The "Compact Impact" in Hawai'i: Focus on Health Care

The political, economic, and military relationship between the former Pacifi c Trust Territories of the United States is defi ned by the Compact of Free Association (COFA) treaty. The respective COFA treaties allow the United States military and strategic oversight for these countries, while COFA citizens can work, reside, and travel with unlimited lengths of stay in the United States. The unforeseen consequences of the diaspora of the people of the COFA nations to the United States and its territories is called the “Compact Impact.” In 2007 the social, health, and welfare system costs attributed to the estimated 13,000 COFA migrants in Hawai‘i was $90 million dollars. The US federal government does not take full responsibility for the adverse economic consequences to Hawai‘i due to COFA implementation. The lack of health and education infrastructure in the COFA nations, as well as the unique language, culture, political, and economic development of the region have contributed to the adverse elements of the Compact Impact. The Department of Human Services of Hawai‘i, once supportive of the COFA peoples, now looks to withdraw state sponsored health care support. This paper reviews the historical, political, and economic development, which surrounds the Compact Impact and describes Hawai‘i’s government and community response. This paper attempts to understand, describe, and search for solutions that will mitigate the Compact Impact. Background Geography Micronesia is comprised of a series of remote islands and atolls stretched for thousands of miles across the western Pacifi c Ocean. The total area of Micronesia is equal to twice the continental United States, however the total land mass of all the islands combined is approximately the size of the state of Rhode Island. Micronesia, from a geographical perspective, comprises the Marshall Islands, Pohnpei, Yap, Palau, Chuuk, Kosrae, Northern Marianas, Guam, Nauru, and Kiribati. From a Hawai‘i political and popular press perspective, the Federated States of Micronesia (FSM), which includes Pohnpei, Yap, Chuuk and Kosrae, the Republic of the Marshall (RMI), and Republic of Palau (ROP) are commonly referred to as “Micronesia”, and the peoples of these areas are “Micronesians”. Micronesia and Micronesian for the purposes of this paper will be limited to the ROP, the RMI and the FSM. Population The current population of the FSM is 107,000 (Chuuk: 54,000; Kosrae: 8,000; Pohnpei: 34,000; and Yap: 11,000). The RMI has 60,000 people and the Republic of Belau has 18,000 inhabitants. Since early 1990 there has been a signifi cant migration of the people from the FSM and Marshall Islands to Hawai‘i, Guam, the Common Wealth of the Northern Marianas and the continental United States. It is estimated that more than 15% of the Marshall Islands population lives outside of the RMI. 1,2