Hawaii’s congressional delegation on Wednesday introduced federal legislation to reinstate Medicaid coverage for eligible Micronesians living and working in the United States.

The Covering Our FAS Allies (COFA) Act would permit low-income health coverage for citizens from the three nations party to the Compact of Free Association: the Republic of the Marshall Islands, the Federated States of Micronesia and the Republic of Palau.

This class of Micronesians is often referred to as being from the what’s known as the freely associated states, or FAS — hence the title of the proposed act.

Micronesians in the U.S. were eligible for Medicaid and other benefits until 1996, when Congress ended their access rights.

Many Micronesians emigrate because of poor health care services in their homelands — and because of elevated numbers of people suffering from diseases such as diabetes and tuberculosis — so the loss of Medicaid eligibility was a blow to thousands of Micronesians.

As Civil Beat reported in its series The Micronesians, states like Hawaii, where an estimated 15,000  Micronesians live, currently receive insufficient federal dollars to provide medical care and must instead draw on state funds.

In Hawaii, Medicaid is known as Med-QUEST, and the state allows some eligibility for qualified Micronesians. Spending on health, education and social services for COFA citizens typically exceeds $160 million annually.

U.S. Mazie Hirono and Brian Schatz and U.S. Reps. Colleen Hanabusa and Tulsi Gabbard authored the COFA Act.

“We have a moral obligation to provide FAS citizens living in Hawaii and across our country with access to medical care,” Hirono said in a press release. “The COFA Act will ensure that each FAS citizen in the United States can access health care, and help states like Hawaii dealing with unfunded mandates created by the compacts.”

Righting A Wrong

Hanabusa said the bill “…also seeks to ensure that the state of Hawaii, along with other states where COFA beneficiaries reside, are not forced to shoulder the financial burden associated with providing medical care to COFA beneficiaries, benefits arising out of COFA agreements negotiated and entered into by the United States.” 

“This bill will right a wrong that has gone on for far too long,” added Gabbard.

Rep. Michelle Lujan Grisham (D-N.M.), Raul Grivalja (D-Ariz.), Madeleine Bordallo (D-Guam) and Keith Ellison (D-Minn.) also cosponsored the House version of the COFA Act.

Guam has been heavily impacted by Micronesian immigration, burdening local support services.

Born in Chuuk, Emichan and her family are among the hundreds of Micronesian immigrants who have ended up homeless in Hawaii, many in Kakaako. Her father came here seeking medical help. Mark Edward Harris/Civil Beat

Under COFA, citizens of the three nations can migrate freely and legally to the United States and its territories. In exchange, the U.S. retains sole control of defense of the region, which covers some 2 million square miles in the Central Pacific.

It includes a missile testing site on Kwajalein in the Marshall Islands, where the Pentagon last month successfully shot down an intercontinental ballistic missile using a long-range interceptor missile. The launch “was widely seen as a test of U.S. ability to counter a North Korean missile launch,” CNN reported.

Whether the COFA Act will receive a sympathetic reception from the Republican-controlled Congress and White House is uncertain. Many GOP leaders seek more restrictive immigration laws, even though COFA citizens have a legal right to come to the U.S. and its territories. Republicans are also looking to restrain Medicaid funding in their efforts to replace Obamacare.

This is not the first time Hawaii delegates have pushed similar legislation, to little avail.

But local Micronesian leaders such as Joakim Peter, chairman of the COFA-Community Advocacy Network, and Jocelyn Howard, program director at We Are Oceania, remain hopeful.

“This restoration of fair and accessible healthcare support for everyone is consistent with the enduring partnership that has existed between our peoples for many years,” Howard said in the delegation’s press release. “It’s a relationship built on trust, shared sacrifice and our common faith in democracy.”

 “We pay our taxes just like everyone else but we do not have equal access to the fundamental solutions to our healthcare needs,” said Peters. “We cannot tell a COFA resident, who has limited to no income, that she is treated justly and fairly in giving her a different coverage from everyone else, one based solely on her national origin.”

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