Established by an act of Congress in the mid-1980s, the Compacts of Free Association (COFA) give freedom of migration to the United States for citizens of the Federated States of Micronesia, the Republic of the Marshall Islands and the Republic of Palau.
However, while these citizens are legally entitled to live and work here, since the mid-90s, they have been unfairly denied federal benefits available to other legal permanent residents, including Medicaid coverage.
It’s heartening that after unsuccessful hard pushes — several led by members of Hawaii’s congressional delegation — to see benefits restored, Congress was poised last week to finally bring back Medicaid eligibility, with the action folded into the colossal year-end package for COVID-19 relief and government funding.
In Hawaii, and elsewhere in the U.S., the need for the long overdue health-care fix is now underscored by the pandemic’s ongoing assault. Last month, according to state Health Department data, Pacific Islanders here, excluding Native Hawaiians, had by far the worst rates of infection, making up more than a quarter of cases despite composing just 4% of the state’s population.
For many years, researchers and others have persuasively pointed out that the 1996 Welfare Reform Act, which stripped the COFA community of access to the low-cost Medicaid health program, touched off decades of health inequities. Further, it’s galling that the move was due to an apparent technical error.
By refusing or resorting to foot-dragging in correction of the error, our nation has sidestepped its commitment to the deal hammered out between the Pacific Island nations and the U.S. in the decades after the U.S. military used the Marshall Islands as a testing site for dozens of nuclear bombs in the 1940s and 1950s.
In return for giving the COFA community special rights to resettle in the United States, the U.S. gets access to establish military bases in the nations, which hold an increasingly strategic value in the Indo-Pacific region.
In the wake of President Bill Clinton signing off on the welfare reform legislation, the federal government essentially dumped the COFA-related financial burden on the states. Earlier this month, U.S. Rep. Ed Case introduced a measure requiring the federal government to “pay for basic services that the states and territories are now forced to provide and fund.”
Citing a recent federal report, Case said in a news release that Hawaii, Guam and the Northern Marianas Island were “required to spend some $3.2 billion for services to COFA migrants from 2004 to 2018 but were only reimbursed some $500 million.”
He added, “For Hawaii alone, our bill is now around $200 million annually and no doubt growing rapidly with the severe COVID-related needs” in the COFA community. Clearly, the federal government has shortchanged both the COFA community and the group picking up costs tied to our federal obligation.
In regard to Medicaid access here, about five years ago, Gov. David Ige’s administration ushered thousands of migrants from state-funded Med-QUEST to Obamacare enrollment, maintaining they could fare better with private insurance. But a study that tracked the aftermath of the switch found that many in the COFA community struggled with confusion over coverage and premium costs.
Addressing the action Congress took last week, U.S. Sen Mazie Hirono said in a statement: “By allowing states to enroll COFA citizens in Medicaid, we are upholding the promises we made to our critical national security partners in the Freely Associated States, and supporting jurisdictions like Hawaii that have traditionally stepped in to provide health care for the COFA community.”
Indeed, this move to reinstate access to the federal health-care safety net is an urgently needed step in the right direction.
