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Hawaii paying for federal promises


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POSTED: Monday, August 31, 2009

Inflammatory and inaccurate comments made at legislative briefings and in media reports about Basic Health Hawaii—the state's new medical assistance program for legal aliens—are unfortunately missing the big picture.

Here are some facts that give a much-needed perspective on an issue of great importance for migrants from Pacific Island nations and for all Hawaii residents.

The U.S. government conducted extensive testing of nuclear weapons in the Pacific during the 1940s and 1950s. As compensation for the lingering after-effects of those radioactive tests, the U.S. enacted Compacts of Free Association (COFA) that allow people from Micronesia, the Marshall Islands and Palau to travel freely, live, work and attend school in America.

Paying for services that Hawaii provides to COFA migrants is undeniably a federal responsibility. It is also undeniable that the U.S. government has shirked those responsibilities for many years—and continues to do so.

In 1996, Congress made COFA migrants ineligible for Medicaid. Since that time, Hawaii has provided them with free and comprehensive Medicaid-like coverage. Congress recently allowed COFA children and pregnant women to be covered by the Children's Health Insurance Program. However, Hawaii must spend state tax dollars to receive matching federal funds under this program.

Hawaii provides COFA migrants with more than $100 million in services annually, with the highest costs for education and health care. In return, the federal government gives Hawaii less than $11 million a year, meaning we are reimbursed at about ten cents on the dollar.

This lack of compensation for Hawaii occurs despite language in the Compacts that says “;it is not the intent of Congress to cause any adverse consequences for an affected jurisdiction.”;

The Lingle-Aiona administration has repeatedly urged our congressional delegation and the U.S. Department of the Interior to rectify this long-standing injustice by fully compensating Hawaii for all quantifiable COFA expenses. Those pleas have largely been ignored.

It is a simple fact that our taxpayers can no longer afford to fund the U.S. government's obligation, especially given the state's unprecedented budget gap and when many of our citizens are struggling with unemployment, foreclosures and the high cost of rent, food and other necessities.

At the Department of Human Services (DHS), we must cut expenses by $42 million in state funds over the next two years. We will achieve $30 million of those savings by giving about 7,000 adult, non-pregnant COFA migrants medical assistance through our new Basic Health Hawaii program, which starts September 1.

In addition to generating substantial savings for taxpayers, Basic Health Hawaii will extend free medical assistance—for the first time—to low-income aliens from non-COFA countries who are ineligible for federal aid.

Basic Health Hawaii includes 12 outpatient doctor visits each year, 10 hospital days, six mental health visits, three procedures and emergency medical and dental care, plus more pharmacy benefits, which is identical to our QUEST-ACE and QUEST-Net plans for low-income residents.

Hawaii is the only state that provides free medical coverage for COFA migrants, and we will continue doing so despite the state's unprecedented revenue shortfall.

Many COFA migrants are concerned about receiving less comprehensive medical coverage, and we are working closely with providers to ensure that their critical health care needs, such as kidney dialysis and chemotherapy, continue to be met.

In conclusion, it is time for the U.S. government to step up and fulfill its moral and legal obligations under the Compacts. It is also time for the U.S. to fully compensate Hawaii taxpayers for all they do to improve the lives of COFA migrants. These injustices have gone on for far too long.

Lillian Koller is the state human services director.