The four members of Hawaii’s congressional delegation Tuesday introduced legislation to reinstate Medicaid eligibility for Compact of Free Association (COFA) migrants.

“Without federal dollars, Hawaii has borne the cost of care for COFA migrants which has strained the state’s resources,” according to a joint press release from Sens. Mazie Hirono and Brian Schatz and Reps. Tulsi Gabbard and Mark Takai. “Each year, the state spends an estimated $30 to $40 million to provide health care to these families.”

Some background: The 1986 Compact allows citizens of the Federated States of Micronesia, Palau and the Republic of the Marshall Islands ease of travel in order to live and work in the United States. In exchange, the U.S. government has defense control over some 2 million square miles of the northern Pacific Ocean and operates a military base on Kwajalein Atoll in the RMI.

Many COFA migrants suffer from high rates of diabetes and other noncommunicable diseases. Because they cannot receive adequate health care in their home countries, many migrate to Guam and Hawaii in search of help.

Jojo Peter assists fellow Hawaii residents originally from Micronesia in signing up for the Health Connector during at drive at St. Elizabeth church in Kalihi.  7 feb 2015. photograph Cory Lum/Civil Beat

Josie Howard, second from left, and Jojo Peter, at right, assist fellow COFA migrants in signing up for the Hawaii Health Connector at St. Elizabeth’s Episcopal Church in Kalihi on Feb. 7.

In Hawaii, COFA migrants had access to adequate health care through the state’s Med-QUEST program. But the Lingle and Abercrombie administrations sought to halt the service beginning in 2009, citing lack of reimbursement from the federal government. That action was later upheld in U.S. courts, which cited a 1996 law passed by the U.S. Congress that made migrants ineligible for federal Medicaid dollars.

Meanwhile, the Lingle administration in 2010 established the Basic Health Hawaii program for some COFA migrants, but the program was considered inferior to MedQUEST. After the court action, in late 2014 the Abercrombie administration said it would continue “to provide state-funded medical assistance benefits at the same level as the benefits available under Medicaid, including long-term care, to COFA residents who are aged, blind or disabled (ABD), and will extend those benefits to certain other adult non-citizens who are ABD.”

But the state decided to stop providing benefits to adult noncitizens who are not ABD. That left thousands of Micronesians in Hawaii, many of them with serious medical needs, scrambling for medical care.

The Restore Medicaid to Compact of Free Association Migrants Act would require that the federal government “honor our Compacts of Free Association and share the cost of providing health care,” the delegation stated. “Restoring Medicaid eligibility for these compact migrants has been a priority of Hawaii leaders for more than a decade.”

Hirono said in the press release, “In the history of our country, many migrant groups have had growing pains and it is our duty as a nation of migrants and immigrants to welcome new people and their families to our communities. Addressing the Compact impact on local communities has been a long-standing challenge for Hawaii and continues to be a major priority for me.”

Kids enjoy doing art and looking at books created by pacific island children as Hawaii Health Connector volunteers sign up clients at St. Elizabeth's church in Kalihi. 7 feb 2015. photograph Cory Lum/Civil Beat

Kids enjoy doing art and looking at books created by Pacific Island children as Hawaii Health Connector volunteers sign up COFA migrants.

Cory Lum/Civil Beat

The press release included praise from local advocates of the COFA community.

“The ultimate goal of the COFA treaty, highlighted in the open immigration and shared national security responsibility, has to be the full integration of our common values for well-being, security, and the opportunity to contribute to society,” said Josie Howard, a Hawaii COFA migrant from Chuuk who is director of We Are Oceania. “However, continued denial of basic healthcare access for our COFA Micronesian citizens is a sure path towards continued marginalization and segregation.”

This spring, advocates for the COFA community like Howard have worked to enroll some 7,500 COFA migrants in the islands in health insurance through the Hawaii Health Connector. But the process has been fraught with complications stemming in part from lack of awareness about the new requirements that fall under the Affordable Care Act, or ObamaCare.

Hirono, Schatz, Gabbard and Takai are Democrats, and persuading Republicans who control both houses of Congress to help people who are not Americans may be a tall order. Many of these same Republicans also wish to repeal ObamaCare.

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