PATCH Act Mandates 1.5x Pay Floor for Hawaii Doctors Starting 2026 to Combat High Costs

The Protecting Access To Care in Hawaii Act, or the PATCH Act, is a short but impactful piece of legislation focused squarely on healthcare funding in Hawaii. Starting January 1, 2026, this bill mandates a new minimum payment rate for doctors practicing in the state, specifically targeting the high cost of living.

The Cost-of-Living Adjustment, Guaranteed

When the federal government pays doctors for services, they use something called the "work geographic index" to adjust the payment based on local costs. Think of it like hazard pay for high rent and high grocery bills. Currently, if that index is too low, doctors in expensive areas can struggle to keep their practices open. The PATCH Act sets a hard floor: the work geographic index for physicians’ services in Hawaii can never drop below 1.5. If the standard calculation comes out lower than 1.5, the Secretary of Health and Human Services must automatically bump it up to 1.5 for payment purposes (SEC. 2).

Why This Matters for Your Doctor’s Office

In plain terms, this means doctors in Hawaii are guaranteed a pay bump that reflects the state’s notoriously high cost of living. For the average person in Hawaii, this is about keeping doctors in the state. If physicians can’t afford to live where they work, they leave, creating healthcare deserts. By stabilizing physician compensation, the PATCH Act aims to improve recruitment and retention, which ultimately means better, more consistent access to care for patients, especially in rural or remote areas.

The Fine Print: Who Pays for the Increase?

Here’s the part that policy wonks and fiscal conservatives will notice: the bill explicitly states that this increase to the work geographic index will not be budget neutral. Normally, when the government raises payments in one area, they have to find cuts elsewhere to keep the overall budget balanced. This bill waives that requirement (SEC. 2). This means the federal government is committing to covering the full cost of this payment floor without offsetting it with reductions to other payment rates nationwide. For federal taxpayers, this translates into a guaranteed increase in federal health expenditures to support physician services in Hawaii. While it’s a necessary measure to stabilize healthcare in a high-cost region, it sets a precedent for non-budget-neutral, geographically specific funding mandates.