I'm an independent contractor with a pretty good income - and I can't afford even bad healthcare here anymore. This is like the 4th year of 25% year over year increases from HMSA. Health insurance shouldn't cost more than our food. The current system of employer-based group plans (which is most people in Hawaii) is deliberately engineered to hide the costs. Under the typical state or city plan each worker is expending over $20k per year for that plan when the employer contribution is counted. And that needs to be counted - it's not extra money your employer had lying around, it's money that could have paying you more. It's effectively a healthcare tax, but taken before the money even hit your pocket, so you never missed it. And you didn't have a choice about it - try refusing your employer-based plan and then asking for that employer contribution back as salary. The USA really is the laughing stock of the first world. I'm a scientist - I know many who left the US for this reason.