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U.S. restores Medicaid for Marshall Islands, exposing longtime injustice, experts say

President Bill Clinton signed a welfare bill 24 years ago that altered those eligible for federal aid, stripping Marshallese and other nations of coverage.
Image: Senate Minority Leader Schumer holds a weekly news conference in the U.S. Capitol in Washington
Sen. Mazie Hirono, D-Hawaii, during a weekly news conference in Washington on Dec. 15.Al Drago / Reuters file

The government recently restored federal health care to the Marshallese and other Pacific Islanders, decades after the programs were taken away.

Lawmakers, led in part by Sen. Mazie Hirono, D-Hawaii, reinstated Medicaid for the groups as part of the larger coronavirus relief and year-end funding, which President Donald Trump signed this week.

President Bill Clinton signed a welfare bill 24 years ago that altered who was eligible for federal aid, stripping the Marshallese and other nations of coverage. Experts say it was an injustice that had long been ignored.

Hirono said the measure was necessary given the U.S.'s history of destruction in the region, which is in the central Pacific Ocean. The government used the Marshall Islands as a nuclear testing site, and the Pacific Islander community has been devastated by the coronavirus pandemic.

"This is a group of people who sacrificed much, and in fact their countries [play] a big part of our national security, especially in the Indo-Asia Pacific region," Hirono said of the Marshallese and others. "They certainly deserve this kind of coverage, which never should have been taken away."

The package reinstated Medicaid not only for the Marshallese but also for those from the Federated States of Micronesia and the Republic of Palau. Since the 1980s, the three nations have been under the Compacts of Free Association (COFA), a series of treaties that established the U.S.'s exclusive military use rights in them.

The treaties have given the U.S. access in the Asia-Pacific region. As part of the agreement, citizens of COFA nations are able to live, work and study in the country. The populations, considered "legal nonimmigrants," also pay U.S. taxes and had previously been promised medical care.

Eldon Alik, consul general of the Republic of the Marshall Islands in Arkansas, who had been advocating for such measures for some time, said that after a decadeslong gap in the U.S. commitment, he found himself in tears upon hearing the recent news.

"Many of our folks came here to not only seek medical care, but also employment and educational opportunities for our families. We are not a rich nation, and we come here to look for the American dream," Alik said. "A lot of our folks are hard workers. A lot of them face a lot of hardships. Just like everybody else, we pay all the taxes that are required. So it is just right that we get Medicaid also."

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Alik said relations with the U.S. have always been friendly. But the history has also been dotted with pain. For about a decade during the Cold War, the U.S. detonated 67 nuclear bombs in and around the Marshall Islands. The U.S. also dumped 130 tons of soil from an irradiated Nevada testing site onto the Enewetak Atoll, part of the nation.

The testing had devastating consequences, vaporizing entire islands and forcing people from their land. Birth defects and cancers spiked in the population.

Even so, Alik said, the Marshall Islands has stood loyally by the U.S., particularly on the global stage. A 2018 voting report from the State Department found that the Marshall Islands was among the top 10 countries whose United Nations voting record most closely matched that of the U.S. He said that not only do its citizens pay taxes but that many, including him, have also served in the U.S. military.

"We gave the ultimate sacrifice for the United States, which is our land." Alik said. "We really sacrificed not just the land, but our health, our culture. There was so much at stake."

The pandemic, Alik said, further emphasized the dire need for Medicaid among the Marshallese population. The Covid-19 cases in Arkansas, home to one of the largest Marshallese communities in the world, are perhaps the most chilling example. During one of the peaks of the outbreak in June, there were 600 active cases of the coronavirus in Northwest Arkansas. While the Marshallese are about 3 percent of the population there, they accounted for half of the pandemic-related deaths.

"In Arkansas, the majority of the Marshallese are working the poultry plants. They say we are essential workers. At one point, Donald Trump said, 'You guys got to keep those plants open to feed the nation,'" Alik said. "We're up at the front. So it's just fair that we get Medicaid."

Hirono said that stripping the program was inadvertent and that there's no evidence in the legislative history of the welfare reform law to justify exclusion of COFA citizens from Medicaid.

"It just took a long time. And I tell you, it took far longer than it should have," she said. "And the conference, citizens were suffering health disparities long before Covid came along."

However, reinstating the program has been a long, arduous battle for Hirono and other Democratic lawmakers.

Alik said he the slow progress can be chalked up to the lack of education in government agencies about the Marshall Islands and the plight of its people. But Hirono said one big roadblock was the way some Republican lawmakers framed the issue.

"The Republicans chose to view it as an immigration issue. But there are a lot of times that facts do not impinge on some of their decision-making — a lot of their decision-making, in my view," she said.

She added: "I've explained to Republicans, in particular, this is not an immigration issue. This is what we should provide under our compacts. It seemed to be really hard for Republicans to understand that these are not immigrants. These are people who are legally in our country."

Alik said he hopes further benefits will be provided to those from the Marshall Islands, including programs like food stamps.

"All these things that we do for the United States — this is just something in return, in my opinion, to solidify this relationship that we have with the United States," he said.