Health care leaders celebrated the Supreme Court decision which allows Hawaii to continue the work it has begun.
The state estimates there are 83,000 people in Hawaii with no health care insurance.
Access to affordable care is what those pushing Hawaii's model maintain is key. They say without insurance, everyone else shoulders the burden.
"That costs everybody and makes premiums rise," said Gov. Neil Abercrombie.
Local providers are hailing the high court ruling upholding the Affordable Health Care Act which requires taxpayers to have health insurance, since it solidifies Hawaii's head start.
"We are going to be able to achieve universal care, and I hope Hawaii is the first state in the country to do so,” said Janet Liang of Kaiser Pemanente.
The state's insurance commissioner Gordon Ito pointed out Hawaii's approach has helped keep insurance hikes at two to three percent in the past two years, compared to six to eight percent in prior years.
"This is a great day for patients. The old system didn't work. The old system was based on volume. The new system will be based on outcomes," said Hawaii Executive Director George Green.
Provider reimbursement is one area Green says will see a boost. Others point to Hawaii Health Connector a go-to website, now in development, that will make shopping around for affordable health care insurance easier starting in January 2014.
"It’s a marketplace we are focusing on individuals and small businesses will be able to shop and compare," said Hawaii Executive Director Coral Andrews.
But, not everyone believes the high court ruling on what's been termed “Obamacare,” is a good thing.
"Today is sad day for all Americans now they give more power to the government to tax all of us," said Seth Foumai.
The steel worker said he is looking forward to cast his vote in November as a way to reverse the healthcare decision.
"The only way to appeal this, is to have someone take over. I hope its Romney," Foumai said.