As congressional Republicans ponder — threaten? — swift repeal of the Affordable Care Act, it’s imperative to remember that real people’s health coverage is at stake.

In a foreshadowing of the tumult that abrupt policy change can bring, nearly 400 small businesses in Hawaii could now be scrambling to adjust to a new ACA waiver. The federal government’s waiver frees Hawaii from a requirement to operate a Small Business Health Options Program (SHOP); businesses buying employee coverage via SHOP got tax credits based on premiums spent per employee. Hawaii’s waiver is supposed to come with federal funds for state subsidies that small businesses can apply for in lieu of the tax credits, to defray the cost of employee health insurance. But, says one SHOP employer, there’s been no word about any replacement subsidy plan.

Surely state can afford 1 more epidemiologist

It’s puzzling that the state closed the books on the last fiscal year with a record-setting $1 billion cash surplus, yet there was no money to hire an environmental epidemiologist needed to track ongoing public health concerns. The Department of Health’s Hazard Evaluation and Emergency Response (HEER) Office post is no luxury item.

The HEER office has limped along for at least four years without expertise needed to fully evaluate data tied to lead, pesticide and other poisoning cases as well as assess public concerns about air pollution. (The office gets results of about 20,000 lab tests for heavy metals and pesticides annually.) A funding request made several times in recent years has again failed to make it into Gov. David Ige’s proposed budget.