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FEATURE | Micronesians and social injustice

MANY Micronesians struggle while living in U.S. territories or states because of social injustice.

They pay taxes, contribute to the state or territorial economy and can serve in the military to help protect the U.S., but they have limited access to health care services and other opportunities provided to U.S. citizens.

Hawaii, for example, has excluded migrants from the Compacts of Free Association nations — the FSM, the Marshalls and Palau — from its Medicaid program, citing funding constraints.

“Denying Medicaid to indigent people (as one must be below 133 percent of federal poverty levels to qualify for Medicaid) would result in adverse health outcomes for them,” Seiji Yamada and Gregory G. Maskarinec said in an article posted on Honolulu Civic Beat.

They also noted that:

“While the children of COFA migrants born in the U.S. are U.S. citizens, COFA migrants cannot vote in Hawaii. Thus, Hawaii politicians need not pay attention to Micronesians as a voting constituency.

“The general populace of Hawaii had been subjected for years to political pronouncements about the ‘cost’ of COFA migrants — and a commonly held belief is that this cost should be borne by the federal government. Such logic ignores the fact that employed COFA migrants pay both federal and state payroll taxes, and all participants in the economy pay the state general excise and use tax.

“The inability of COFA migrants to vote is thus a form of taxation without representation. Their exclusion from Medicaid means that they are taxed while being barred from benefitting from the social commons.”

In 2011, in an article published by the Hawaii Medical Journal, Dina Shek, JD, MA and Seiji Yamada, MD, MPH wrote:

“Many COFA migrants travel back and forth between the islands and the United States. Migrants report a number of motives for moving: employment, as dependents of job-seekers, education, and for medical reasons….

“But life is not easy here in Hawaii for migrants from the Compact Nations. Housing is expensive, and jobs have been hard to come by. Furthermore, access to health care has been difficult. Until July 1, 2010, people from the Compact Nations were able to enroll in Med-QUEST, the state’s managed care Medicaid program. While Medicaid is funded partially by states and partially by the U.S. federal government, during the Clinton administration people from the Compact nations were excluded from federal funding for Medicaid. Although migrants from the FAS have the right of free entry into the United States, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 disallows federal funds from being expended for their participation in Medicaid. According to State of Hawaii rules, until July 1, 2010, they had been eligible for health insurance under Hawaii’s managed care Medicaid program, Med-QUEST, as long as they met the eligibility requirements for federal poverty levels. ‘Compact Impact’ funding from the federal government to the State of Hawaii to offset health and educational costs have been inadequate, coming in at approximately $10 million each year. The COFA Task Force developed under the Hawaii Attorney General’s Office estimated ‘Compact Impact’ costs at over $100 million in 2007. The State argued that this put the burden on the taxpayers of the State, which had to entirely fund Med-QUEST for people from the Compact nations. These figures, however, fail to consider the contributions of Compact migrants including working people from the Compact nations who pay income taxes.”

Micronesians residing in the states and territories deserve to be heard and should be entitled to certain benefits, especially healthcare services, including referrals to overseas medical treatment.