Are migration challenges faced by islanders and U.S. states fixable?

Out-migration to the United States of tens of thousands of islanders from U.S.-affiliated islands has become a front-burner issue for U.S. states and territories hosting the largest numbers, with headlines—mostly negative—now regularly in the media. Hawaii and Guam, in particular, are raising the volume of their complaints to the U.S. federal government over lack of reimbursement for health and education costs, and other areas—Arkansas, for example, where an estimated 7,000 Marshall Islanders live—are likely to follow.

Since 1986 when the first Compact of Free Association came into effect between Washington and the Federated States of Micronesia, Marshall Islands and Palau, citizens of these three freely associated states (FAS) have had visa-free access to the U.S. to study, work and live.

The tempo of out-migration picked up in the mid- and late-1990s, particularly from the FSM and Marshall Islands, as job markets remained stagnant, and health and education services declined.

When Guam Governor Eddie Calvo said at a Washington, D.C. meeting of governors in February that FAS citizens were pushing Guam government agencies ‘to the breaking point’, and said the problem was many in-bound FAS migrants were uneducated and unhealthy, it ratcheted up official state concern about migration to a new level. This follows the state of Hawaii’s decision reached late last year, supported by U.S. courts, to stop providing expensive dialysis and cancer treatment to most FAS citizens as of March 1.

Recent estimates suggest the number of FAS citizens now in the U.S. is approaching 100,000, though more and more are American citizens by virtue of birth in the U.S. The large numbers in Hawaii, Guam, Arkansas, Oregon and Washington, to name a few, are beginning to stand out with state agencies under budget pressure as they attempt to provide health and social services with dwindling resources.

Although officials from the FAS often attend meetings to discuss what is called ‘Compact impact’, there has been little engagement overall with these far-flung communities.

Noted Micronesia commentator Fr. Francis X. Hezel observed recently: ‘Some who have chosen to remain in the islands may think of the migrants as people who have deserted their homeland when things became tough. Sometimes political figures in FSM can put their own stamp on this position, as when they state that migrants have made their choice to leave and so should be left to take care of themselves without any help from FSM government. At times, political leaders seem to regard migrants as an embarrassment on the grounds that they bring unwelcome attention upon FSM. There are, of course, abundant stories of people getting tossed into jail, or filing for federal benefits within hours after they have landed. But the real problem for those FSM leaders may be that the very number of people leaving seems to be evidence that the problems back home haven’t been fixed: lack of jobs in a struggling economy, a mediocre educational system, and the absence of the advanced health care that many require.’

The fact that these islands have some of the highest rates in the world of tuberculosis, Hansen’s disease and diabetes tends to complicate the situation of FAS migrants in the eyes of officials providing services in U.S. areas.

What can and should be done to deal with both the legitimate budget concerns of areas such as Guam and Hawaii, and the legitimate needs of a group of people who are legally in the United States pursuant to a treaty from which the U.S. government derives numerous benefits? One major problem is that a U.S. law adopted in 1996 removed Medicaid health coverage for FAS citizens, which has put islanders at the mercy of state-level health care. Since a large number are uninsured and ineligible for federal or state health insurance programs, FAS citizens tend not to seek early health care because of costs. So many end up in emergency care situations, increasing hospital costs exponentially.

A paper published in the American Journal of Public Health last month, ‘Effect of U.S. policies on Health on Health Care Access for Marshallese Migrants’, argues that U.S. federal and state health policies should be changed to extend health care coverage to citizens of the Marshall Islands and other freely associated states legally living in the U.S. and its territories. ‘Marshallese persons and all Compact of Free Association (COFA) migrants in the United States (should be) treated as equal and have access to affordable, quality health care.’ Given that for most other legal immigrants in the U.S., health benefits have been incrementally restored since the U.S. Congress cut off Medicaid in 1996, it is hardly an unreasonable recommendation.

An important point made by this paper written by three U.S. university-based Americans is this: ‘Securing health care coverage for Marshallese migrant children is an important part of improving the overall health of the Marshallese community.’ This observation equally applies on the home front in the FSM and Marshall Islands, which have been unable to get a grip on communicable and non-communicable diseases that are spiraling out of control. Greater focus on improving the health of citizens resident in the FSM and Marshall Islands would have a positive impact on how arriving FAS immigrants are perceived in the United States, as well as reducing costs.

There is no question FAS countries are benefitting from the migration opportunity provided by the Compact of Free Association. With few job opportunities and stressed education and health systems, what would the FSM and Marshall Islands do if the nearly 100,000 islanders now resident in the U.S. were still living at home? In addition, with thousands of FAS citizens now employed in the U.S., albeit largely in entry-level positions, it is resulting in remittances to families back home, which is a huge benefit as economic conditions in the islands have shown little improvement in recent years. FAS citizens also fill a gap in Guam and U.S. states: they are filling entry-level and factory jobs that many U.S. citizens don’t want. In addition, hundreds of islanders enlist in the U.S. military at a higher per capita rate than Americans, the U.S. military has control of a western Pacific ocean area nearly the size of the continental U.S., and the Reagan Test Site in the Marshall Islands is a key part of the Defense Department’s missile defense program.

One state-level intervention shows a model for successful engagement by U.S.-resident FAS citizens. The Oregon state-based CANN—the Compact of Free Association (COFA) Alliance National Network—engaged state legislators and the governor two years ago to gain passage of a law making FAS citizens eligible for the same state identification and driver’s licenses as other Oregon residents. A 2005 federal law blocked issuance of all but temporary ID to FAS citizens, negatively affecting their ability to get jobs and housing. CANN has now gained support from legislators for the introduction of legislation to provide health care to FAS citizens living in Oregon. Though the bill may face challenges, since it was introduced at the end of January it has gained support in the media and from American military veterans, among others.

Clearly legislation and policy action at the national level would help the needs of FAS citizens living in the U.S. and is preferable to mounting multiple state-level efforts. The Oregon model suggests that active engagement with media, the community, and legislators has a positive outcome. Generally, this type of engagement by FAS government or community leaders in relation to Guam and Hawaii has been lacking except as a reaction to negative publicity or budget cutting moves, such as Hawaii has now taken to cut its spending on health care services for FAS citizens.

Relative to citizens of other nations attempting to migrate to the U.S., the estimated 100,000 FAS citizens in the United States are barely a blip on the radar and would remain so even if the entire populations of the FSM and Marshall Islands, roughly 160,000, moved to America tomorrow. In many states, they are small minority, though not so in smaller places like Guam and Hawaii.

Since both the U.S. federal government and the FAS governments benefit from the provisions of the Compact, positive action on these issues is called for. Moreover, it offers the FAS governments more than some positive public relations to engage at the federal and state level for their citizens in America—it offers a platform for addressing other issues of concern within the free association relationship. The Oregon results suggest the benefits of engagement with legislators.