Governor Josh Green convinced HMSA to delay a major payment change for Hawaii's primary care doctors until January 2027.

At first glance, that sounds like an inside-baseball fight between doctors and insurance companies.

It's not.

The dispute could affect whether many local primary care practices stay open.

How Doctors Get Paid Today

For the last decade, HMSA has largely paid primary care doctors a monthly amount for each patient under their care, regardless of how many times that patient visits.

Think of it like a gym membership.

Whether you go once a month or 15 times, the gym still receives your monthly membership fee.

In this system, if Dr. Smith is your primary care physician, HMSA sends the practice a monthly payment to help manage your overall health. The doctor gets paid whether you come in once, ten times, or not at all that month.

Supporters say this encourages doctors to focus on keeping patients healthy rather than simply scheduling more office visits.

What HMSA Wants To Change

HMSA wants to move doctors back to a more traditional fee-for-service model.

Under fee-for-service, doctors generally get paid when they actually see patients and perform services.

No visit? No payment.

One visit? One payment.

Ten visits? Ten payments.

It's the way much of American healthcare operated for decades.

HMSA argues the new system will create a more straightforward reimbursement structure and align payments with actual services provided. Doctors who are ready can still move to the new system beginning July 1.

Why Doctors Pushed Back

The problem wasn't necessarily the concept.

It was the timeline.

Doctors say HMSA originally gave them roughly 60 days to completely change how they bill patients, track services, manage cash flow, and operate their practices. Many physicians argued that wasn't enough time to overhaul systems they've used for years.

Some practices warned they could face serious financial strain during the transition.

Others worried that smaller independent clinics — already struggling with staffing shortages and rising costs — might be forced to reduce services or even close.

Enter Governor Josh Green

According to reports, physicians began contacting Governor Josh Green directly about the issue.

Green said doctors were calling his personal cellphone expressing concern that the rapid transition could threaten patient access to care.

After discussions involving HMSA, physicians, and the governor's office, HMSA agreed to delay the change by six months. Doctors can now remain under the current payment model until January 1, 2027 if they choose.

Why This Matters To Patients

Most patients will never notice how their doctor gets paid.

But payment models can determine whether clinics hire staff, expand services, accept new patients, or stay in business.

Hawaii already faces a shortage of primary care physicians, particularly on the Neighbor Islands. Doctors argued that an abrupt payment change could make those challenges worse. HMSA's revised plan also includes additional support for some practices and higher reimbursement rates for Neighbor Island physicians.

What's Next?

The six-month delay doesn't end the debate.

It simply buys time.

The larger question remains: What's the best way to pay doctors?

Should physicians receive a predictable monthly payment for managing a patient's overall health?

Or should they be paid primarily when they provide a specific service?

For now, Governor Green's intervention means Hawaii doctors have six more months to prepare before that question becomes reality.