The promised repeal of Obamacare could mean big changes for the state's Med-Quest Program, which offers health insurance to low-income children and adults.
At the very least, experts say, Hawaii might have to cover more of the cost for covered health services. And the price tag could be astronomical.
Marian Bernadino, of the Kalihi-Palama Health Clinic, said she gets about 20 people a day applying for the program.
"A lot of them are under Obamacare at this time and they've been depending on it," Bernadino said.
But most of the people she talks with end up getting Medicaid through the state's Med-Quest program. That's because Obamacare made it easier to get on Medicaid because eligibility requirements were expanded.
When Hawaii expanded Medicaid services, the number of people on the program rose significantly -- from about 292,000 right before the ACA became law in 2010, to about 345,000 today.
And the number of people on Medicaid in Hawaii looks like it will keep rising.
The state Department of Human Services recently told lawmakers it predicts the number of people on Medicaid will go up by 1 percent each year -- to about 360,000 in 2018 -- and another 1 percent in 2019. Plus, the department is also expecting a 4 percent increase in the cost of providing health care.
And for some services, like family planning or patients with breast or cervical cancer, the federal government currently pays for 90 percent of the treatment and the state pays just 10 percent. But what troubles lawmakers is that if Obamacare is repealed and replaced, states may have to cover all of the costs.
"Anybody on Medicaid, if the feds cut services 10 or 20 percent, you would see our uninsured rate go up, you would see the hospitals that historically worked in the rural areas hit hardest, you would see some facilities potentially close," said state Sen. Josh Green, chairman of Senate Committee on Human Services.
Added state Rep. Della Au Belatti, chairwoman of the House Committee on Health: "Across the nation, a number of states, including a lot of Republican states expanded Medicaid, so if any of that funding mechanism changes states will be on the hook."
Plus, with any significant change in Obamacare, Hawaii may see a ripple effect for consumers, according to Beth Giesting, a health care and policy consultant.
"If there are big changes, we as taxpayers in Hawaii will pay for it and also we as consumers even if we have commercial insurance we'll be paying for it because our rates will go up."
It could also mean eliminating services.
And for Bernadino, Kalihi-Palama Health Clinic, any cut in services would devastate her clients.
"They say that if they don't have insurance they won't come at all and they wont be able to take their medications," she said.