Hawaii has been saddled since 1986 with providing health care to low-income migrants from Palau, the Marshall Islands and Micronesia that had been promised by the federal government. A federal judge’s rejection of the state’s limitation of their health care should spur an urgent, renewed effort to make Congress pay more of the tab.

The Government Accountability Office, the nonpartisan congressional research arm, is working on an audit of federal funds that have gone to pay for the health care promised under the Compacts of Free Association Act, which gave the Pacific nationals the right to live and work as "migrants" in the U.S. The audit is sure to conclude that the funds are inadequate, which is already woefully known here.

The federal government has ignored its obligation from the beginning. Last year, the U.S. State Department notified the Marshalls and Micronesia that it has "no commitment" to provide medical care to their migrants in the U.S. At this point, Hawaii spends $120 million a year on health care for the migrants, while the federal government contributes only $11 million.

The Hawaii congressional delegation inserted language into last year’s health care reform act that would have made Pacific island migrants eligible for federal Medicaid and increased federal funding to Hawaii for their health care, but it was dropped from the bill’s final version.

"Everyone here would rather see this cost spread around the entire nation than just the state of Hawaii," said U.S. District Judge J. Michael Seabright in ordering adherence to the obligation forced upon the state.

But the judge cannot tell Congress what it must do.

Hawaii had recently limited annual health care for the migrants to 10 days of inpatient hospitalization, 12 outpatient visits and four medication prescriptions per month as a way of cutting costs by $8 million.

Hawaii is not the only state to be forced to cope with expenses thrust upon it by federal abrogation of its onetime commitment. While 7,500 Pacific islanders receive health care in Hawaii, about 40,000 Micronesians and Marshall Islanders are living in the United States, including about 7,000 in Arkansas. Two congressmen from Arkansas joined Hawaii’s Rep. Mazie Hirono and then-Rep. Neil Abercrombie, as well as four Pacific delegates to Congress, in asking the GAO for the audit in February.

Now Hawaii governor, Abercrombie remarked that Seabright’s decision "will have a significant impact on the state’s economy." He reiterated what Hawaii public officials have pointed out for years, that the responsibility to pay for Pacific islander migrants’ health care "lies with the White House and the Congress," despite last year’s State Department notice.

Congress is not likely to assume the obligation of paying for full health care of migrants. At most, Hawaii’s congressional delegation should press for federal matching funds to help care for Pacific migrants.