Of course Hawaii is a state, and has been since I was a child. Before that it was a US territory. You do have to have an SSN or TIN to open a bank account in the US. The law went in so that the DEA could track drug money and to better assess taxes. It has nothing to do with reporting between countries. I doubt very much that the US is going bother reporting banking transactions back to Canada unless there is some legal request.

Hawaii has, or at least it used to have, a state sponsored medical insurance program. That's the HMSA that is referred to in the original post. He checked into it and has to live there for six months to be eligible.