New cuts to medical benefits for low-income residents based on nationality amount to discrimination, according to a federal class action lawsuit filed Monday against the state of Hawaii on behalf of disabled Micronesians.

Roughly 7,500 Micronesians live in Hawaii as legal residents and depend on the Hawaii Department of Human Services for medical benefits. Significant changes to their health-care plan went into effect in July — including limiting coverage to 12 doctors’ visits per year and four prescription medications.

“We’ve very sensitive and empathetic to the financial situation we all find ourselves in — our state and country. We just don’t think that denying critical health care to the most marginalized people in our society is a good way to start solving these problems,” said Victor Geminiani, executive director for the nonprofit Lawyers for Equal Justice, which filed the suit along with firms Alston Hunt Floyd & Ing and Bronster Hoshibata.

At issue is the state Department of Human Services’ new “Basic Health Hawaii” program, a health insurance program established to cover legal aliens who have lived in the U.S. for less than five years. The program also covers Hawaii residents from Pacific nations that have entered treaties with the U.S. that grant them the same privileges given to U.S. residents — including health care.

Last year, the state attempted to cut benefits to COFA residents entirely. Lawyers filed suit and won an injunction on procedural grounds, showing that the state made changes without giving the public adequate notice or holding the necessary public hearings. A federal judge also temporarily struck down the department’s attempt to deny benefits.

The state’s new plan no longer eliminates benefits but instead reduces them. Monday’s suit challenges the substance of the plan changes.

Micronesians are covered by the Compact of Free Association, a series of treaties signed and ratified in 1986 between the U.S. and the Federated States of Micronesia, Republic of Palau and the Republic of the Marshall Islands. The treaties gave the U.S. certain strategic rights, including permission to operate armed forces in those Pacific territories, in exchange for the right to emigrate as legal residents and travel freely in the U.S., as well as gain access to services available to U.S. residents.

But the state’s new insurance program treats Hawaii residents who hail from these Pacific nations differently than other low-income residents, a violation of the U.S. Constitution’s equal protection amendment, advocates say. The new coverage restrictions severely impact residents with serious health problems and effectively eliminate preventive care.

“To allow people to die as a means of responding to a fiscal problem will define who we are as a people. And saying that people will die is not an exaggeration,” Geminiani said, noting that the limit on doctor’s visits and medications applies to patients on dialysis and those with cancer going through chemotherapy.

One of the plaintiffs named in the complaint is Tojio Clanton, a citizen of the Republic of the Marshall Islands who has had a kidney transplant and heart bypass surgery. The 66-year-old came to Hawaii in 2002 to get dialysis, which isn’t available in the Marshall Islands. Between 2002 and 2006, in addition to three dialysis sessions per week, he had three doctors visits per month and took 10 prescription medications, which were covered because he was a COFA resident, according to the suit. On July 1, 2010, Clanton was forced to enroll in the new health program. The complaint continues:

“Because of BHH’s (Basic Health Hawaii) prescription medication limit, he could not afford to fill many of his prescriptions including Mycophenalate, which kept his body from rejecting the kidney transplant. As a result, two weeks ago, he suffered from kidney failure and was hospitalized for 14 days. After he was discharged from the hospital, he was told that any further doctor’s visits would not be covered by BHH…He has ceased taking some medications because of the limit imposed by BHH, and as a result, is likely to have further health complications and will likely need to be hospitalized.”

Said Geminiani, with Lawyers for Equal Justice: “What they’re basically saying is they want to push the cost off to the federal government by sending them to the emergency rooms. COFAs are here in a football game with the federal and state government and the marginalized population will suffer big time for it.”

The state of Hawaii received federal funds totaling $10.6 million in fiscal year 2009 and $11.2 million in fiscal year 2010 to help cover the expense of providing public services to immigrants from COFA countries. Geminiani says the state has never produced documentation showing how much it costs to provide health care to Micronesians and other COFA residents.

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