Akaka Introduces Medicaid Restoration Bill

by Staff on August 5, 2011

Hawaii has aloha for COFA migrants, but not sufficient funding

When the United States federal government passed the Compact of Free Association (COFA) Act in 1985, it made a promise to provide specified protections, economic benefits and domestic programs to the Federated States of Micronesia (FSM), the Republic of Marshall Islands (RMI), and the Republic of Palau in exchange for certain military permissions in these “associated” states.  Under the COFA, the federal government has the freedom to operate U.S. armed forces in the region and deny access to the associated states by other countries, and citizens of the associated states have the right to U.S. economic assistance and the ability to work and live in the U.S.

The relationship detailed in the COFA was intended as a mutually beneficial exchange between the U.S. federal government and the associated states of FSM, RMI, and Republic of Palau.  However, over the years, domestic U.S. states have taken on the burden of making good on the promises the federal government made.  The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 eliminated Medicaid benefits for migrants from the associated states, forcing U.S. state governments to provide social service and public health services for the resident aliens.  So while the federal government continues to benefit from military privileges granted by the COFA, state governments have been covering much of the costs of the arrangement.

Due to Hawaii’s proximity to the Pacific Islands, it has naturally become home to many migrants.  And while the Micronesians, Marshallese and other Pacific Islanders contribute to the work force and the cultural diversity of Hawaii, the state has become financially burdened as the result of the COFA.  Hawaii spends more than $120 million a year on services for migrants, while the federal government contributes just $11 million.

Although Hawaii wants to continue to show aloha to Compact migrants, the state can no longer do so at such a high cost and with so little help from the federal government.  This week Senator Akaka introduced the Medicaid Restoration for Citizens of Freely Associated States Act (S. 1502) and urged the federal government to follow through on the promises it made in the COFA.  If passed, this bill would re-establish Medicaid eligibility for Compact migrants living in the U.S.

Senator Akaka, noted that while “Hawaii has deep compassion and aloha for our brothers and sisters across the Pacific” the state cannot continue to bear the financial burden, particularly at this “time of severely constrained budgets”.

In consideration of the recent federal debt deal – that includes caps on federal spending and the creation of a committee that will determine future cuts – it seems unlikely that the federal government will find the funds needed to make good on its COFA commitments.  And if the federal government cannot provide the financial support it promised Compact migrants, perhaps it is time to revisit the rights and responsibilities detailed in the COFA and amend them accordingly.

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