Hawaii is unique in that it taxes health care for private medical practices with the state general excise tax, which can reach 4.7% with county surcharges. Very few other U.S. states tax health care, which penalizes patients for being sick or injured.

It is one thing to tax people when they buy a new car or home. It is quite another to tax people when they break their hip, or need cancer treatment. Many patients are already struggling with medical bills, and they may be unable to work. For families trying to adhere to their budget, the GET tax on health care services amounts to surprise taxation on top of already unplanned medical expenses.

Today Hawaii is experiencing a critical shortage of doctors and advanced practice registered nurse (APRNs), with a 44% shortage on Hawaii island, 39% on Maui and 30% on Kauai. The statewide shortage of doctors is estimated at 820 and the APRN deficit exceeds 500.

Hawaii hospitals and their employed providers are exempt from the GET tax, but overburdened primary care providers and specialists in the communities are struggling to keep their doors open. Most Hawaii medical practices operate on a slim profit margin, and are forced to pass the GET tax on to patients with private insurance.

With Medicare patients, providers absorb the tax, which can easily push medical practices into the red, or discourage them from accepting Medicare patients. Hawaii currently has the least number of providers able to accept Medicare among all 50 states. Not surprisingly, it is incredibly difficult for Medicare and Medicaid patients to find a health care provider, especially on the neighbor Islands.

This snowball is gaining strength and speed. Hospital emergency rooms have become the only place where many patients are able to access care. In Hawaii County, Mayor Harry Kim has declared “a healthcare crisis that will get worse unless we, as a community become aware of this crisis and act to address the issues.” To compound the problem, a third of practicing doctors on Hawaii island are in their late 60s or 70s, often working 60 or more hours a week and forgoing retirement, as there are no other providers to care for their patients. There is no cavalry, no back-up, no safety net for these providers. It is imperative that we address the physician shortages now.

Mahalo to state Sen. Rosalyn Baker, Sen. Lorraine Inouye and Rep. John Mizuno for introducing bills such as Senate Bill 2542 that would exempt patients from paying the GET tax on doctor and APRN services. Health care workers also greatly appreciate the United Public Workers’ support for such measures. At the next step, we hope that the state House Finance Committee will schedule the sister bill, House Bill 2228, for a hearing as soon as possible.

If these patient-friendly bills are passed into law, Hawaii will be much better able to recruit the needed health care providers, and replace the many aging physicians, who may not be able to provide care for patients much longer.

Please talk to your senators and representatives about supporting this tax reform, and stopping the regressive taxation of health care. If Hawaii could recruit the providers required to meet our medical needs, it is likely that overall tax revenues could actually increase. Let’s fix this problem, and take care of our patient ohana.

Lisa Rantz, of Hilo, is president of the Hawaii State Rural Health Association (HSRHA); Celeste Baldwin, Ph.D., A.P.R.N., C.N.S., is a Maui nurse and University of Hawaii faculty member; Stephen M. Smith, M.D., is a Hilo pathologist and councilor at large for the Hawaii Medical Association (HMA).