Nearly 25 years ago, with the stroke of a pen, the United States broke its commitment to provide medical care for Marshall Islands residents living in the United States.
Last month, congressional negotiators agreed to reinstate that promise, delivering Medicaid and Children’s Health Insurance Program coverage to tens of thousands of Marshallese and residents of several other Pacific Island nations living in the United States.
“We are all so overjoyed with tears of joy for this fight that many of us have been part of” for decades, said Sheldon Riklon, a Marshallese physician at the University of Arkansas Medical Center’s Northwest Center. “This is a historic legislation that we finally right the wrong.”
The healthcare assistance comes as the COVID-19 pandemic and related job losses have hammered many Marshallese and Pacific Island communities in the United States, from Washington state to Arkansas.
In 1986, the United States and the Republic of the Marshall Islands signed a bilateral agreement that allowed the Marshallese to enter the United States as “legal non-immigrants” in return for the U.S. military continuing to operate a weapons testing base in the Marshalls. It also provided the Marshallese with Medicaid coverage.
Similar agreements, known as Compacts of Free Association (COFA), were signed with the nations of Palau and the Federated States of Micronesia.
Then, in 1996, President Clinton signed the welfare reform bill, which changed the categories of people qualifying for federal aid, including Medicaid—the Marshallese and other compact nation citizens were shut out.
Although the omission of these residents was considered an error, Congress refused to reinstate them—even as some legislators, including Sen. Mazie Hirono and Rep. Tulsi Gabbard, both Democrats from Hawaii, pushed to have them reinstated.
Their efforts, and those of others, have now paid off.
“This bipartisan agreement will unlock new tools to assist the COFA community suffering from unequal access to health care,” said Hirono in an email statement. “By allowing States to enroll COFA citizens in Medicaid, we are upholding the promises we made to our critical national security partners in the Freely Associated States.”
Gabbard noted the bill would also help states such as Hawaii, Oregon, and Washington, which had stepped in to fill that federal void for compact residents.
Juliet Choi, director of the Asian and Pacific Islander American Health Forum, said she was thrilled and stunned by the news, which comes at such a politically fraught and polarized time in American politics. She called it a “bright and hopeful” indication the nation can rally together to right wrongs during “this dark time,” she said, referring to the pandemic.