by Edwin Quinabo
Hawaii’s Filipino community is among the 403,670 adults and children enrolled in Med-QUEST in Hawaii who are at risk of losing their health coverage should the U.S. Senate push through the House’s “One Big Beautiful Bill Act” which is supported by President Donald Trump.
The Act – passed by the House on May 22, 2025, and currently in the Senate — has a provision that could potentially reduce the number of Medicaid recipients by 7.6 million over the next 10 years, raising concerns among many beneficiaries about losing their coverage, according to the Congressional Budget Office (CBO). Medicaid is a joint federal and state health insurance program that provides health insurance to more than 71 million low-income and disabled Americans.
U.S. Senator Brian Schatz (HI) told the Hawaii Filipino Chronicle, “More than 400,000 people in Hawaii, which include nearly half of the children in our state, rely on Med-QUEST. It’s a safety net program that’s supposed to protect the most vulnerable in our community. These proposed cuts from Republicans will take health care from people who need it most. It’s cruel, it’s un-American, and we are going to do everything we can in the Senate to stop this from happening.”
Given the close vote of the bill in the House — 215–214–1 – politicos say Republican senators are finding it impossible to accomplish three things simultaneously: protect Medicaid, deliver a huge tax cut mainly to the rich, and prevent the budget deficit and national debt from exploding. Two of the three are possible, but not all three. Politicos anticipate the bill gets bogged down or passed with major changes.
Critics of the bill say if the three Democrat representatives who passed away since the start of this legislative session were alive, the bill wouldn’t have made it out of the House.
President Trump said in a statement, “THE ONE, BIG, BEAUTIFUL BILL has PASSED the House of Representatives! This is arguably the most significant piece of Legislation that will ever be signed in the History of our Country! Now, it’s time for our friends in the United States Senate to get to work and send this Bill to my desk AS SOON AS POSSIBLE! There is no time to waste.”
“The media and the Democrats have consistently dismissed any possibility of House Republicans succeeding in our mission to enact President Trump’s America First agenda. Once again, they have been proven wrong. Today, the House has passed generational, nation-shaping legislation,” said House Speaker Mike Johnson.
Sen. Mazie Hirono said in a statement, “Medicaid is an essential resource that helps rural communities, people with disabilities, keiki, and kupuna access health care, and I will do everything in my power to protect this crucial program.”
She told KHON, “This is like a self-induced pain that is being imposed on the most vulnerable in our population. Why? Because the Republicans who are in charge of the House, the Senate and the White House want to make sure they have money to pay for tax breaks for the richest people in our country.”
Supporters of the bill argue it will curb dependency and make Medicaid more efficient by adding work requirements. House cuts to Medicaid amount to $625 billion.
Opponents of the bill say studies have shown that most working-age Medicaid recipients already have jobs — 64% of those on Medicaid have jobs according to KFF but just don’t have enough hours to get medical coverage. Politicos say cuts to Medicaid are being made to extend the 2017 Tax Cuts which most benefit the wealthy. The 2017 Tax Cuts are set to expire at the end of 2025. The tax cuts in the “One Big Beautiful Bill Act” is the most expensive provision amounting to $2 trillion in tax breaks.
New York Congresswoman Alexandria Ocasio-Cortez said, “They’re not just out here to cut health care for health care’s sake, they have an assignment. Their assignment is to cut the taxes of their donors, and to have giveaways to Big Oil, which financed their election, Big Tech, which financed their election, Elon [Musk], [Jeff] Bezos, etc.”
The Senate is expected to review the bill and aim to come up with a decision by July 4th prior to recess. Senate Majority Leader John Thune who is tasked to shepherd the legislation through the upper chamber said they have only three votes to spare. Republican Sens Lisa Murkowski, Josh Hawley, Susan Collins, and Rand Paul have expressed reservations. Sen. Paul said his red line for any bill is a debt ceiling increase. Hawley said his red line to the final package is cuts to Medicaid.
Besides added work requirements, the House version of the bill also requires Medicaid recipients above the federal poverty line to pay more fees for coverage, adds new verification requirements, increases the number of times states need to check the eligibility of their Medicaid expansion recipients, prohibits Medicaid from being used for gender-affirming care, prohibits Medicaid from funding nonprofits that provide abortion care, and makes it harder for illegal immigrants to use Medicaid.
It’s a hyper contentious bill that is divided along party lines. Republican Sen. Joni Ernst recently has come under fire from Medicaid supporters after she shrugged off her constituents’ concerns at a townhall about the impact of the Medicaid cuts proposed in the GOP mega-bill. She said flippantly, “Well, we’re all going to die.”
Impact on Filipino community
Dr. Rainier Dennis Bautista, President of the Philippine Medical Association of Hawaii (PMAH), said about 60,987 or 14.8% of Med-QUEST members are Filipinos. Medicaid in Hawaii is provided through Med-QUEST, a division of the Department of Human Services in Hawaii.
He told the Hawaii Filipino Chronicle, “Cuts to Medicaid would disproportionately impact our Filipino community, which has long relied on Med-QUEST for access to essential healthcare services. Many Filipino families include multigenerational caregivers, essential workers, and older adults managing chronic conditions. Losing coverage could mean losing access to medications, primary care, dialysis, and home-based services, thus putting thousands at risk.”
He said at his place of employment around 13% of the clinic’s patients are solely covered by Med-QUEST. “The typical Med-QUEST enrollee is a working-age adult with a part-time or low-wage job that doesn’t offer employer-based insurance. Many of them work in retail, food service, caregiving, or tourism — sectors essential to our economy but often lack health benefits. Others are parents of young children, students balancing school and work, or immigrants navigating new beginnings.
“While Med-QUEST also supports seniors and people with disabilities, most adult enrollees are under 65 and earn too much to qualify for other public programs but not enough to afford private insurance. Without Med-QUEST, they would fall into a coverage gap,” Dr. Bautista said.
Portrait of a Filipino Med-QUEST member in Hawaii
Dr. Bautista describes one of his patients who he says there are countless others like him. This patient who is referred to as Fernando for privacy is in his early 50s who had to stop working after a series of escalating health issues. He had been a reliable worker for most of his life, but over time, his medical conditions began to accumulate: type 2 diabetes, congestive heart failure, and eventually end-stage renal disease (ESRD). Today, he requires dialysis three times a week, multiple medications, and regular visits with specialists to manage his conditions.
Fernando is covered under Med-QUEST, and that coverage “is literally keeping him alive,” said Dr. Bautista. Through the program, Fernando has access to life-sustaining dialysis, his prescriptions, and coordinated care. His doctors, lab work, transportation assistance, and hospitalizations are all managed through the program. If his coverage were cut, he would not be able to afford all of these treatments out-of-pocket, and his survival would be in immediate jeopardy.
Dr. Bautista said there are many others like Fernando — “people whose medical complexity doesn’t align with their financial means, and who rely on Med-QUEST not for luxury, but for the basic continuity of care that keeps them stable. These are not hypothetical scenarios. These are real people, with real families, whose health hangs in the balance of how we choose to fund or cut programs like Medicaid.”
Dr. Bautista lays bare the human cost to Medicaid cuts — “the growing number of patients who will delay care, ration medications, or avoid the doctor altogether until their condition worsens and they end up in the emergency room,” he said.
Medicaid cuts impact in Hawaii
Critics warn that if passed, the bill could dismantle one of the country’s core public health pillars — with fallout felt in every state. In Hawaii, federal funds cover 73% of the $3 billion spent annually on Medicaid. It provides health care for 1 in 3 keiki and covers 1 in 3 births in the state. Around 60% of adults on Med-QUEST are employed, often with multiple jobs.
Although details remain in the air, KFF said any reduction in federal Medicaid would leave states with tough choices on how to offset reductions. Based on analysis by the Center on Budget and Policy Priorities, Hawaii would have to raise taxes or cut other parts of its budget by an estimated $3 billion over 10 years to maintain Med-QUEST, including the Medicaid expansion to low-income adults.
“It’s a very holistic program and so I always think of it in the context of what does this do to people who are really trying their very best but struggling to make ends meet,” said Francoise Culley-Trotman, Alohacare CEO. Until cuts are finalized, Medicaid providers, like Alohacare, say it’s important to voice your opinions or talk to your legislators.
She said any cuts to Medicaid funding would be “very devastating” for Hawaii. “The difficulty of thriving in an expensive state itself is a challenge. When you remove those resources, you’re challenging the household and people’s ability to take care of themselves. There’s going to be disruption in caregiving,” said Culley-Trotman.
Health experts say if Medicaid cuts are made, it could affect the health coverage to low-income children and adults, pregnant women and aged, blind and disabled people, among others, for doctor visits, inpatient hospital services, prescription drugs and more. It also provides nursing home coverage and home-based care for those who qualify. Medicaid also acts as a temporary safety net for people who suddenly lose their jobs or get into accidents and experience temporary disability. Cuts to Medicaid could shred that safety net.
Impact on Hawaii’s healthcare system
“Cuts to Medicaid would have a ripple effect across the entire healthcare system in Hawaii. For physicians in private practice, including myself, we may be able to adjust in the short term by accepting more Medicare or commercially insured patients. But that solution isn’t scalable or sustainable,” said Dr. Bautista.
Hawaii health experts say a reduction in Medicare reimbursements would increase the financial burden for hospitals, many of which are already struggling. Hilton Raethel, president and CEO of the Healthcare Association of Hawaii, said all of Hawaii’s hospitals would be affected by Medicaid cuts, as all care for Medicaid patients.
Dr. Bautista said for hospitals, particularly safety net facilities and those serving rural or neighbor island communities, the impact could be financially devastating. “These institutions are legally and ethically obligated to care for anyone who shows up in their emergency departments, regardless of insurance status. If Medicaid is cut and more patients lose coverage, hospitals will be absorbing those costs without reimbursement. Over time, this can lead to staff shortages, reduced services, or even hospital closures in the most vulnerable areas,” Dr. Bautista said.
He elaborates, “In essence, the financial burden doesn’t disappear, it just shifts. When we underfund Medicaid, we don’t eliminate the need for care; we just make that care more expensive, less coordinated, and harder to access. The most harm will be done to the very people who already face structural barriers to health: immigrants, low-income families, and communities of color, including a large segment of the Filipino population in Hawaii.”
The state Department of Human Services announced on its website that Med-QUEST recipients should continue to access healthcare by making and keeping appointments with your health care professionals and picking up any medications that are prescribed.
Pathways to Medicaid eligibility
The Medicaid eligibility income limit for adults is 138% of the Federal Poverty Line (FPL) which is broken down to annual income of $24,828 (single adult), $33,564 (family size 2), $42,300 (family size 3), $51,036 (family size 4), etc. There are different income criteria for Medicaid for Children, Medicaid for Pregnant Women, and other programs.
Lorna Gasman, Ewa, said her son was on Med-QUEST temporarily after he lost his full-time office job and was working only part-time. “I’m thankful that such a program exists because my son required medical treatment during this transitional time in between jobs. One day he was experiencing stomach pain and bloating. We went to the ER because it was sudden and excruciating for him. After running tests, he was diagnosed with a bacterial infection in his abdominal tract. He was referred to his primary care physician for a follow up. Treatment required medication and fortunately there was no major underlying problem. It would have been very costly if he hadn’t had Med-QUEST.”
She said Med-QUEST is a crucial safety net for a lot of people for their temporary or permanent medical needs. “I cannot imagine how devasting it would be losing Med-QUEST for older people, but still too young to qualify for Medicare, with chronic health problems. I’m concerned that sick people will not seek needed treatment if they don’t have health insurance.”
Marylou Salvador, Moanalua, said she believes lawmakers are going in the wrong direction. “Instead of fighting for guaranteed health care for all, like a Medicare for All bill, it’s just cruelty that instead Republicans are proposing to gut Medicaid and take away the health care from millions of children and working poor Americans, including many in our Filipino community.”
Salvador adds, “It’s disturbing and immoral that Medicaid is being targeted so that wealthy Americans and billionaires can have more tax cuts. I read that the top 0.1% of income earners will gain nearly $390,000 in tax cuts annually from this bill. Meanwhile, the fate of Americans with severe chronic health problems could end in literal death if they cannot come up with the money to continue their life-saving treatments. What about our disabled Americans, how will they survive? It’s frightening what happened to our nation’s values. This bill is like a reverse Robin Hood scam. In Hawaii where it’s already too costly to live, for those who lose Med-QUEST and must come up with more money somehow – if at all possible — that means there will be a big drop in quality of life for them. We need to save Medicaid from these raiders acting on behalf of the super wealthy.”
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