The chances are that you get a sizable Federal subsidy for your medical care as well. Everyone who works in Hawaii (and most places on the mainland) and gets a medical plan from their employer gets a Federal subsidy as does your employer— employer gets a tax credit, and every employee gets an exemption from income tax for the share of their medical plan paid by their employer. And there are many others involving drug costs, cost of having your children on your plan, etc. Without a subsidy of some kind, half the households in the US with a family of 4, could not afford medical insurance without subsidy because half the households in the US earn less than $75,000.