Spurned by a federal court, Pacific migrants seek justice through politics

Micronesians in Hawaii, who face adjustment problems similar to other relatively new arrivals, have turned to the courts for help but now are poised to change tracks and go political.

A federal ruling that would relieve the state of Hawaii of the obligation to cover low-income health benefits has riled up a community that otherwise engages relatively little with the political process. Earlier this month, a contingent marched through downtown Honolulu to the Federal Building, carrying placards with messages such as "Federal Obligation Is State Responsibility."

Beyond that action, a core group of the migrant population, joined by supporters, is mobilizing under the name COFA Community Action Network, or COFA CAN.

At the helm sits a University of Hawaii graduate student, Joakim Peter, born in Chuuk, who believes political action is the only path toward improving conditions for Micronesians. Advocates for their cause, including attorney Victor Geminiani, see Micronesians like Peter as the vanguard of new leadership.

"He will tilt against windmills in a way other Micronesians can’t," said Geminiani, who is executive director of the Hawaii Appleseed Center for Law and Economic Justice, a nonprofit group that has published briefs and otherwise advocated for Micronesians.

Peter, who is himself wheelchair-bound, is pursuing a doctorate in special education at UH. In recent weeks, COFA CAN has been doing some organizational strategy to fight for equitable medical benefits for Micronesians.

COFA stands for the Compact of Free Association, the agreements entitling the people of three Micronesian nations to come and go as they please and work in the United States, without the need of a visa. The focus of this legal fight has been the health-care costs to the state of about $52 million annually.

But they also pay state taxes, which help cover other benefits such as public education.

Micronesia is a geographic region encompassing the compact nations of the Federated States of Micronesia, Palau and the Marshall Islands. Firm census counts are elusive, but the size of the community has been estimated at 12,000-15,000 in Hawaii.

Circumstances also have shifted over the years on the benefits Micronesians can tap while in the U.S. Originally they qualified for almost any federal program available to citizens, but that has changed, particularly on the issue of health care.

"This issue is one that we continue to ask ourselves questions about, that are difficult because it has to do with human lives," Peter told COFA CAN members at a strategy meeting, held April 12 in a Kuhio Park Terrace community conference room. "It has to do with the rights of people to have access to health care. It has to do with the rights of families to be taken care of.

"We got a joint resolution from the Legislature, basically asking Congress to fix the problem."

Micronesian health care history has been complicated from the start because of the nuclear weapons testing in that Pacific area after World War II. Some of the original health concerns arose as an aftermath of the testing and included forms of cancer.

According to a 2009 study published by a team including Ann Pobutzky, a state Department of Health epidemiologist, chronic diseases were the vast majority of identified conditions among Micronesians. Diabetes was the most frequently reported medical condition, reported by one in three adults 40 and older, according to "Micronesian Migrant Health Issues in Hawaii."

Getting better treatment of such conditions is at the heart of the current mobilization effort. Earlier this month, the U.S. 9th Circuit Court of Appeals ruled in Korab v. McManaman that the state was not compelled to offer benefits equivalent to Medicaid to qualifying Micronesian migrants, given that the federal government does not fund it for this population.

This would mean the state could resume what was dubbed Basic Health Hawaii (BHH) when it was first launched in 2009 under the administration of Gov. Linda Lingle. It is enabled by state money; some federal funds are available but much less than what Uncle Sam provides through Medicaid.

BHH provided for 12 outpatient visits, 10 in-patient hospital days, five prescriptions (later cut to four) and other limited services. It also was capped at 7,000 enrollees, and it did not cover dialysis or cancer treatments, except on an emergency treatment basis.

This appellate ruling overturned a 2010 decision by a lower court that invalidated BHH. Since then, migrants who met the low-income qualifications have been restored to full Medicaid-level benefits under the state’s QUEST program.

For the near term, that status quo will remain in place. The state Department of the Attorney General issued a statement that the Micronesian community would continue to receive full benefits "until a full and final resolution of the issues in Korab v. McManaman is reached."

"The state will make sure that COFA residents continue to have uninterrupted access to their health benefits while this lawsuit is pending," said Attorney General David Louie in the written statement.

It’s what happens later that worries the members of COFA CAN. Deja Marie Ostrowski, an attorney who worked with the Appleseed Center on the issue as an AmeriCorps staffer, said enrollments of Micronesians are being made with an added notation not appearing for anyone else: BHH. That seems to position the state to revert to the reduced-benefit program when litigation ends, Ostrowski said.

She added that there could be appeals, but immigration attorneys worry that this could provide an opening to the U.S. Supreme Court to reverse rights established in 1971 in a case called Graham v. Richardson.

"It’s the foundational case that says the constitutional protections under the 14th Amendment apply not just to U.S. citizens but all noncitizens in the United States," Ostrowski said. "It’s always been said that there’s a really great risk of doing great harm to the COFA community and also all immigrant communities if there is an appeal to the U.S. Supreme Court."

That’s why the path has turned from judicial to political action, leading up to Capitol Hill. That’s where COFA nations were barred from Medicaid benefits in the first place, under welfare reform (the Personal Responsibility of Work Opportunity Reconciliation Act of 1996).

COFA citizens are uniquely excluded. The law states that immigrants qualify for medical coverage (and certain other federal benefits) after living in the U.S. for five years, but technically the COFA residents are legal migrants, not immigrants. That’s because of the unique arrangement allowing for free travel and work without the visa expiration dates that apply to legal immigrants.

Armed with the state joint resolution, advocates have approached Hawaii’s congressional delegation, Peter said, starting with U.S. Sen. Mazie Hirono, who sponsored an amendment to immigration reform legislation that would restore Medicaid eligibility for Micronesians.

The bill passed the Senate but is almost certain to be dead in the House. So the community underscored its resolve for a Medicaid fix in that April 16 march to the Federal Building. The event was sponsored by St. Elizabeth Episcopal Church, a parish in Palama that includes many Micronesian members. Marchers delivered a petition seeking Medicaid restoration to the four congressional offices.

On the state level, the push will be to get rid of the BHH program, Peter said. In his job as an assister to enroll people in health plans under the Affordable Care Act, he said he has seen the COFA enrollees signed up in the separate BHH class.

As the strategizing meeting wound down, the challenge ahead was outlined on a large board at the front of the room, COFA CAN members picking up assignments that are standard to any number of 21st century movements.

Some would work to unify the message among the disparate Micronesian groups; some would build the Web and social media outreach; some would work with sympathetic groups who could provide solidarity, Peter said.

"We need to talk to our partners — who are our partners? Here on Oahu, in the state? On the mainland? Back home?

"We need to talk to our communities," he added. "Our communities have to know what is at stake here for them."