At the capitol, a series of public meetings began Wednesday so lawmakers can learn more about why Hawaii Health Systems Corp. is facing a $48 million shortfall.
HHSC is the largest provider of health care in the islands, other than Oahu and Molokai.
The company does receive state funding. It's gotten so bad, Hawaii Health Systems Corp. is calling at least one of its facilities a "madhouse."
Hilo Medical Center, which HHSC said has one of the state's busiest emergency rooms, is cutting staff.
Kauai representatives are looking at cutting funded, but unfulfilled positions.
HHSC asked lawmakers this legislative session for $150 million, but got $114 million. They said collective bargaining ate up more than 95 percent of their budget.
The state also blames what it believes is a fractured system.
"It's called the Hawaii Health System Corp. but I don't see it operating as a system. I think we have individual regions operating as independent hospitals and that creates a certain amount of inefficiencies," said state budget director Kalbert Young.
"We've got some substantial issues here. We're going to have to address it together, otherwise we're going to have public fights and its not going to serve anybody," said Ken Ono, HHSC West HI Region board member.
The public meetings run through September statewide. One possibility they are looking at is a public-private partnership. Another is centralizing the system.
There was a meeting on Kauai Wednesday to discuss the possibility of closing the island's Kalaheo facility.