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Back to State Legislation on Comprehensive Health Care Coverage


  • Hawaii was the first U.S. state to enact laws creating a near universal health care coverage system, with the Hawaii Prepaid Health Care Act (PHC), Haw. Rev. Stat. §§ 393-1 - 393-51, which was passed in 1974 and implemented in 1975.
  • Initially the PHC conflicted with the federal Employee Retirement Income Security Act of 1974 (ERISA), which sets requirements for employer provided health benefits.  ERISA was amended in 1983 to exempt the PHC.  29 U.S.C. § 1144(b)(5)(A).


Employer Contribution

  • Employers pay for “at least one-half of the premium” for health coverage.  Employers must also cover that share which cannot be covered by the employee. Haw. Rev. Stat. § 393-13.

Individual Contribution

Benefits Assistance

  • Premium supplementation is available to certain small employers if their share of health care costs exceeds 1.5% of the total wages payable to employees and that amount is greater than 5% of the employer’s income before taxes.  Haw. Rev. Stat. § 393-45 .


  • Certain employers are exempted from the requirement to provide health care: state and Federal government entities, those employing seasonal employees, insurance agents and real estate agents, and brokers paid by commission.  Haw. Rev. Stat. § 393-5.
  • An exemption is also allowed on the basis of religious or group beliefs.  Haw. Rev. Stat. § 393-22.

For more information on Hawaii see:

Last Updated: 06/09/2015