Letter: HMSA-HPH Merger Proposal Lacks Substance

Readers express concerns over potential monopoly power and lack of details on how the merger would address healthcare challenges in Hawaii.

Published on Feb. 25, 2026

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A letter to the editor in the Honolulu Star-Advertiser criticizes a commentary by the heads of HMSA and Hawaii Pacific Health touting their proposed merger. The letter argues the commentary was "long on 'feel good' and short on substance" and failed to explain how the merger would moderate rising premiums, increase appointment availability, or address physician and nurse shortages. The letter expresses concerns that the merger could create a monopoly leading to higher costs and reduced access to healthcare services.

Why it matters

The proposed HMSA-HPH merger is a major healthcare policy issue in Hawaii, with implications for costs, access, and competition in the state's healthcare market. The letter reflects broader public skepticism about the merger and the need for more transparency and substantive justification from the organizations behind it.

The details

The letter responds to a commentary by Dr. Mark Mugiishi of HMSA and Ray Vara of Hawaii Pacific Health promoting their organizations' proposed merger. The letter argues the commentary failed to explain how the merger would address the stated problems in Hawaii's healthcare system, such as rising premiums, physician shortages, and inefficiency. The letter expresses concern that the merger could create a monopoly that would lead to higher costs and reduced access to services for consumers.

  • The letter was published on February 25, 2026.
  • The commentary by Mugiishi and Vara was published on February 22, 2026.

The players

Dr. Mark Mugiishi

Head of HMSA, one of the organizations proposing the merger.

Ray Vara

Head of Hawaii Pacific Health, the other organization proposing the merger.

Randolph Moore

The author of the letter to the editor criticizing the merger proposal.

Queen's Health Systems

An independent healthcare provider in Hawaii that the letter suggests should be concerned about the potential monopoly created by the HMSA-HPH merger.

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What they’re saying

“The Feb. 22 commentary by Dr. Mark Mugiishi, head of HMSA, and Ray Vara, head of Hawaii Pacific Health, touting the proposed merger of their two organizations was long on 'feel good' and short on substance ('Isle health care needs major shakeup,' Star-Advertiser, Island Voices).”

— Randolph Moore (Honolulu Star-Advertiser)

The takeaway

This letter highlights the need for HMSA and Hawaii Pacific Health to provide more substantive justification and details on how their proposed merger would address the key challenges facing Hawaii's healthcare system, rather than relying on "feel good" rhetoric. The concerns raised about potential monopolistic effects and reduced access to services will likely need to be addressed for the merger to gain broader public support.