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Hawaii’s congressional delegation is urging the U.S. government to develop “policy options” to manage the growing cost of providing health care benefits to Micronesian immigrants.

The options include medical “screening measures” that would reduce the number of migrants “who are likely to become a public charge.”

The request, the second in 18 months by the delegation, comes in the wake of a court ruling in December that said Compact of Free Association (COFA) migrants must receive full medical benefits — a ruling that one attorney warned could cost the state up to $15 million a year.

The letter has upset some Pacific Island officials who say that, the U.S. is trying to to migrants from a region that was the location for nuclear tests in the 1940s and 1950s.

Such a restriction could violate “both the letter and spirit of the Compact,” said one Marshall Islands official.

The single greatest cost of providing health care to COFA migrants is for services to people who need long-term medical treatment for conditions like diabetes, the letter states.

The delegation wants federal grant money to pay for dialysis treatment facilities in Micronesia “so that patients will not need to seek treatment” in the United States.

Costs Exceed Coverage

The request, made in a May 12 letter to Secretary of State Hillary Clinton and Secretary of the Interior Ken Salazar, is signed by Sens. Daniel K. Inouye and Daniel Akaka and Reps. Mazie Hirono and Colleen Hanabusa.

The lawmakers say the policy that allows migrants from the three nations covered under COFA — the Republic of the Marshall Islands, the Federated States of Micronesia and the Republic of Palau — “is unsustainable” due to recent trends.

The migrants’ “increasing reliance” on social services and associated costs “is greater than was anticipated” and “well exceeds” the $30 million provided annually by Congress to defray the costs, the letter states. Approximately $10 million goes to Hawaii, though it’s estimated the state spends 10 times that amount on services.

COFA, enacted by Congress in 1985 and amended in 2003, allows COFA migrants to be admitted into the United States to work and live. The three COFA nations were formerly part of the Trust Territory of the Pacific Islands, a United Nations trusteeship administered by the United States following World War II. The U.S. used the Marshall Islands to test 67 nuclear weapons from 1946 to 1958.

The lawmakers ask that that the U.S. government express COFA the policy concerns and that the screening measures be considered during bilateral meetings scheduled for this summer. They also want the State and Interior departments to report back to Congress by Oct. 1.

“It is in the interest of all parties that the increasing costs of Compact migration be effectively managed before they become a source of serious friction in relations,” the lawmakers write.

Letter Sparks Protest

News of the lawmakers’ letter has upset some Pacific Island officials, who charge that it represents the first time U.S. officials have sought to restrict “unfettered flow” of islanders into the U.S.

A May 23 in said that Marshall Islands Foreign Minister John Silk expressed his concern at the move, saying the Marshall Islands “will object to any system that imposes a de facto visa requirement on our citizens in the U.S. That could violate both the letter and spirit of the Compact.”

Noting that the U.S. “operates an important missile testing base in the country,” Marianas Variety reported that the May 12 letter “was issued two days after an agreement was signed by Marshall Islands landowners cementing use of the Kwajalein missile testing range by the U.S. Defense Department” through 2066:

It calls on State and Interior to take grant funding currently designated for health and education development in these western Pacific nations and use a portion to educate islanders bound for America about their responsibilities in the U.S. under the visa-free agreement, and to fund dialysis treatment in the islands to reduce costs of health care for increasing numbers of islanders seeking treatment in America.

Marianas Variety points out that the May 12 letter was also signed by New Mexico Sen. Jeff Bingaman, chair of the Energy and Natural Resources Committee that oversees legislation on U.S.-affiliated islands in the Pacific; Alaska Sen. Lisa Murkowski and both senators from Arkansas — a state where up to 10,000 Marshall Islanders live.

Hawaii Tried to Limit Care

Last summer, the Department of Human Services made significant changes to health care provided to COFA immigrants, providing them a cheaper but limited program than the one available for U.S. citizens under Medicaid.

The migrants successfully challenged the implementation in court. Last December, Judge Michael Seabright determined that the changes made by the DHS were illegal and that irreparable harm could come to the migrants if they were denied access to the same state Medicaid program as all U.S. citizens in Hawaii.

A 2008 Census report determined that there were 12,215 COFA migrants residing in the state.

requiring DHS to provide medical assistance for dialysis, chemotherapy and other cancer treatments, inpatient and outpatient physician visits, and drug prescriptions for immigrants and non-citizens from COFA nations did not receive a hearing at the 2011 Legislature.

But non-binding and identical urging increased federal aid for dialysis and chemotherapy centers in the region passed.

The resolutions that Hawaii spent $101 million on state services for the COFA migrants, $10 million more than it spent in 2006.