Since 1947, the United States has had a moral and legal responsibility for the welfare of Pacific Islanders within the region commonly referred to as “Micronesia.” That responsibility began after World War II when the United Nations created the Trust Territory of the Pacific Islands (TTPI), assigning to the United States responsibility for administering islands that were previously possessions of Japan or Germany. In this “strategic trust,” the United States accepted responsibility for the health, education, and welfare of those Pacific Islanders.
In 1960, the United Nations issued a report critical of how the United States had discharged its legal responsibility, especially in failing to prepare Micronesians for self-governance. Following that report, the United States significantly increased financial assistance to the islands, but instead of promoting the islands’ self-sufficiency, the United States engaged in a strategic political policy fostering economic dependency to ensure that the islands would remain permanently bound to the United States, denying to any other nation or potential adversary a military presence to this vast geographic territory.
As a measure of how its moral responsibility was discharged: the United States military subjected the islands and its people to weapons-testing. From 1946 through 1958, the United States detonated 93 atomic and hydrogen bombs (1,000 times more powerful than the bomb that destroyed Hiroshima) in atolls of the Marshall Islands. The military further experimented with weapons of germ warfare on Eniwetak to test germ-laden aerosols dispersed over water. The military continues the use of the world’s largest lagoon in Kwajalein Atoll as a missile test range.
In the period from 1986-1994, independence for three of the island-nations was achieved through establishing the Compacts of Free Association (COFA). The COFA nations are the Republic of Palau, the Federated States of Micronesia (Yap, Chuuk, Kosrae, and Pohnpei), and the Republic of the Marshall Islands. Under these compacts the three nations are sovereign, self-governing, while receiving financial support from the United States for a limited number of years.
In exchange for granting the United States exclusive access to its lands and oceans, the major bargaining chip the nations obtained under COFA was the right to free-entry travel and work in the United States. COFA citizens are exempt from the visa and labor certification requirements of the Immigration and Nationality Act.
How does all this relate to persons with disabilities? In a multitude of ways! After eight decades of legal and moral responsibility for the region, COFA citizens, including those with disabilities, still lack access to quality health care, education resources, and a safety net of social services. The region is virtually without any medical specialists, therapy services, or rehabilitation opportunities. Services for children and adults with disabilities are limited, even in urban areas, and nonexistent in rural areas. And, because of the legacy of nuclear tests, high rates of chronic disease, and substandard health care, the prevalence of disabilities is significantly higher than in the United States.
As a result, many adults with disabilities and parents of a child with disabilities, exercise their right as a COFA citizen to emigrate to the United States to access services unavailable to them in their nation. What is life like for them after they leave their nation to seek a better life? Unfortunately, much depends on which state they select for their future home.
Prior to 1996, Micronesians were considered “qualified aliens” eligible for federal assistance such as Medicaid. However, with the passage of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, this status changed to “non-qualified aliens,” making them ineligible for Federal aid.
Thus, eligibility for federally funded safety-net programs (such as Temporary Aid to Needy Families, Food Stamps, and Medicaid) is denied to COFA emigrants. Some states have made compassionate decisions to provide many of these safety-net services using state, not federal, funds. But information on which states, providing which services, is not readily available to emigrants, who generally chose where to emigrate dependent on the location of family members who have emigrated earlier.
For example, if a child with disabilities moves to Arkansas, the child is not eligible for Medicaid, but would be eligible in Hawaii or Oregon. If a family with a child with disabilities lives in Washington State, they are eligible for TANF and Food Stamps, but not eligible for these services in the neighboring state of Oregon!
These disparities and inequities, and the injustices they perpetuate, could be eliminated with passage of legislation introduced in the current Congress by Hawaii’s Congressional Delegation. This legislation, “The Covering our FAS Allies (COFA) Act,” would restore Medicaid coverage for COFA citizens living in the United States. Senator Mazie Hirono called this “a moral obligation.” Senator Brian Schatz described the legislation as “the federal government taking responsibility.”
Unfortunately, the legislation does not go far enough to ensure access to a full range of safety-net services. And, sadly, similar legislation was introduced in previous Congresses without passage.
But this is a hopeful step for the nation to repay a debt it owes to Pacific Islanders and to create a more level playing field for all COFA emigrants, especially enabling those with disabilities to have a higher quality of life.
Jean L. Johnson, PhD, MPH, MA, Associate Professor at the University of Hawaii, has been with the Center on Disability Studies (CDS) for the past two decades, serving as Acting Director (2004-2005 & 2013-2014) and Associate Director (2006-2013).