Gov. Green Neutral on One Health Hawaiʻi Plan But Says Reforms Needed

As regulators review the proposed partnership between insurer HMSA and care provider Hawaiʻi Pacific Health, Gov. Josh Green shares thoughts on vertical integration at the 2026 Hawaiʻi Health Workforce Summit.

Gov. Josh Green held to a neutral stance on the proposed combination of Hawaiʻi’s largest medical insurer and the second-largest hospital system, but he urged local leaders and medical professionals to proactively reform the state’s healthcare landscape before outside forces dictate its future.

Addressing a crowd of medical professionals and medical students at the 2026 Hawaiʻi Health Workforce Summit on Saturday at the University of Hawaiʻi’s John A. Burns School of Medicine, Green said Hawaiʻi remains vulnerable to major insurers pulling out of the market or being acquired by out-of-state entities.

“We are in a moment before any of that happens,” Green said. “We get to contribute to what the solution could be. Because if we just stood back and kind of let it roll over us, we could wake up one day where we hear that some outside force is going to take over that hunk of HMSA or AlohaCare or Kaiser, and we could be left in the lurch.”

As both governor and a licensed physician, Green is in a unique position to comment on the potential partnership between Hawaii Medical Service Association (HMSA), and Hawaiʻi Pacific Health (HPH). The two entities plan to form a shared parent organization known as One Health Hawaiʻi, a divisive move that has drawn fierce support and dissent.

(Read our previous coverage on the issue: Clash of Titans: Hawai‘i’s Healthcare Leaders Disagree on Best Path Forward and High-Powered Steakhouse Chat with State’s Biggest Merger on the Menu.)

“I’m not going to opine whether it should or shouldn’t go forward. It’s not my role right now. It’s in front of the regulators,” Green said. “There’s a lot of very good ideas in there, and there’s a lot of open questions there for providers. If that is what happens in the coming years, then we as healthcare providers and students and faculty and health policy people, we have to make sure that we mold it and shape it in a way that meets our needs.”

While Green did not endorse or denounce One Health Hawaiʻi, he did offer ways in which he thinks vertical integration could transform the state’s health care landscape for the better: “We have the opportunity to create a system where we take whatever monies are in our state and invest them in the right places, while changing the way we get to practice,” Green said. “If we are aligned, we shouldn’t have to spend time – which is energy and money – on prior authorizations, because it is implicit that if we are working in an integrated way, we are trusted as providers.”

Green emphasized that if health care consolidation moves forward, the incoming generation of medical professionals must leverage the opportunity to make their input heard.

“We should have demands that work for us as young nurse practitioners, young docs that are up next. We should be able to set our own course with standards that we will know will not be violated – whether it’s guarantees that we are going to make a certain amount of resource to survive in Hawaiʻi, or that we’re going to have our loans forgiven universally,” he said.

Streamlining authorizations and reducing paperwork could also directly address Hawaiʻi’s persistent health care workforce shortage, Green added.

“If we could cut in half the administrative burden and not just the cost, but the time … we would have lower burnout,” Green explained. “Providers would stay on years longer, which solves your problem on shortage.”

Acknowledging past legislative and technological promises that fell short, Green cautioned that healthcare leaders must remain pragmatic about systemwide updates, such as Electronic Medical Records (EMRs). Still, he argued that consolidation might resolve long-standing fragmentation.

“It argues, interestingly, for vertical integration because for years we had too many cooks in the kitchen on electronic medical record systems, too many cooks in the kitchen on prior authorization rules,” Green said. “That has to be fixed.”