Medicaid Anniversary: Congress Must Act to Restore Coverage to COFA Communities

This week marks the anniversary of Medicaid, the nation’s reliable safety net for millions of people for whom access to quality health care would otherwise be unaffordable. For 51 years, Medicaid has strengthened lives and bettered the outlooks for individuals, families and communities across the nation. Today, Medicaid provides cost-effective health coverage to more than 58 million people living below poverty level. Still, the promise of affordable health care access eludes far too many hardworking, struggling families.

These families include people like Kasil Kapriel of Oregon and Accent Penney of Washington state. Kapriel and Penney are among the more than 56,000 people living in the United States who are from the Pacific Island nations that share a special relationship with the United States under the Compacts of Free Association (COFA) — the Federated States of Micronesia, the Republic of the Marshall Islands and the Republic of Palau. Signed in 1986, the Compacts support our national security infrastructure by allowing the United States exclusive military control over the islands’ areas in the Pacific. In exchange, COFA citizens may travel to, study, live and work in the States without restriction. COFA communities have established strong roots in the United States working in critical industries, yet many who struggle with poverty cannot access federal safety-net programs like Medicaid because federal law inadvertently removed their eligibility.

The cost of not having access to Medicaid is high, with many like Kapriel being unable to afford to get sick. A single mother of three who is from the Federated States of Micronesia, she has earned minimum wage for nearly a decade helping passengers at Portland International Airport who have special needs get to and from their destinations. Kapriel has no health insurance through her employer, a contractor for the airport. While more Americans than ever rely on Medicaid’s safety net, Kapriel and other COFA migrants fall into a gap that was never intended: They are eligible for private plans in the Marketplace, but because their incomes are so low — often below the poverty line — they can’t afford premiums and co-pays for those plans.

Thanks to the efforts of COFA advocates, Oregon is trying to meet that gap by providing assistance to help people like Kapriel pay their insurance premiums starting in January 2017. Meanwhile, COFA communities elsewhere in the nation remain locked out of the same health programs their tax dollars support because Congress hasn’t acted. These communities make valuable contributions to our nation’s economy and well-being and bolster our national security. For example, the largest concentration of Marshallese in the continental United States lives in Northwest Arkansas, contributing to the region’s economy by working for meat processors in the area. COFA residents in the United States and their home islands also serve in America’s armed forces, representing higher per-capita U.S. military enlistment rates and casualties than any U.S. state.

Affordable health care is a basic need for everyone. For COFA migrants, the need is particularly acute because of health challenges such as high rates of communicable diseases and chronic diseases like obesity, heart disease and diabetes. Some of these health conditions are linked to the U.S. military activities in their region, including radioactive fallout from test bombs. Penney is among those who was exposed to the fallout of Castle Bravo, the largest thermonuclear device ever detonated by the United States and one of 67 nuclear tests conducted in the area. He lost close family to radiation sickness and cancer following Castle Bravo, and has faced serious illness himself. Today he and others from the Marshall Islands continue to be medically monitored by the government.

Penney, Kapriel and other COFA migrants struggle to bridge the gap they face in access to health care, and organizations such as the Asian Pacific American Network of Oregon, COFA Alliance National Network (CANN) and Children’s Alliance in Washington have partnered with them as vital resources and advocates. But federal law must meet these community efforts in the middle. The restoration of Medicaid coverage — and with it, affordable and reliable health care options — must be fixed by Congress. Congress has failed to act on 21 bills in the last 15 years that would have reinstated COFA eligibility for Medicaid. Sen. Mazie Hirono and Rep. Tulsi Gabbard of Hawaii have legislation that is currently pending in Congress that would restore COFA access to coverage.

Each anniversary of Medicaid is a reminder of the program’s achievements, but there is progress yet to be fulfilled. For COFA communities, who continue to pay a high human and economic toll for the federal government’s broken commitment to them, Congress’s action to make that progress happen is long overdue.

Kathy Ko Chin is the president and CEO of the Asian & Pacific Islander American Health Forum.