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Kathy Ko Chin Headshot

Protecting the Lasting Achievement of Medicaid

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Forty-nine years ago, President Lyndon B. Johnson ushered in a new American era, creating a social compact that would withstand generations when he signed two hallmark health care programs, Medicare and Medicaid, into law. On that day, Mr. Johnson reflected on the nation's duty to care for its citizens and the crippling consequences of having to go without basic health care: "Thou shalt open thine hand wide unto thy brother, to thy poor, to thy needy, in thy land."

Since then, Medicaid has quite literally served as the nation's lifeline for the poor and vulnerable, providing access to quality care they otherwise would never be able to afford. For the more than sixty-five million Americans relying on Medicaid for health care today, the program needs no introduction.

Yet, that duty has not always been honored for migrants from three island nations to which America is duty-bound. Residents from the Republic of Palau, the Republic of the Marshall Islands and the Federated States of Micronesia have a special relationship with the U.S. as a result of the contributions these islands made to our war efforts through the 1950s. In return for unfettered military access to the Pacific waters and in acknowledgement of the nuclear test bombings in some of these areas, the U.S. entered into treaties known as the Compacts of Free Association (COFA).

These treaties allow COFA migrants to freely live and work in the U.S. without restriction. They fill critical roles in the agricultural, elderly care and hospitality industries, pay taxes and serve in our nation's military. And until 1996, they were eligible for health care through Medicaid if they fell on hard times.

That changed with the so-called "welfare reform law," which rendered COFA migrants ineligible for public health programs. Prior to that year, these migrants could access basic health programs, consistent with the nation's commitment to provide for health and economic support under the COFA treaties.

The human and economic toll in the aftermath of Congress' actions in 1996 have been significant. Many of the 56,000 COFA migrants living and working in the U.S. face serious health conditions and despite being employed, cannot afford private health coverage. The health challenges -- cancer, diabetes, obesity, hypertension and cardiovascular disease -- stem from a combination of poor infrastructure in their home countries and America's military activities there.

States with the largest influx of COFA migrants, including Hawaii, Arkansas and Oregon, have felt the fiscal burden of providing needed care to those within their borders. More than 13,000 COFA migrants live in Hawaii alone, and the state has borne the full brunt of paying for services under its state health program, to the tune of $238 billion from 2004 - 2010.

Meanwhile, health care for COFA migrants in Hawaii is in a state of flux. The Court of Appeals for the Ninth Circuit recently ruled that Hawaii does not have to provide care for COFA migrants within its borders. If the ruling stands, COFA migrants will be left with very minimal coverage, putting everyone's health at risk.

There is a dire need to restore Medicaid eligibility for COFA migrants, but it is the job of Washington to do it. In exchange for maintaining exclusive use and military strategic positioning in the Pacific, the U.S. is obligated to provide for the health and economic supports of COFA migrants. Yet, we have failed to live up to this obligation. Health care for COFA migrants is in an unacceptable state of crisis. COFA migrants who call America home pay a significant toll for the government's broken promise and unmet obligation in terms of health and equity.

Rep. Hanabusa and Sen. Hirono of Hawaii have both introduced bills and amendments to restore access to essential health programs that COFA migrants have accessed in the past. Sen. Hirono's amendment to the Senate-passed immigration reform bill would restore coverage, as would Rep. Lujan Grisham's recent HEAL for Immigrant Women and Families Act and the Health Equity and Accountability Act, reintroduced with each new Congress.

On this anniversary of one of America's greatest achievements for our citizens, let us not lose sight of our obligations to the Pacific jurisdictions. Now is the time to do our duty and provide quality care for COFA migrants. It's a matter of fairness and responsibility.