Hawaiʻi has long been a leader in expanding access to essential health care.

In 1970, the state was the first in the nation to pass legislation to legalize abortion — three years ahead of Roe v. Wade. Hawaiʻi cemented this legacy with the Prepaid Healthcare Act, guaranteeing employer-based health care for any person working at least 20 hours per week.

These bold actions reflect our core values of bodily autonomy, reproductive rights, and health care access.

But as national threats to sexual and reproductive rights intensify, we must ensure Hawaiʻi is prepared to meet the challenges ahead.

While abortion remains a protected right in Hawaiʻi, significant barriers remain — especially on neighbor islands with limited providers and financial and logistical obstacles. Planned Parenthood and our partners work tirelessly to address these inequities, but we fully expect the challenges to grow under the new presidential administration.

‘A Perfect Storm’

Safety net providers already face a perfect storm of rising health care costs, workforce shortages, and increased patient volumes — problems that have only deepened since the fall of Roe v. Wade.

Organizations are struggling to keep up, leading to closures, layoffs, and reduced services. The Trump Administration will make a dire situation worse, as we’ve already seen with significant proposed cuts to Medicaid and other social services. 

Project 2025 lays out the blueprint for a direct attack on sexual and reproductive health care. Since Trump’s inauguration, we’ve already witnessed an overwhelming number of threats to our communities. Trump’s executive orders foreshadow a grim four years, with federal policies designed to erode access to abortion, gender affirming care, and other essential health care services.

During Trump’s first term, a “gag rule” forced family planning providers funded through Title X, the nation’s only family planning program, to withhold information about abortion from patients in order to continue to receive funding. Providers like the Hawaiʻi Department of Health and Planned Parenthood were among nearly 1,000 health care providers pushed out of this program, resulting in a loss of all federal Title X dollars that jeopardized access to birth control, STI testing, and cancer screenings to patients with low incomes.

We have no doubt that the Trump administration will decimate Title X yet again, and we will need the state to continue stepping up in a big way, investing more than $4 million over two years to maintain access to family planning services. Without additional state support, access will be gutted, leaving thousands without the care they rely on. We’re heartened that the Legislature has already proposed putting $200 million into the rainy day fund to prepare for such an eventuality.

But we know the attacks won’t stop there. MedQuest, the state’s Medicaid program, is a lifeline for over 400,000 Hawaiʻi residents, many of whom live in rural areas. Planned Parenthood plays an outsized role in delivering reproductive and preventive care, with a significant portion of our patients relying on Medicaid at a much higher rate than the state average.

Project 2025 calls for prohibiting Medicaid funding for Planned Parenthood, and Speaker Mike Johnson has made clear his intention to follow through. If that happens, health centers like ours will face severe funding gaps, forcing closures and cutting off care for those who need it most. Hawaiʻi must be ready to step in, or thousands will lose access to essential health care.

We have never seen Hawaiʻi shy away from anticipated threats and we don’t expect that to change with these existential threats to reproductive health. We are counting on state leaders to continue taking decisive action and lead the nation by securing essential state funding to fill gaps left by federal defunding of Title X and Medicaid, strength protections for providers and patients to ensure continued access to care, and stand firm against federal overreach that threatens reproductive freedom.

We simply can’t afford complacency. The attacks against vital health care services are relentless — and so must be our response.

Hawaiʻi has a long history of courage, innovation, and resilience. Now is the time to lean into our values and take bold, proactive steps to ensure our state remains a beacon of reproductive freedom — no matter what happens at the federal level.