by OHA Trustee, Keli’i Akina PhD, April, 2026, Ka Wai Ola

For a pregnant mother on Molokaʻi, giving birth can mean having to leave home weeks before her due date. In many cases, the island simply does not have the resources needed for safe delivery. So, she travels to another island, often alone, and waits for her baby to arrive.

This means time away from her family, her job, and her usual support system. It is expensive, disruptive, and emotionally challenging. Yet for many families, it is the only practical option.

This experience highlights a broader challenge. Hawaiʻi doesn’t have enough doctors, nurses, and specialists to meet the needs of our population. The statewide shortage of physicians is estimated to exceed 800. The gaps are especially severe on the neighbor islands, where access to specialty care can be limited or unavailable.

These shortages affect everyone. But the impact is not evenly distributed. Native Hawaiians, in particular, experience higher rates of chronic illness and lower life expectancy than many other groups in Hawaiʻi. When healthcare access is limited, these disparities worsen. Delays in diagnosis and treatment can lead to preventable complications and poorer outcomes.

Recently, leaders from Hawaiʻi Pacific Health and HMSA met with Office of Hawaiian Affairs (OHA) trustees to discuss the future of healthcare in Hawaiʻi. Leadership from Queen’s Health Systems joined in as well. The discussion reflected an important fact: our healthcare system must evolve if it is going to serve the people of Hawaiʻi effectively.

The proposed merger between Hawaiʻi Pacific Health and HMSA could reduce administrative duplication, such as pre-authorization processes, and create a more streamlined system that can better serve the public. At the same time, Queen’s shared that such a partnership could bring reduced competition and the possibility that rural communities would have fewer choices for care.

Both perspectives deserve thoughtful consideration. Each organization has a long history of serving Hawaiʻi and contributing to community health. And they are making a sincere effort to deal with problems in healthcare delivery that are structural and long-standing.

Whatever solution prevails, there are meaningful steps that can be taken right now to respond to the current medical care-provider shortage.

First, Hawaiʻi and the federal government should reduce the regulatory and financial barriers that make it harder for providers to practice here. Hawaiʻi’s General Excise Tax on medical services, coupled with low Medicare and Medicaid reimbursement rates, make it difficult to recruit and retain healthcare professionals, especially those in private practice.

Reforming the state’s certificate-of-need laws is another important step. These laws require healthcare facilities to go through an often-burdensome process to obtain state approval before expanding services or adding equipment. Simplifying these rules could help communities to respond more quickly to local needs, especially in areas that lack adequate services.

Expanding telehealth is also a practical solution. By allowing Hawaiʻi residents to receive care from qualified physicians located out-of-state, we could significantly increase access to specialists. For neighbor island residents, it could mean fewer long-distance trips and faster access to expert consultation.

None of these ideas is extreme. Many have been implemented successfully in other states without compromising patient safety. Together, they could help reduce delays, increase competition, and expand access to care across our islands.

For women on Molokaʻi preparing to give birth – and for families throughout Hawaiʻi – the quality of healthcare should not depend on geography. Access to timely, reliable medical care is not a luxury. It is a basic need.

Healthcare should not feel like an ocean away. It should be available, dependable, and within reach on every island, for every Native Hawaiian and for every resident.