Congress is considering a proposal to share the costs with Hawai'i for the health care of its residents from the Federated States of Micronesia, the Marshall Islands and Palau, which would be a much fairer arrangement than what exists today.

The migrants from these nations are covered by the Compact of Free Association, an agreement by which the U.S. offers medical care and other benefits for the Pacific nations where nuclear testing during the 1950s contaminated the environment. States previously used Medicaid funds to pay part of the health care cost, but welfare reform ended that in 1996.
For the last dozen years or so, the state Department of Human Services has been managing health care for compact nations, providing the same full coverage that Medicaid-eligible U.S. citizens get and using only state funds to pay for it.
The department last week announced the Sept. 1 launch of scaled-back coverage for most migrant adults (children and pregnant women still receive the full benefits through the S-CHIP program). The new program, dubbed Basic Care Hawai'i, reduces coverage to include 12 outpatient doctor visits, 10 hospital days, six mental health visits, three procedures and emergency medical and dental care.
That saves about $30 million for the biennium, the lion’s share of the $42 million in savings DHS needs to find. Department officials said it was selected because it’s used only state funds and would not lead to losing matching federal money.
Now, however, an amendment to the House version of the health care reform legislation would provide federal matching funds to offset the costs of health care for compact migrants in the U.S..
It makes sense for the federal government to carry at least an equal share of the costs because the compact itself is a federal commitment. Hawai'i's geographic location makes it a logical stopping point for U.S.-bound Micronesians, but the state should not be penalized for taking in a disproportionately large migrant population.
DHS also plans to expand the new basic coverage to other legal alien residents, and federal help will make that fiscally easier. Ultimately, providing some coverage to all Hawai'i’s people will reduce the numbers of patients seeking care in emergency rooms, which is far more expensive for hospitals and ends up adding to the premiums the rest of the state pays.
As health care proposals continue their way through Congress, federal aid for the medical care of migrants is an element worthy of keeping.