Alarmed by the threat posed by the Covid-19 pandemic, lawmakers are urging congressional leaders to restore health coverage for tens of thousands of uninsured Pacific Islanders who were promised Medicaid after U.S. nuclear weapons testing but lost coverage in the 1996 welfare reform bill.
“We are in the middle of a national crisis that is unlike anything we’ve ever faced. Stopping the spread of the virus begins with ensuring that everyone has access to health care,” said Rep. Tony Cárdenas (D-Calif.), who’s leading the bipartisan effort with Sen. Mazie Hirono (D-Hawaii). “We have ignored this problem for too long, and it is time we fixed it.”
The United States promised that residents of the Marshall Islands, Palau and Micronesia would have access to Medicaid through a 1986 pact known as the Compact of Free Association, or COFA — about four decades after the U.S. conducted dozens of nuclear weapons tests in the Marshall Islands that have been linked to myriad cancers and other health problems. However, the 1996 U.S. Personal Responsibility and Work Opportunity Act stripped the islanders of their access to Medicaid, a decision described as a legislative oversight.
Cárdenas, Hirono and colleagues like GOP Reps. Steve Womack (R-Ark.) and Don Young (R-Alaska) urged congressional leaders on Wednesday to use the next coronavirus stimulus package to restore Medicaid for the 61,000-plus islanders who live in the United States.
“As the United States confronts the Covid-19 pandemic, it is vital that individuals in our communities can access testing and treatment so they can care for themselves and help prevent additional transmission of the virus,” the lawmakers wrote in a letter shared with POLITICO.
Limited studies of the islanders who live in the United States — who disproportionately work in low-wage, part-time jobs in roles like factory or restaurant workers — have found that more than half may lack health insurance. The islanders also tend to suffer from high rates of diabetes and obesity, and many families have long histories of cancer that some researchers say can only be explained by the radiation levels that, in some parts of the Marshall Islands, remain higher than Chernobyl.
“Any expansion of coverage for testing or treatment of Covid-19 must include all immigrants, regardless of status,” the Asian & Pacific Islander American Health Forum urged congressional leaders last month.
Hirono’s office said that restoring the lost Medicaid coverage would cost $356 million over a decade. Cárdenas’ office said the House’s version of the previous coronavirus stimulus package included a two-year patch but the provision was not included in the Senate version and was dropped from the final bill.
“Ever since I got elected I’ve been working on this,” said Hirono, who noted that the provision was included in a 2013 comprehensive immigration package that died in the House. “Every time I see Chuck [Schumer] he says, ‘yes, the COFA citizens.’”
One reason for Hirono’s focus: Her state, Hawaii, is home to about 17,000 COFA citizens, the largest population in any single state. Hawaii also attempted to cover the islanders for years through its own Medicaid program after national coverage was revoked. However, Hawaii in March 2015 revoked its state coverage amid concerns about the cost to taxpayers and a legal challenge.
In a forthcoming paper, a team of researchers at UCLA, the University of Hawaii and Hawaii’s state health department determined that the islanders’ death rates increased by about 21 percent in the three years after Hawaii revoked their access to Medicaid. POLITICO obtained a copy of the paper, which has been accepted to be published in a peer-reviewed medical journal.
“We find that the loss of traditional Medicaid benefits for COFA migrants was associated with higher mortality for this already vulnerable community,” the researchers write, even though state health officials and advocates attempted to mitigate the policy change by steering the islanders to low-cost private health insurance and by taking other steps.
Given the islanders’ high uninsured rates, the burden of caring for them has disproportionately fallen to community health centers, and POLITICO in January profiled the efforts of Crescent Community Health Center in Dubuque, Iowa, to craft services that were tailored to the islanders’ unique needs. About 800 islanders have moved to the small Midwestern city — a population that continues to grow, lured by the promise of low-cost or free health care at Crescent.
However, the health center is struggling to cover its own costs amid the Covid-19 downturn, and the social worker assigned to work with the islanders was recently laid off.