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*New!*  Information on Restoring Medicaid Access for COFA Migrants

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life_liberty_and_justice_for_all_final_v2.pdf
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Talking Points for the PRWORA Problem Campaign

The Healthy Pacific Team supports all efforts to include U.S. resident taxpayers, workers, students, and community members present under the Compacts of Free Association a "qualified aliens" under the PRWORA, which would reinstate their eligibility for federal benefits including federal Medicaid funds.  Here are a few reasons why:
 
1.
  Closing the PRWORA loophole will benefit all in our state who seek medical treatment.  Including our COFA residents as "qualified aliens" eligible for life-saving Medicaid funds under PRWORA will lead to the investment of substantial federal monies in our Hawai‘i’s medical infrastructure, which will boost our economy and bring a higher quality of care for anyone in our state who needs to go to the doctor.

2.  A responsible adult cleans up their own mess.  The United States has made a huge mess of the islands and lives of the indigenous peoples of the Freely Associated States, and it must take responsibility in cleaning up this mess.  Reinstating federal benefits for U.S. resident taxpayers, workers, students, and community members present under the Compacts of Free Association will help the United States take ownership of this ongoing responsibility, just as a responsible adult would.

3.  No one should have to choose between going to the doctor to save their life, or keeping food on their family's table, or a roof over their child's home.  By denying healthcare eligibility for our Pacific Islander residents, the PRWORA may force the chronically ill and seriously injured to choose between saving their own lives, or ensuring that their families have the basic necessities of life in the U.S.  Aspiring nurses, doctors, or engineers may have to drop out of college just to pay off a relative's healthcare costs, impacting not just their families, but our economy and our society as a whole.    Closing the PRWORA loophole and including COFA residents as “qualified aliens” eligible for federal healthcare protections acknowledges the contributions and sacrifices of our Pacific Islander neighbors, which will benefit not just our COFA residents, but our broader society as well.

4.  We can affirm America as the land of opportunity, where individuals are given a fair shake to pursue the American Dream.  America’s strength and pride come from its basic ideal as a land of opportunity, where all individuals should be given a fair shake in their pursuit of life, liberty, and happiness.  However, the exclusion of our Pacific Islander neighbors and allies under the PRWORA denies them the same opportunity as all other legal residents, including the ability to pursue adequate healthcare, social security, and other public safety nets intended to uphold our enlightened social contract. Closing the PRWORA loophole will ensure that America keeps its promise of opportunity to our Pacific Islander allies lawfully residing here under the Compacts of Free Association.

5.  We can uphold America’s vision of justice.  America prides itself on its sense of justice, and despite its historic contradictions, has struggled to ensure that we do acknowledge and address the injustices of our past.  However, some of the darkest moments in our recent history have yet to be fully acknowledged and addressed, threatening to leave a long and ugly scar in our reputation as a land of justice, and freedom.  Closing the PRWORA loophole and fulfilling the intent of the Compacts of Free Association will take America one step forward towards its vision of liberty and justice for all. 

Please consider supporting efforts to urging Congress to ensure equal treatment for our COFA residents, taxpayers, students, workers, and community members.  Visit our Take Action page to learn how you can join the cause!

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Talking Points for the Stop Basic Health Hawai'i Campaign

The Healthy Pacific team supports the Micronesian community who are fighting for fairness and equal access to health care. Here are some key points about this important struggle:

WHAT IS "COFA"?

• The United States entered into a Compact of Free Association (COFA) agreement with the independent nations of Federated States of Micronesia (1986), Republic of the Marshall Islands (1986), and Republic of Palau (1994).

• COFA allows citizens of these nations free and relatively unrestricted travel to the U.S., and grants the U.S. exclusive military control over the entire Micronesian region.

• Notably, one of the region’s largest income source is the Ronald Reagan Ballistic Missile Defense Test Site on Kwajalein Atoll, Marshall Islands. And Micronesia has the highest per capita rate of U.S. military enlistment, more than any U.S. state.

• In 1996, the federal Welfare Reform Act limited certain federal benefits for many immigrants, including those from COFA nations. Most other legal immigrants are allowed to receive benefits after 5 years, but COFA immigrants are never allowed to receive Medicaid, SSI, and other benefits.

WHAT IS BASIC HEALTH HAWAII?

• In August of 2009, the Hawaii Dept. of Human Services announced its plans to cut state- funded healthcare benefits to all immigrants from COFA nations. In its place they offered a reduced benefits plan called “Basic Health Hawaii.” (For more info, see www.HealthyPacific.org.)

• In September of 2009, nonprofit and pro bono law firms partnered with the Micronesian community in Hawaii to protest these cuts and won a Restraining Order to halt BHH.

• On July 1, 2010, the State imposed its BHH plan, claiming it was necessary in the hard economic times. However, the increase in emergency services and delayed care are NOT cost-effective healthcare. At least 30 people are known to have died as a result of the cuts to healthcare for Micronesians.

• On December 13, 2010, the community again prevailed in a case called Korab v. McManaman when U.S. District Court Judge Michael Seabright granted a Preliminary Injunction and ordered the State to reinstate Quest coverage for Micronesian immigrants. The judge cited “irreparable harm” to Micronesian’s health.

WHAT IS HAPPENING WITH THE LAWSUIT?

•Despite Governor Abercrombie’s repeated support for the Micronesian community, his administration is continuing Gov. Lingle’s appeal of the Korab case to the Ninth Circuit.

•The Ninth Circuit Court of Appeals has tentatively rescheduled a hearing for Korab on September 18, 2012 in San Francisco, California.

•HealthyPacific.org, a coalition of Micronesian community leaders, advocates, and allies, is working to end the Korab appeal and allow the “equal protection” decision to stand.

PROPOSED SOLUTIONS

•Sign the petition asking the Governor to stop the Korab appeal on this website, www.HealthyPacific.org. Commit to working together with our Congressional delegates and Governor Abercrombie to correct this injustice and restore federal benefits for Micronesian healthcare. Share this information with others!

•Commit to working together with our Congressional delegates and Governor Abercrombie to correct this injustice and restore federal benefits for Micronesian healthcare.  For example, contact your Congressional representative and ask them to support the the Health Equity and Accountability Act of 2012 (S. 2474), introduced by Senators Daniel K. Akaka and Daniel Inouye.

•Share this information with others -- see below for a downloadable version of these talking points!


For more FAQs and information, please visit www.HealthyPacific.org. Updated: April 6, 2012

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Additional facts about the Micronesian community and Basic Health Hawai`i (BHH)

1.  What is COFA anyway? 

COFA, the Compact of Free Association, is a series of treaties between the United States and the Federated States of Micronesia, Republic of Palau, and the Republic of the Marshall Islands. 

2.  Why do the COFA residents have a right to receive government benefits?

COFA residents make positive contributions to the economy and receive very few government benefits.  COFA residents are legally eligible to work in the United States and required to pay state and federal taxes. COFA states account for the highest per-capita number of military recruits than any other U.S. state or territory.  Despite paying taxes, unlike all other immigrants and U.S. citizens, COFA residents are never able to establish residency and receive Federal government means-tested benefits.  Refugees, victims of domestic violence, trafficking victims, those whose deportation is withheld, immigrant victims of crime, and asylum seekers are all eligible to receive these benefits, but COFA residents are not.

3.  Do COFA residents place an unfair financial burden on Hawai’i?

The State of Hawai`i received $10,571,000 million for fiscal year 2009 and $11,229,000 for fiscal year 2010 in Compact Impact funds from the federal government to help pay for services to COFA residents living in our state. Other states, such as Washington and Arkansas have sizable COFA populations.  They not only provide comprehensive health benefits, but also provide food stamps and other state funded assistance to the COFA population without receiving any Compact Impact funds.

4.  Why should the State pay for coverage for COFA residents in tough economic times?

Spending on COFA residents represents a very small expenditure in our state budget and a wise investment. Cutting $13 million in essential health care spending toward primary and preventative health care for our COFA population eliminates less that than .0184% of the State’s $1.3 billion deficit.  Additionally, it is not a wise investment. It eliminates spending on the front end while increasing overall spending for health care by ensuring that emergency service costs are significantly increased and emergency rooms overloaded.  In addition, the COFA population suffers disproportionately with serious health problems, many linked to past and ongoing US occupation and nuclear weapons testing in their home countries.

5.  Were the services offered by BHH sufficient to maintain a person’s health?

BHH provided very limited health care coverage not adequate for disabled or seriously ill persons.  Some patients must use the allotted doctor visits simply to get diagnosed.  Most disabled individuals often need to visit the doctor more frequently, may need more than four prescription medications, and need access to medical devices. From a public health perspective, cutting access to health care from a newly arrived population is not a wise management decision to make sure serious illnesses and diseases are diagnosed and treated.

6.  Why does the U.S. have this special relationship with these countries? 

The three COFA countries were formerly part of the Trust Territory of the Pacific Islands.  Under the COFA treaties, the U.S. exercises strategic control of over half a million square miles of the Pacific between Hawai`i and Guam.  The United States conducted nuclear testing in the Pacific for many years.  The U.S. Eniwetok and Bikini were used as nuclear testing grounds, setting off 67 open-air atomic and hydrogen bomb blasts that equaled 1.7 Hiroshima-sized bombs every morning for 12 years.  Because of nuclear fallout and militarization, residents were forced to relocate. Diets changed, as traditional agriculture could not longer be supported on lands rendered unusable from nuclear fallout or military operations.  With no other economic means for support, the United States military recruits more members from COFA states than from any other state or territory to serve overseas in our military endeavors. The treaty allows COFA residents to live and legally work in the U.S. 

7.  Isn’t this a federal problem?

This is a Hawai`i issue and local problem.  Other states provide services for the COFA population without receiving any Compact Impact Funds.  It is only in Hawai`i that we have targeted the Micronesian immigrant population as responsible for the budget deficit. 

8.  Wasn’t there already a lawsuit about all of this?

COFA residents have been fighting these cuts for two years. Most recently, in November 2010, Federal Court Judge Michael Seabright found that State had violated the 14th amendment in specifically targeting COFA residents for cuts to medical services, and issued a preliminary injunction reinstating benefits for COFA residents by January 2011. The state is now appealing this ruling.

9.  Keeping COFA residents healthy promotes health for all, and a healthier Hawai`i.

Cutting access from a marginalized immigrant population is a shortsighted plan that does not address the real problem and will not contribute to the health and well being of all state residents.  The ability to access health services ensures that communicable diseases and illnesses are diagnosed, treated, and managed.  When a marginalized population is systemically denied access, chronic conditions are left to fester until they become emergency issues.