Micronesians, Palau, and the Marshall Islands come to Hawaii and the rest of the United States through the Compact of Free Association (COFA), a law that guarantees Americans and Micronesians easy entry into one another’s countries. COFA allows migrants in the U.S. a status nearly identical to that of a native-born American citizen. The U.S., in turn, enjoys exclusive military access and base rights to the strategic waters of Micronesia.
Hawaii Congressional Delegation Leads Effort to Restore Health Care Access for FAS Citizens
June 21, 2017 | WASHINGTON, D.C.
Senators Mazie K. Hirono and Brian Schatz, and Representatives Colleen Hanabusa and Tulsi Gabbard introduced legislation to reinstate Medicaid coverage for Freely Associated States (FAS) citizens living in the United States.
The Covering our FAS Allies (COFA) Act would restore Medicaid coverage, known in Hawaii as Med-QUEST, for FAS citizens. The United States entered into the Compacts of Free Association (COFA) with the governments of the Freely Associated States (FAS), which include the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau that allow FAS citizens to live in the United States and receive certain benefits, including medical coverage. However, in 1996, Congress cut off FAS citizens from access to certain Medicaid benefits.
“This bill will right a wrong that has gone on for far too long,” said Representative Gabbard. “The Federal Government made a promise to these individuals, and it must uphold that commitment, and provide Medicaid to FAS citizens from Micronesia, Palau, and the Marshall Islands.”
“We have a moral obligation to provide FAS citizens living in Hawaii and across our country with access to medical care,” said Senator Hirono. “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 creates by the Compacts.”
“This bill seeks to restore much needed federal medical benefits to COFA beneficiaries residing in the United States,” said Representative Hanabusa. “It 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 is about the federal government taking responsibility,” said Senator Schatz. “Hawaii has shouldered the costs here because we know it’s the right thing to do. But at the end of the day, the U.S. government—through Medicaid—should provide coverage to FAS citizens.”
Representatives 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.
Since FAS citizens lost their Medicaid coverage, states with large populations of FAS citizens like Hawaii have taken on a large share of uncompensated care, putting strain on local resources, including utilizing emergency room visits for basic or regular health care.
The COFA Act continues the Hawaii Congressional Delegation’s efforts to restore Medicaid eligibility to FAS citizens. The delegation introduced similar legislation in previous Congresses, and in 2013, Senator Hirono included an amendment that would have restored FAS citizen access to Medicaid in the Senate’s comprehensive immigration reform bill.
Advocates for FAS citizens praised the Hawaii Congressional Delegation’s introduction of the COFA Act:
“Our COFA communities are grateful to Sen. Mazie Hirono and her colleagues in the US Congress for recognizing the fundamental need to provide equitable healthcare for our citizens and their families living and working in the United States,” said Jocelyn Howard, Program Director at We Are Oceania. “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. It’s a relationship built on trust, shared sacrifice, and our common faith in democracy.”
“The Medicaid restoration will go a long way to addressing the disparities in healthcare for our hard-working COFA residents and their families in the nation,” said Joakim Peter, Chairman of the COFA-Community Advocacy Network. “We pay our taxes just like everyone else but we do not have equal access to the fundamental solutions to our healthcare needs. 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.”
“COFA communities have contributed to our nation’s security and welfare, and as a country, it is our responsibility to honor the treaty agreements by allowing COFA communities the same access to affordable health programs that their tax dollars support,” said Kathy Ko Chin, President and CEO of the Asian & Pacific Islander American Health Forum. “We thank Senator Hirono and Representative Hanabusa for their leadership in introducing this important bill to ensure America fulfills its promise to COFA communities.”