I’ve had a funny old Christmas song running through my head lately — “Grandma Got Run Over By A Reindeer.”
But I’ve changed the lyrics a bit after reading the Grassroot Institute of Hawaii’s newest white paper about how to improve healthcare in Hawaii by reforming the state’s rules concerning medical certificates of need.
Referred to as CONs for short, medical certificates of need are a regulatory tool used to control the number of healthcare resources in an area. In Hawaii, they are required for 87 out of 109 possible medical services and facilities, which means our state has one of the strictest CON laws in the nation.
Anyway, about the song. I think you’ll probably remember the tune well enough to hum along, and maybe even sing along with these new lyrics I came up with.
The original song is quite a bit longer, but you get the idea.
According to my Grassroot colleague Malia Hill, who wrote the new white paper, “Even changing the number of beds or reclassifying their usage within a facility requires a certificate of need.”
Hill further points out that studies have linked CON laws to higher medical costs and fewer healthcare facilities and services, especially in rural areas and for vulnerable populations such as our kupuna.
This is a situation that our state lawmakers really should be taking a closer look at.
I bet Santa would approve.
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This commentary was Keli‘i Akina’s weekly “President’s Corner” column for Dec. 20, 2025. If you would like to have his columns emailed to you on a regular basis, please call 808-864-1776 or email info@grassrootinstitute.org.
