A split ruling by an appeals panel that allows the state of Hawaii to reduce health benefits for migrants from Micronesia, Palau and the Marshall Islands is not the last word on this subject. In the interest of public health, and despite its preliminary legal victory, the state government should continue to extend full coverage as the case proceeds. Gov. Neil Abercrombie’s administration must simultaneously engage Hawaii’s congressional delegation to solve this problem at the federal level, where the financial responsibility rests.

A three-member panel of the 9th U.S. Circuit Court of Appeals — with one judge dissenting — ruled in favor of the state last week, vacating a District Court injunction that had prevented the state from reducing health coverage. That injunction was first granted in 2009 in a class-action lawsuit on behalf of people living in Hawaii under a Compact of Free Association with the U.S., which conducted dozens of nuclear weapons tests in the Marshall Islands through the late 1950s and maintains exclusive military rights over more than 2 million square miles of ocean encompassing the three island nations.

COFA migrants are allowed U.S. travel without visa or time constraints, designated as legally residing non-citizen nationals. Prior to 1996, they qualified for federal benefits such as Medicaid; U.S. welfare reform that year stripped their eligibility. As "nonimmigrant aliens," they are excluded from the class of "qualified immigrants" who remain eligible for Medicaid, the federal health insurance for the very poor. The U.S. government must correct this.

When federal funding dried up, Hawaii initially was among the states committed to providing robust health coverage to COFA migrants through state-funded programs. Although costly, that was the right decision, on moral, fiscal and public-health grounds — regular doctor’s visits are cheaper than the emergency room, which is where too many patients who lack insurance end up. Sadly, many COFA migrants, who come here primarily looking for work, end up in part-time jobs that don’t include health coverage. They also are overrepresented among Hawaii’s homeless, representing another public-health risk.

It was Abercrombie’s Republican predecessor who sought to reduce coverage. Despite last week’s victory, his administration could wisely choose to diverge from a path that makes certain Pacific Islanders — who are closely associated in culture and traditions with Hawaii’s own indigenous people — a permanent underclass.

The Lingle administration had sought to implement Basic Health Hawaii for low-income COFA migrants, limiting doctor visits to 12 a year and prescriptions to four a month. Preliminary injunctions in 2009 and 2010 thwarted both attempts. The plaintiffs contend that Basic Health Hawaii violates the Equal Protection Clause of the 14th Amendment because it extends less coverage than is offered to citizens and qualified aliens eligible for federal reimbursements through Medicaid.

While the appeals panel held that Hawaii had no constitutional obligation to fill the gap created by welfare reform, the ruling was no slam dunk. The dissenting judge wrote that the federal government is permitted to discriminate against aliens in a way that the state government is not, and that the panel should have applied strict scrutiny — the toughest standard of judicial review — to the issue. The COFA migrants have clear room to appeal.

Rather than denying full benefits, the state should focus on pushing the federal government to meet its obligations. The best long-term remedy is to specify COFA migrants in federal statute as among those eligible for Medicaid. In the short term, the U.S. government must provide more impact aid for states the migrants now call home. People from Micronesia, Palau and the Marshall Islands do hold a unique status in Hawaii, but it shouldn’t be second class.