The following “Island Voices” commentary was first published on March 19, 2026, in the Honolulu Star-Advertiser under the headline “Relax health care facility, service regulations to boost access.”
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Hawaii is facing a health crisis, and we cannot regulate our way out of it. In fact, our only hope might be to reduce the regulations that make it difficult for health care to expand in our state.
One example of such regulations is the requirement that health care providers in Hawaii obtain what’s called a certificate of need from the state Department of Health before adding or making changes to facilities, equipment or services — a process that can be costly and time-consuming for providers, with no guarantee of success.
Worse, Hawaii’s CON laws are among the most restrictive in the nation, so even modest reform would be a step in the right direction.
Fortunately, state legislators are considering a bill this year that could make a difference.
HB2319, part of the governor’s legislative package, would exempt the state Department of Health from having to apply for certificates of need, though private health care providers would still have to go through the CON-application process.
The bill would also allow health care providers — public or private — to change up to 30% of their existing licensed beds within a two-year period without having to obtain a certificate of need, up from the current 10% threshold.
In the Senate, members of the Committee on Health and Human Services considered a proposal, SB2289, that would have allowed CON exemptions for some health care facilities and services aimed at medically underserved areas and vulnerable patients, but that measure did not advance any further.
Nevertheless, it is encouraging to see lawmakers consider health care reforms that would reduce costs and improve access for Hawaii residents.
Supporters often claim that CON rules are needed to curb health care costs and guarantee access to higher-quality care. However, more and more states are fully repealing or partially rolling back their CON regulations because of the wide body of research that demonstrates they actually do the opposite.
For example, patients in states with strict CON laws tend to receive fewer health screenings and have less access to hospitals and MRIs.
Additionally, pregnant women in states with CON laws have an 8% higher rate of receiving inadequate prenatal care, and Medicare beneficiaries in those states are less likely to receive diagnostic imaging.
During the COVID-19 crisis, states that required certificates of need for hospital bed changes were more than twice as likely to experience shortages of intensive care unit beds.
In short, CON law reform is one of the most significant actions Hawaii’s policymakers could take to improve health care access in the islands, especially in rural areas.
Yet few lawmakers seem willing to risk the political pressures that come with pursuing transformative change related to certificates of need.
For instance, Gov. Josh Green applied for federal grant funding through the Centers for Medicare & Medicaid Services’ Rural Health Transformation Program and received nearly $189 million. It’s possible, though, that the state could have received more money had he included CON reform in his proposal.
In general, the governor’s recent efforts to improve health care services in rural areas through expanded telehealth and other technology are commendable, and will certainly make a difference. However, substantial CON reform — which has the greatest potential to improve health care access and lower treatment costs for residents — has been left out.
Repealing or reforming Hawaii’s CON regulations is not the only way to fix the state’s broken health care system. But it should not be overlooked.
