BY MALIA ZIMMERMAN – Tony Korab, 58, has had his share of health-related challenges. After getting through his heart bypass surgery, he must have regular dialysis for his failing kidneys and he’s taking 16 prescription medications per month. A citizen of the Republic of the Marshall Islands, Korab cannot receive this costly medical treatment at home where there is no dialysis treatment available. So in 1999, in search of affordable and accessible medical care, he moved to Hawaii. Under the Compact of Free Association agreement the United States has with Micronesia, the Marshall Islands and Palau, Hawaii state taxpayers and federal taxpayers now pay for Korab’s medical care.
There are several thousand stories like Korab’s in Hawaii. Citizens of the Republic of the Marshall Islands, the Federated States of Micronesia, the Republic of Palau and the Commonwealth of the Northern Marianas, are self-governed. However, through the “COFA” agreement, the United States has military access and a place to perform drills (including at one time, controversial nuclear testing) in exchange for millions of dollars in state and federal aid and unlimited access to the United States and its social services.
An estimated 12,215 aliens now reside in Hawaii via COFA. They moved here without VISAs, in most cases to take advantage of free healthcare, public education, low-income housing and other social services. These legal immigrants comprise less than 1 percent of the population, but consume more than 20 percent of Hawaii’s social services, according to state estimates. Congressman Charles Djou, R-HI, and Hawaii state government officials maintain that much of the cost burden is falling on Hawaii residents impacting public schools, homeless shelters, low-income housing complexes and medical providers. The state continues to request more money from the federal government and is working to curb the social services cost.
However Korab and other plaintiffs have filed a class action lawsuit against the state of Hawaii to ensure their health benefits remain intact. The lawsuit, filed by such notable Hawaii attorneys as Paul Alston and former attorney general Margery Bronster, and some of their peers, claims that the clients’ 14th Amendment Rights, the Equal Protection Clause, was violated in through a state program, Basic Health Hawaii, implemented July 1, 2010 through the state Department of Human Services.
Plaintiffs are seeking an injunction to forbid the state Department of Human Services from discriminating against “aliens” when it comes to providing health benefits.
While the state Department of Attorney general sought to have their case dismissed, U.S. District Judge Michael Seabright refused the state’s motion on November 10. He has not yet ruled on the Plaintiffs’ Motion for Preliminary Injunction, which would likely force the state to restore the previous health benefits.
State Maintains COFA Too Costly
Hawaii has become a magnet for COFA migrants because of the generous benefits, says Alan Lee Eyerly, Senior Communications Advisor for the State of Hawaii Department of Human Services.
Currently, Hawaii spends about $130 million in state taxpayer dollars each year on services for these COFA migrants.
The federal government is supposed to reimburse Hawaii, yet the state only receives $11 million in federal monies.
“The State of Hawaii undeniably should receive full federal reimbursement for all the services we provide to COFA migrants, yet we only receive about ten cents on the dollar. Unfortunately, Congress continues to ignore our State’s repeated requests for relief,” says state Department of Human Service Director Lillian Koller.
The biggest expenses are health care and public education. Eyerly says the costs go higher each year as more COFA migrants move to Hawaii in search of health care, housing and food stamps. “In 1996, Congress made COFA migrants ineligible for Medicaid health insurance. In response, Hawaii gave these migrants Medicaid-like coverage entirely paid for with state tax dollars. In July 2010 we moved some COFA migrants into Basic Health Hawaii, which offers less comprehensive coverage than our Medicaid-clone program. However, the BHH benefits are still generous and COFAs do have access to kidney dialysis and chemotherapy drugs,” he says.
DEPARTMENT OF EDUCATION IMPACTED BY INFLUX
Prior to this school year, the numbers of Micronesian students were estimated based on “first acquired language” codes when students registered for school, says Sandra Goya, Communications Director for the Hawaii State Department of Education.
Based on self-reported “first acquired language,” she says the data shows 4,440 Micronesian students at the end of last school year, with a total of 157 June graduates.
Starting this 2010-2011 school year, the federal government is requiring all school districts to use newly implemented ethnic codes for self-reporting, including a separate category – Micronesian (Ex. Chuukese, Marshallese, Pohnpeian), so the numbers may change, she says.
Some of the challenges for these young students and their teachers include language barriers and cultural differences as well as an impact on the state’s public education budget.
LEGAL IMMIGRATION POPULATION SEEKS SPACE IN HOMELESS SHELTERS, STATE LOW INCOME HOUSING
Institute for Human Services executive director Connie Mitchell, who operates two homeless shelters on Oahu, sees firsthand the impact of immigrants who come to Hawaii seeking a better life, but aren’t prepared for the high cost of living.
Many are helping to fill the beds at her Kalihi family shelter.
She says there also are cultural challenges, language barriers, and problems finding employment because of these issues, so many Micronesian immigrants end up homeless, filling local shelters and seeking the state’s already limited low-income housing.
IHS does what it can to help, sending its adult homeless shelter residents to learn English and working with the school children after school to ensure they can complete their studies.
Advocates for Hawaii’s homeless families say that the state’s low income housing resources are going to these legal immigrants rather than local residents.
MICRONESIANS WANT MORE, NOT LESS
There is a passionate Micronesia community now well established in Hawaii seeking to maintain or gain additional benefits for themselves. The Micronesian Community Network based in Honolulu, and the Micronesian Health Advisory Coalition, held a concert just weeks ago to raise money to sue the state over the Basic Health Hawaii care issue. These are two of the five Micronesian organizations that signed a pro bono contract with the Lawyers for Equal Justice to sue the state. Entertainment at the October 23 event included 6 bands and a puppet show.
An advertisement for the concert says: “Many Micronesians in need of critical health care in Hawaii suffer from the effects of U.S. nuclear tests on Bikini Atoll after WWII and migrated to Hawaii to seek medical treatment. In the past, Micronesians were covered for chemotherapy, dialysis, and other comprehensive medical needs by MedQuest. However, due to state budget cuts, MedQuest was replaced by BHH. Implementation began on July 2010. The new health plan does not give the comprehensive healthcare Micronesians need, and as a result, the Lawyers of Equal Justice agreed to file a lawsuit against the implementation of BHH on behalf of all affected Micronesians. Please help us fight this legal battle to save lives.”
Should Hawaii be forced to provide Medicaid-like health coverage for COFA migrants when the federal government has refused to do so since 1996? That is the question that will be left for the federal court will decide. If not, the state says it will save State taxpayers an estimated $8 million annually because “COFA migrants will transfer from Medicaid-like coverage to less comprehensive coverage.”
The current GOP state administration and some social service providers, maintain that the state taxpayers and private donors supporting local charities cannot afford to keeping paying for the education, healthcare, housing, food and other expenses of those Compact members – especially during tough economic times when so many Hawaii residents are hurting economically.
Djou maintains that for too long, the State of Hawaii has had to bear a disproportionate burden in providing social services for Micronesian citizens. “This burden is simply unfair to the taxpayers of Hawaii who, like citizens of any state, are making tough choices during these difficult economic times. … The Compact with Micronesia is an important part of our foreign policy, and I welcome Micronesian citizens to the United States in general and to Hawaii in particular. But there remain certain legal standards for residency that must be met, and those Micronesian citizens who are unable to care for themselves should not become charges of the State.”
Djou, a Republican who served in Congress since May 2010 via a special election, will be replaced by Congresswoman-elect Colleen Hanabusa, D-HI, this January, so will be unable to continue to advocate for these reforms from within Congress.
Whether the next administration, run by Democrat Governor-Elect Neil Abercrombie, will restore the healthcare benefits, and boost other services for Micronesians, will be determined after December 6 when he takes office.