By Joyce McClure
For Variety
WHEN Guamanians cast their votes in 2026, they won’t just be electing a new governor. They’ll be deciding whether Guam can finally deliver a safe, modern and resilient public hospital — or remain stuck in decades of patchwork fixes and political gridlock.
The condition of Guam Memorial Hospital has become a mirror reflecting the island’s broader challenges: governance, transparency and long-term planning. With sections of the hospital failing, storm resilience in question and accreditation under constant threat, the next administration’s approach will determine not only where care is delivered, but how well Guam’s government can execute on its promises.
Governor Lou Leon Guerrero’s administration has made significant financial commitments toward the hospital effort, though not without controversy.
More than $100 million in American Rescue Plan funds has been allocated to power and water infrastructure in Mangilao, the site of the proposed Guam Medical Campus. Within that, $35.4 million is already designated for a new substation and grid improvements to support the hospital and nearby communities.
In 2025, the Legislature also approved $40 million for GMH itself — money aimed at paying down vendor debts and funding critical repairs. A separate proposal would allocate $36 million from government bond-refunding savings for capital upgrades and modernization.
Together, those funds represent real progress. They stabilize GMH for the short term and ensure that the site infrastructure for a future hospital is partially financed. But they cover, at best, a quarter of the full cost of construction, equipment and commissioning for a new facility. The next governor must bridge the gap between commitment and completion—and voters should demand to know how.
Every candidate will say they support “fixing GMH.” The real test is whether they can articulate how. Will they renovate the existing Tamuning campus, rebuild on Ypao Point or continue the move to Mangilao? Have they published cost estimates, timelines and financing sources? Do they acknowledge trade-offs in emergency response times, zoning and land use?
A strong candidate should present phased milestones and fallback options, not open-ended rhetoric. Guam has seen big projects fail because information was withheld until it was too late. Voters should look for specificity, not sentiment and should ask:
• Will the next governor create a public hospital project dashboard — tracking spending, progress and change orders?
• Will there be independent audits or third-party reviews at each construction milestone?
• How will the governor coordinate with the Legislature and the Guam Medical Association, which have repeatedly complained of being shut out of planning?
The ability to run an open, verifiable process is as vital as choosing a construction site. A governor who insists on secrecy is a warning sign.
The next governor must be both financial architect and federal negotiator. Federal dollars — through the Department of the Interior, the Defense Community Infrastructure Program and congressional earmarks — will make or break the project. The successful candidate should demonstrate a working understanding of these funding mechanisms, along with Guam’s debt limits and bond market constraints.
Does the candidate have relationships in Washington or a credible plan to lobby for inclusion in programs that have previously excluded territories? Can they protect the ARP funds already committed to Mangilao from being clawed back or reprogrammed?
Good intentions don’t build hospitals. Competent fiscal engineering does.
A hospital is not a campaign promise; it’s a multiyear construction, procurement, and staffing enterprise.
Guam’s next governor will need to manage contracts worth hundreds of millions of dollars, enforce federal compliance standards and keep multiple agencies synchronized. Voters should look for candidates who have demonstrated execution ability — either in government projects, large organizations or private-sector infrastructure.
Those who dismiss execution as “details” risk repeating Guam’s history of stalled projects and unspent funds. In this election, competence is character.
The last thing Guam needs is a shiny new building without the specialists to run it. Doctors, nurses, and administrators aren’t the opposition — they’re the people who will staff and sustain the facility once it’s built.
Voters should ask whether each candidate has engaged clinicians directly. Do they understand staffing shortages, credentialing and the need for telemedicine partnerships while Guam recruits new professionals? Will they involve health workers in design and transition planning?
Typhoons, earthquakes and power outages are not hypotheticals. A modern Guam hospital must be storm-ready and self-reliant, with hardened power, water and communication systems.
And with recent federal cuts to FEMA’s disaster-mitigation and recovery programs, Guam can no longer count on Washington to bail out damaged infrastructure after the next super-typhoon. The next governor will need to budget for resilience up front, building stormproof systems into the design rather than waiting for federal aid that may never come.
Candidates who treat resilience or sustainability as optional extras reveal short-term thinking. Energy efficiency, backup generation and climate-adapted design are investments in survival and fiscal prudence. Voters should reward those who see resilience not as vanity, but as necessity.
A new hospital will impose long-term costs: debt service, maintenance and staffing. Can the candidate explain how Guam will pay for operations once construction ends? Are their debt assumptions conservative, or do they rely on optimistic growth projections? Do they recognize the risk of overbuilding or adding non-essential amenities that could inflate costs?
Leadership means setting limits, not just writing wish lists. The most responsible candidate will be the one who treats public debt as a public trust.
Guam’s biggest projects often falter when administrations change. The next governor must have the courage to continue sound work already underway, even if it was started by a rival. Voters should favor candidates who pledge policy continuity — not political score-settling. A hospital project that spans multiple election cycles demands steady hands, not shifting egos.
Guam’s hospital backlog often reflects gaps in primary care and public health. Leaders who connect these dots will save money, save lives, and reduce future crises. A hospital is the centerpiece of care, not the whole system. The best candidates will integrate the project into a comprehensive health plan that includes preventive care, behavioral health, telemedicine and rural outreach.
In 2026, the ballot box is not just about personalities. It’s about who can govern through complexity. The next governor should be someone capable of explaining the numbers, honoring past commitments, managing engineers and nurses alike and admitting when trade-offs must be made.
Guam has been talking about a new hospital for decades. The question before voters is simple: who can finally finish the job — on budget, on schedule and in trust with the people who depend on it?
