Mahalo nui to the Asian Pacific Islander Health Forum for their press release regarding a new bill for health justice in Washington, D.C. 

From the Forum:

WASHINGTON—The Asian & Pacific Islander American Health Forum (APIAHF) welcomed today’s introduction of the Health Equity and Accountability Act of 2014 (HEAA) (H.R. 5294). The bill, introduced by Rep. Lucille Roybal-Allard, builds on the strengths of the health care reform law and provides additional tools to address health and health care disparities affecting minority and underserved communities

“We commend Rep. Roybal-Allard and the Congressional Tri-Caucus for their commitment to health equity for all communities,” said Kathy Ko Chin, president and CEO of APIAHF. “The Health Equity and Accountability Act complements the historic Affordable Care Act to create a more equitable health care system that truly meets the needs of all.”

“The HEAA is what is needed to ensure our health system responds to the country’s changing demographics,” said Priscilla Huang, APIAHF policy director. “The bill calls for targeted reforms to improve the health of subpopulations of communities of color that face additional barriers based on immigration status, disability, gender and gender identity, sexual orientation, geographic location and limited English proficiency.”

Mahalo to our friends and allies at the Asian & Pacific Islander American Health Forum for the following press release and statement of support for the restoration of equal access to federal healthcare safety nets for COFA residents, issued today:

Korab Decision Demonstrates "Dire Need" for Congress to Act

Case impacts access to care for COFA migrants in Hawaii  
April 16, 2014

WASHINGTON—Earlier this month, the U.S. Court of Appeals for the Ninth Circuit in Korab v. Fink ruled that Hawaii is not required to provide full Medicaid coverage to Compacts of Free Association (COFA) migrants from the Republic of Palau, the Republic of the Marshall Islands and the Federated States of Micronesia.  

The case arose after Hawaii shifted COFA migrants who were previously eligible for full-scope Medicaid in the state to the Basic Health Hawaii (BHH) program, which provides more limited coverage. Plaintiffs in the class action needed benefits such as dialysis and cancer treatment that were not covered by the BHH program.  They argued that Hawaii’s refusal to provide full Medicaid coverage violated the Equal Protection Clause of the Constitution.   

The Court rejected the argument and held that Hawaii was not required to “fill in the gaps” left by Congress as Congress has the power to regulate immigration and the conditions upon which aliens remain in the country. For many years, COFA migrants were eligible for Medicaid. In 1996, that changed when federal law rendered them ineligible. As a result, states with large COFA migrant populations have come under increasing pressure to tackle this humanitarian issue. Without federal dollars, states have shouldered the responsibility of providing care. 

“The Ninth Circuit decision showcases the dire need for immediate restoration of COFA eligibility for federally supported health programs,” said Kathy Ko Chin, APIAHF president and CEO. “The federal government is obligated to provide for the health of COFA migrants under long-standing treaties. This is demanded by America’s duty and commitment to the pacific territories. It is because Congress has not lived up to this commitment that COFA migrants are experiencing a crisis in access to needed care and states are left to cover the costs.” 

COFA migrants have a special status under U.S. law and are allowed to freely travel, reside and work in the U.S. as tax-paying residents. There are over 56,000 COFA migrants residing in the country. Many of them experience heath disparities and inequities as a result of conditions in their home countries and U.S. military activities in these jurisdictions. Despite working and paying taxes in the country, they are excluded from federally supported health programs. 

Rep. Hanabusa and Sen. Hirono have both introduced bills and amendments to restore access to critical health programs in the past. 


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On July 18, Congresswoman Colleen Hanabusa, in partnership with the Asian Pacific Islander Health Forum (APIAHF) and the Association of Asian Pacific Health Organizations (AAPCHO) hosted a Congressional briefing on the exclusion of US residents present under the Compacts of Free Association from the federal Medicaid program.  

Mahalo nui to Priscilla Huang of APIAHF for the following report-on the briefing, along with a copy of the handouts distributed.

The video recording linked below is also available on our  Background: The PRWORA Problem page. 

From APIAHF: 

On July 18, 2013 the Asian & Pacific Islander American Health Forum (APIAHF) along with Congresswoman Colleen Hanabusa and the Association of Asian Pacific Community Health Organizations (AAPCHO) hosted a briefing on Capitol Hill entitled Health Equity: Access to Care for Compact of Free Association (COFA) Migrants from the Freely Associated States; the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau. The briefing featured the following panelists: Dr. Neal Palafox, Professor, University of Hawai’i; Kathy Ko Chin, CEO/President of APIAHF; and Kathy Grisham, Executive Director of St. Francis House Community Clinic in Springdale, Arkansas.

Each speaker provided a unique perspective on the health and health care needs of COFA Migrants. Congresswoman Hanabusa presented opening remarks about the importance of health care access for COFA Migrants from both a fiscal and moral perspective. Dr. Neal Palafox provided an overview of the U.S. relationship with the Pacific, the Compact between the FAS and the United States, the impact of COFA migrants on the Pacific jurisdictions, and expressed the need for an equitable solution to fulfill the U.S. obligation in the Pacific. Kathy Ko Chin spoke about the legislative history of COFA eligibility for Medicaid, the policy impact of current Medicaid legislation on COFA Migrants, and the possible impact the Affordable Care Act will have on this community. Kathy Grisham highlighted her experience as a health care provider in a large Marshallese Community in Springdale, Arkansas and the challenges she has witnessed in the COFA Migrant community in gaining access to care.

Attendees included staff from various Congressional offices, the Department of the Interior, the Government Accountability Office, Department of Health and Human Services, Marshallese Embassy, and Micronesian Embassy. The congressional briefing was generously supported by funds from APIAHF and AAPCHO. The materials in the briefing packets included documents from Rep. Hanabusa’s office, APIAHF, St. Francis Clinic, Dr. Palafox, and HealthyPacific.org.

Below are links to the briefing packet contents and briefing recording.

Briefing Packet

Briefing Recording

Thank you very much to our friends at the AAPCHO, APIAHF, and Representative Colleen Hanabusa's office for setting up this important informational briefing on health access for COFA migrants in the U.S.

Supporters of Health Justice:
Please take a moment to contact your Washington, D.C. contacts and/or any of the Subcommittee on Health Representatives listed here and ask them to attend Representative Hanabusa's Informational briefing on Medicaid for COFA Migrants this Thursday, July 18, 2013 from 1:30 p.m. – 2:30 p.m. at 2456 Rayburn House Office Building, Washington, D.C.  Your one call could make a real difference! Please click on the flier to the left for more details.

For more information on the House bill, H.R.912, introduced by Representative Hanabusa, please see our blog post here.  For more information on the problem that this bill and Senator Hirono's similar Medicaid provision in the Senate Immigration Reform Bill S.744, please see our Background: The PRWORA Problem page.

Great news!  Thanks to Senator Hirono (D-HI) (pictured, left), an amendment has been successfully added to the highly visible immigration reform bill to restore equal access to Medicaid for U.S. resident taxpayers, workers, students, and community members present under the Compacts of Free Association (COFA).  

If the immigration reform bill passes in its current form, these residents would once again have the equal access to Medicaid that may be essential for certain individuals -- particularly for the chronically ill -- to receive proactive treatment in a timely and affordable manner.  

According to sources familiar with the mark-up proceedings, Senators Leahy and Schumer "spoke in favor of the [COFA] amendment -- that it is 'fair,' 'non-controversial,' and 'not going to break the bank." No significant objection was voiced from any other Senators on the Judiciary Committee, from either political party.

Earlier this year, the Hawai'i State Legislature passed several resolutions urging the restoration of Medicaid and other federal benefits for U.S. residents present under COFA.  Senator Mazie Hirono and Representative Colleen Hanabusa, U.S. Congressional delegates from Hawai'i, have both introduced measures to  their respective legislative bodies, that would carry out these resolutions for Medicaid benefits specifically.  

Congresswoman Hanabusa's measure, HR912, is currently in the House Committee on Energy and Commerce, with a referral to the Subcommittee on Health.  

Much kudos to the Asian Pacific Islander American Health Forum, the Association of Asian Pacific Community Health Organizations, the Japanese American Citizens League, the Medical Legal Partnership for Children at Kokua Kalihi Valley, the Hawai'i Coalition for Immigration Reform, the Hawai'i State Coalition Against Domestic Violence, the COFA Community Advocacy Network, the Asian Pacific American Network of Oregon, the Micronesian Health Advisory Coalition, The Pacific Islander Access Project, and the Micronesian Islander Community for their advocacy on the federal level.  Without the effort of groups such as these, it is unlikely that we would have come this far.  

In addition, much thanks to all those groups and individuals who have voiced their support and taken action for the restoration of these benefits.  Every supporter brings us one step closer to health justice for our Pacific Islander friends and allies!

While this is a victorious step forward, much more work remains to be done.  Please visit our Take Action page for updates on what you can do to get involved, or contact us for more ideas on how you can join this cause!  

Mahalo nui to Representatives Hanabusa, Gabbard, Bordallo, Sablan, and Faleomavaega!

APIAHF Applauds Introduction of House Bill Restoring Health Care for
COFA Migrants

March 6, 2013

WASHINGTON--The Asian & Pacific Islander American Health Forum (APIAHF) applauds Rep. Colleen Hanabusa (Hawaii) on her efforts to restore Medicaid coverage for Compact of Free Association (COFA) Migrants in the United States. 

The legislation—known as H.R. 912 or the Restoring Medicaid for Compact of Free Association Migrants Act of 2013—if passed would amend Title IV of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996, which restricts access to federal public benefit programs and effectively bars COFA migrants from access to Medicaid. Because of PRWORA, COFA migrants are also currently ineligible for the expanded Medicaid benefits under the Affordable Care Act (ACA).

"This bill is sorely needed to fulfill our diplomatic and strategic military commitments and to restore safety net health care coverage for COFA migrants who contribute to the American economy, yet are unfairly denied access to quality health care programs," said Kathy Ko Chin, president and CEO of APIAHF. "We strongly support the efforts of Rep. Hanabusa and her co-sponsors—Reps. Madeleine Z. Bordallo (Guam),  Eni Faleomavaega (American Samoa), Gregorio Sablan (Northern Mariana Islands) and Tulsi Gabbard (Hawaii)—and call on Congress to pass this bill quickly. In light of the ongoing negotiations around immigration reform, COFA migrants must also be included in discussions to remedy this longstanding issue."

Under the 1986 COFA, the U.S. government agreed to provide economic assistance to citizens from the Federated States of Micronesia, Republic of the Marshall Islands and Republic of Palau, allowing them to enter, reside and work in the United States and participate in certain federal programs including Medicaid. After the enactment of PRWORA, COFA migrants were cut off from Medicaid, forcing states like Hawaii and the territory of Guam to absorb the costs of providing health care benefits to them in the absence of federal funding. COFA migrants suffer from a number of serious health disparities caused by America’s militarization of the Pacific Islands, nuclear test bombing and lack of economic supports, including high rates of cervical cancer and other chronic diseases. Having access to affordable, quality health care is critical to addressing these disparities. 

If enacted, the bill would properly restore the federal government’s role in providing needed services for COFA migrants—including under the ACA—and give relief to the states and territories with large COFA migrant communities. 

APIAHF is actively involved in the current immigration policy reform discussions and is working to ensure that any legislation supports hardworking immigrants and their families and includes access to affordable health care for all.