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A win for Micronesians in Hawai’i

December 16, 2010 

As reported in the Honolulu Star Advertiser, Micronesian islanders in Hawai’i who are part of the group of Compact of Free Association (COFA) nations won a court victory to restore health insurance benefits several days ago:

A federal judge ordered the state yesterday to restore lifesaving health benefits to low-income legal migrants from Micronesia, the Marshall Islands and Palau, a ruling that will cost taxpayers millions.

U.S. District Judge J. Michael Seabright issued a preliminary injunction requiring that more than 7,500 Pacific islanders receive health coverage equal to plans provided to Medicaid recipients.

The cash-strapped state had tried to save about $8 million annually by offering fewer benefits under a free plan called Basic Health Hawaii that went into effect July 1, but Seabright’s ruling ends that effort.

COFA islanders have a unique immigration status due to their countries’ relationships with the U.S.:

Micronesia, the Marshall Islands and Palau are beneficiaries of the Compact of Free Association, a 1986 pact with the United States granting it the right to use defense sites in exchange for financial assistance and migration rights after it used the Pacific islands for nuclear weapons testing from 1946 to 1958.

While the state of Hawai’i has a large number of migrants from the COFA islands, the federal government has not fulfilled its obligation to cover the cost of health care for these islanders.  Many of the health problems faced by the Micronesians in Hawai’i are the results of U.S. policies in the northern Pacific: nuclear fallout and/or the disruption of traditional economies, lifestyles and diets that have caused new health problems.

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Court Denies Hawaii’s Request for Dismissal of Suit against Basic Health Hawaii

November 15, 2010 

As Yokwe Online reports, U.S. District Court Judge Seabright denied the State of Hawai’i motion to dismiss a class-action lawsuit brought by Hawai’i residents from the Compact of Free Association (COFA) countries of Republic of the Marshall Islands, Federated States of Micronesia, and Republic of Palau.   The State of Hawai’i cut off health insurance for these residents and instituted a lesser insurance program called Basic Health Hawai’i.  This new plan does not cover many of the critical services needed by Micronesian islanders in Hawai’i, many of whom are refugees of U.S. nuclear testing in their home islands or of the intentional economic and social underdevelopment of their islands during the U.S. strategic trust rule over Micronesia.  The COFA residents’ lawsuit seeks to restore equal health benefits as provided to other Hawai’i residents.

While the United Nations mandated decolonization for all colonies under UN trusteeship in the aftermath of World War II, Micronesia was a special case under the “strategic trust” of the U.S. Essentially, Micronesia was treated as spoils of war.  U.S. military and civilian planners debated how to administer the islands and fulfill the mandate to assist the islands in their process of self-determination.  The U.S. wanted to maintain a permanent military presence in Micronesia and Okinawa to maintain hegemony over the Northern Pacific Ocean – the American Lake.

Seabright’s rejection of the State of Hawai’i's motion to dismiss the COFA lawsuit is a good sign that at least the COFA residents of Hawai’i will get their day in court.  Unfortunately the hearing will be too late for the 27 people who have died since September 1, 2009 as a result of being denied critical care.

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Source: http://www.yokwe.net/index.php?name=News&file=article&sid=2706

Court Denies Hawaii’s Request for Dismissal of Suit against Basic Health Hawaii

U.S. District Judge J. Michael Seabright ruled yesterday to deny the State of Hawaii’s motion to dismiss a class-action suit on behalf of migrants from the Compact of Free Association (COFA) countries of the Republic of the Marshall Islands, Federated States of Micronesia, and Republic of Palau.

Earlier this year, the COFA citizens residing in Hawaii filed the class action suit against the State’s Department of Human Services (DHS) officials, challenging the new Basic Health Hawaii (BHH) program which reduces the benefits and services previously provided to critically-ill dialysis and cancer patients.

The suit was filed on behalf of the over 7,000 Marshallese, Micronesians,and Palauns who are eligible for the State’s health program.

The Plaintiffs claim, in Korab et al v. Koller et al, filed August 23, 2010, in Hawaii District Court, that the BHH violates the Equal Protection Clause of the Fourteenth Amendment because it provides less health benefits than the State of Hawaii’s (the “State”) Medicaid program offered to citizens and certain qualified.

It also claims a violation of the Americans with Disabilities Act (the “ADA”) because BHH is not administered in the most integrated setting appropriate to meet the medical needs of this specific population.

At a hearing on November 2 in regard to Hawaii’s request for dismissal, Judge Seabright said he was struggling over the case. Micronesian community representatives reported that elimination of medical benefits has impacted many, including 27 who have died since Sept. 1, 2009.

The new ruling rejects the State’s characterization of their actions “as simply creating a brand new benefits program where one did not exist.”

The Court stated in the November 10 decision:

    For the last fourteen years Defendants have provided COFA Residents the same benefits as those provided to citizens and other qualified aliens, creating a unified program treating citizens, qualified aliens, and non-qualified aliens the same, regardless of federal funding. Accordingly, the issue is not whether a state must create a benefits program for certain groups of individuals where no program exists, but rather where a program involving state funding already exists, whether a state may then exclude certain groups from that program based on alienage.

The Court also said that the Plaintiff’s assertion, regarding BHH’s limitation of benefits requiring them to seek care in a hospital setting, “may be sufficient to state a claim for violation of the ADA.”

– by Aenet Rowa, Yokwe Online, November 11, 2010

Suit seeks restored health benefits for Pacific migrants

August 25, 2010 

The Honolulu Star Advertiser reports that Pacific islanders from nations that have Compacts of Free Association (COFA) with the U.S. living in Hawai’i are suing to restore health care benefits for these Micronesian residents who need critical care that would be denied under the separate and unequal “Basic Health Hawaii” plan created for COFA residents. The lawsuit challenges the constitutionality of creating an unequal health benefit for this group. The article reports that the COFA islanders have a unique status within the U.S.:

Basic Health Hawaii, which went into effect in July, is a reduced benefits package created mostly for Compact of Free Association migrants. Residents of the Federated States of Micronesia, Republic of Marshall Islands and Palau can travel freely in the U.S. due to a 1986 federal agreement. In turn, the island nations gave the U.S. strategic military rights.

The federal government reimburses those states and territories most affected by migrants from the COFA islands for some of the cost of health, education and social services:

Under the Compact of Free Association, Hawaii, Guam, the Commonwealth of the Northern Mariana Islands and American Samoa share $30 million in funding to alleviate the burden the migrants may place on health, educational, social or public-sector services.

Guam has the largest share of the pot, with $16.8 million. Hawaii has $11.2 million, all dedicated to “supplement state funds to support indigent health care,” according to the U.S. Office of Insular Affairs.

That is not enough for the state, which spends up to $50 million a year on medical assistance for migrants, said state Human Services Director Lillian Koller during a July interview with the Star-Advertiser, after the plan went into effect. The state spends about $130 million a year on total public services to migrants.

What’s not mentioned is that many of the Micronesians in Hawai’i are survivors of the 67 nuclear and atomic tests conducted by the U.S. in the Marshall Islands and are suffering the effects of those blasts. Furthermore, few people understand that the U.S. intentionally stunted the development of the Micronesian island states in order to keep them dependent and loyal to the U.S. in the post-WWII period.  The entire north Pacific is a U.S. colony in that sense.

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Source: http://www.staradvertiser.com/news/20100824_Suit_seeks_restored_health_benefits_for_Pacific_migrants.html

Suit seeks restored health benefits for Pacific migrants

By Gene Park

POSTED: 01:30 a.m. HST, Aug 24, 2010

Dialysis patient Manuel Sound needs 11 prescriptions for medication. Each month, he’s able to fill four.

He’s grateful that he’s allowed dialysis care under the recent Basic Health Hawaii plan, a state-funded plan that has been reduced after a compromise with the community it is targeted for: Compact of Free Association migrants. But it still limits his care.

“I need medication for high blood pressure. I need medication for cholesterol. I need medication for diabetes,” said the 70-year-old Kalihi resident, who moved to Hawaii from Chuuk eight years ago. “I have to talk to my doctor about cutting down on the medication, because sooner or later I won’t be able to afford it anymore.”

A class-action federal lawsuit was filed yesterday in an attempt to restore health benefits to Sound and about 7,500 Pacific island migrants in Hawaii.

Basic Health Hawaii, which went into effect in July, is a reduced benefits package created mostly for Compact of Free Association migrants. Residents of the Federated States of Micronesia, Republic of Marshall Islands and Palau can travel freely in the U.S. due to a 1986 federal agreement. In turn, the island nations gave the U.S. strategic military rights.

The state had initial plans for bigger cuts to benefits, including not covering lifesaving dialysis and chemotherapy treatments. A federal lawsuit from the migrant community, of which Sound was a main plaintiff, forced the state back to the drawing board.

A federal judge issued a temporary restraining order on the state’s previous plan. Chemotherapy is now provided as part of the drug benefits in the current plan, while dialysis will be covered as a federally funded emergency service.

THE CRUX of the new lawsuit’s argument questions the constitutionality of providing inferior benefits due to immigrant status and duration of U.S. residency. The suit also alleges a violation of the American with Disabilities Act in that it forces migrants with disabilities to seek care in a hospital setting. It was filed by Lawyers for Equal Justice and firms Alston Hunt Floyd & Ing and Bronster Hoshibata.

“The state of Hawaii may not discriminate on the basis of national origin,” said Margery Bronster, a partner with Bronster Hoshibata and former state attorney general. “Once the U.S. government allowed COFA residents free access to the U.S., no state could limit those rights.”

State human services officials had not seen the lawsuit as of yesterday afternoon. Department of Human Services spokeswoman Toni Schwartz said officials will read the complaint before issuing any statements.

Under the Compact of Free Association, Hawaii, Guam, the Commonwealth of the Northern Mariana Islands and American Samoa share $30 million in funding to alleviate the burden the migrants may place on health, educational, social or public-sector services.

Guam has the largest share of the pot, with $16.8 million. Hawaii has $11.2 million, all dedicated to “supplement state funds to support indigent health care,” according to the U.S. Office of Insular Affairs.

That is not enough for the state, which spends up to $50 million a year on medical assistance for migrants, said state Human Services Director Lillian Koller during a July interview with the Star-Advertiser, after the plan went into effect. The state spends about $130 million a year on total public services to migrants.

“There was no serious effort made to try to help Hawaii deal with this burden for so many years,” Koller said. “The little bit we get now doesn’t even come close to what the costs are. It shows a real lack of political will.”

Without the reduced benefits plan, which would save the state up to $15 million a year, layoffs and program cuts could occur, Koller said. The benefits should be funded in full by the federal government, she said.

“We are doing the best we can. We do care about all people who live here,” Koller said, “but we have not been able to garner the help we need to offer what these people deserve.”

Koller and Gov. Linda Lingle have made numerous requests for more funding, to the U.S. Department of Homeland Security and U.S. Sens. Daniel Inouye and Daniel Akaka.

“Many of these migrants arrive with health conditions that require costly and extensive treatment,” Lingle wrote in a letter to Homeland Security Secretary Janet Napolitano in February. “They also arrive without adequate financial resources and without enough education or training to help them in obtaining employment. … The compact clearly provides that ‘it is not the intent of Congress to cause any adverse consequences for an affected jurisdiction.’”

Hawaii’s congressional delegation did gain the potential to bring in a so-called disproportionate- share allowance to local hospitals. The allowance is $2.5 million per quarter through December 2011.

“They have secured some significant federal resources to pay for uncompensated care provided in Hawaii hospitals that could be used to provide services for compact migrants,” said Inouye’s spokesman, Peter Boylan. “However, the state needs to release the necessary matching resources.”

BASIC HEALTH HAWAII

The Basic Health Hawaii plan, administered by AlohaCare, Hawaii Medical Service Association and Kaiser Permanente, offers four medications a month, including brand-name chemotherapy drugs, and provides the following annually:

» Twelve outpatient doctor visits

» Ten hospital days

» Six mental health visits

» Three procedures

» Emergency dental and medical care, including kidney dialysis

Recruiters target Micronesians for U.S. military

May 5, 2010 

Military recruiters exploit the poverty of Micronesia and other Pacific islands to fill their quotas.  The U.S. took the land, then they take the youth to fight wars of empire.   Here’s a fact to make one ponder:  “A recent study by the Heritage Foundation of US enlistment rates cites “Native Hawaiian/Other Pacific Islander” as the most overrepresented group as of 2005, with a ratio of 7.49, or an overrepresentation of 649 percent.”

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http://www.csmonitor.com/World/Asia-Pacific/2010/0505/Uncle-Sam-wants-Micronesians-for-US-military

Uncle Sam wants Micronesians for US military

US military recruiting from the Federated States of Micronesia, per capita, leads all American states. Many see an economic path out of the isolated Pacific nation, but some don’t know they might fight in Iraq or Afghanistan.

By Tony Azios, Correspondent / May 5, 2010

Pohnpei, Federated States of Micronesia

The portraits of stern-faced young men on armed forces recruiting posters, hanging from cafeteria walls, seem to gaze down at the mingling teenagers. Below, about 130 high school seniors have gathered to sit for a US military aptitude test required by the school’s administration. Several dozen plan to enlist; many more are still on the fence.

The students are from the Western Pacific island of Pohnpei. And the scene is repeated nationwide several times each year – putting the four states that make up the Federated States of Micronesia (FSM) ahead of every US state in Army recruits per capita in recent years.

Lloyd Daniel, a talkative senior with a taste for pizza and American slang, will ship out for Army training on June 29. He joined for the same reasons most kids here do: to see the world, get a steady paycheck, and pay for college. Also, Lloyd feels a sense of debt to America: “The US has been here helping out our island in many ways, so I feel that we, as Micronesians, must return the favor.”

Liberated from Japanese occupation by US troops during World War II, the FSM were administered by the United States as part of the Trust Territory of the Pacific Islands from 1947 until independence in 1986, when the two countries entered into a compact of free association. The independent nations of Palau and the Marshall Islands, which also were administered by the US following World War II, negotiated separate compacts and achieved independence at different times but are also visited by US military recruiters. The compact obligates the US to defend these sovereign countries from attack, and grants their citizens permission to live and work in the US without a visa and serve in its armed forces. Non US-citizens can serve but cannot become commissioned or warrant officers.

This has been a major boon to Micronesia, located 2,500 miles southwest of Hawaii. Its lackluster economy averages $2,200 gross domestic product per capita. With a median age of 18.9, the FSM has one of the world’s youngest populations; with a 22 percent unemployment rate, however, jobs are scarce. Remittances from enlisted citizens help many families stay afloat, and the promise of education benefits, signing bonuses, and a starting salary of just under $17,000 for a private first class all serve as effective lures.

Some critics, however, see military recruiters as preying upon an impoverished population. “Economically disadvantaged families are filling the ranks of the US armed forces,” says John Haglelgam, former president of the FSM. Mr. Haglelgam, who has opposed Micronesians serving in the US military, says most Micronesians share his view, but see the military as their best hope for upward mobility.

An opportunity to advance

“It’s very unfortunate that families here are pinning their economic dreams and hopes on the blood of their children,” says Haglelgam. “The chance for [extra income] has emboldened families to not object.”

It is thought that between 1,000 and 1,500 of the FSM’s approximately 107,000 citizens are currently enlisted, with many more veterans now in the US or on one of the nation’s 607 widely scattered islands.

But while some Micronesians see the US military as their ticket out, many here are poorly informed of the risks. The FSM has suffered more casualties in Iraq and Afghanistan per capita than any US state, and has lost soldiers at a rate five times the US average. Some recruits sign on unaware the US is fighting two wars.

Hideaki Charley, a high school senior planning to ship out for Army training this summer, lives in an outer municipality where newspapers and Internet access are hard to come by. He only found out that America was at war in one country, not to mention two, about a year ago – weeks after he had enlisted.

‘They didn’t tell me about the wars’

“The recruiters didn’t tell me about the wars,” says Hideaki. “They told me about the good things” such as enlistment bonuses and the chance to travel. “But I didn’t ask [about war],” he adds.

US forces may also find the remote islands such fertile ground for recruitment because residents have been largely spared from the deluge of media coverage of the years-old wars. A recent study by the Heritage Foundation of US enlistment rates cites “Native Hawaiian/Other Pacific Islander” as the most overrepresented group as of 2005, with a ratio of 7.49, or an overrepresentation of 649 percent.

With three tours of duty in Vietnam and a career with Special Forces, 1st Sgt. Frank Semens (ret.) is one Pohnpeian who does know the risks. Still, in his role as US Army recruiter here, Semens would rather not discuss with potential recruits the dangers they may face.

“I’ve never tried to explain the risks to [potential recruits] because I don’t want to scare them,” says Semens. “I tell them about the opportunities.”

Semens says that most Pohnpeian parents assume their child will automatically become a sohnpei, or warrior. “Not so,” he tells them. Semens stresses to recruits and their families that there are many noncombat positions available that provide training in applicable skills and trades. It’s these opportunities, as well as a long military tradition that keeps Micronesians enlisting at such high rates, says Peter Prahar, US ambassador to the FSM. “If we didn’t give a [recruitment] test, there would be an uproar,” says Ambassador Prahar. “People want to take this test.”

Haglelgam also recognizes the popularity of service. “This is a volunteer military, and people should have the right to make that choice,” he says. “My hope is that they will have all the information in front of them when they make their decision.”

Even when they know the risks, many still choose to serve. “I would still join. It doesn’t matter,” says Hideaki. For now, what he most wants to discuss is his first trip off-island this summer to Guam, for a medical checkup with the Army.

Plans to cut health care for Micronesians will endanger lives

January 26, 2010 

http://www.starbulletin.com/news/20100126_Planned_cuts_could_risk_health_of_Micronesians.html

Planned cuts could risk health of Micronesians

By Gary T. Kubota

POSTED: 01:30 a.m. HST, Jan 26, 2010

A proposed cut in the state government’s medical assistance to Micronesians could mean some of them will die as a result, the state was told yesterday during a public hearing.

Health experts also raised questions about the long-term savings when preventive measures are denied to a group of Micronesians who choose to live in Hawaii but are unable to afford medical insurance and must be covered by the state’s Quest program.

“The state will not likely save money if it proceeds with this plan,” said Dr. Neal Palafox, chairman of family medicine and community health at the University of Hawaii John A. Burns School of Medicine.

Palafox, who said he was speaking as an individual, said taking away health care that prevents illnesses will increase the likelihood of health complications for Micronesians, who are prone to certain diseases, including diabetes.

Palafox said the state’s estimated population of Micronesians in Hawaii was 13,000, far below other reports of 17,000 to 20,000.

He said he had not seen state health officials present an analysis of the change’s impact.

More than 110 people attended the public hearing at the state’s Liliuokalani Building yesterday.

Under a Compact of Free Association signed by the federal government, residents of Palau, the Marshall Islands and Federated States of Micronesia are allowed to work and reside in the United States.

Micronesians say their islands do not have the high level of medical services available in Hawaii.

State health officials said Hawaii receives $11 million from the federal government for all services provided to Micronesians, while spending an average of $120 million annually. The proposal aims to save up to $8 million a year.

Faced with a tight budget, health officials have proposed keeping state medical assistance for Micronesians who are under the age of 19 or pregnant.

But the proposal cuts medical services for other Micronesians in Hawaii, except in the event of emergencies.

The proposal is to transfer 7,000 adult noncitizens from Quest into a new Basic Health Hawaii Program.

Manuel Sound, 70, a former lieutenant governor of the Federated States of Micronesia, said if he misses too many dialysis treatments, he will be dead.

Sound said Micronesians have been affected by U.S. nuclear tests done from 1946 to 1958 and have high rates of kidney and heart disease.

He said he felt the state was picking on Micronesians.

“This is really unfair,” he said. “This is discrimination.”

Masae Kintaro said the U.S. military recruits Micronesians to serve in wars, including her husband, who died fighting in Vietnam.

“He didn’t die for American citizens only. He died for our people,” she said.