Hawaii island hospitals serving more than 500 Micronesians may be required to provide diversity training for their staff and hire community health care workers and interpreters to translate in Chuukese, Marshall­ese and more.

Prompted by the COVID-19 pandemic and Micronesians signing up for Medicaid, the ultimate goal of Senate Bill 1285 is to bridge cultural and language barriers between these communities and the hospitals. The bill is specifically focused on Micronesians who are migrants from the Republic of the Marshall Islands, Federated States of Micronesia (Yap, Chuuk, Pohnpei and Kosrae) and the Republic of Palau.

Under the Compacts of Free Association — a strategic military agreement between the U.S. and the three COFA nations — it allows Micronesians to migrate visa-free to the U.S. and its territories. Many come every year seeking jobs, education and health care.

The bill, introduced by Sen. Dru Mamo Kanuha (D, Naalehu-Kailua-Kona), passed Tuesday in the House Health, Human Ser­vices and Homelessness Committee.

SB 1285 was originally written to require all state hospitals to provide these services for COFA migrants. But due to financial concerns voiced by Oahu hospitals, the bill was amended to become a pilot program starting with hospitals in Hilo and Kona.

Most of the testimonies were in support of the measure, except for Hawaii Pacific Health.

Michael Robinson, vice president of government relations and community affairs at Hawaii Pacific Health, opposed the measure at the hearing.

In his written testimony, he said, “We acknowledge that implicit bias exists in all levels of society.” His concerns were directed at the language of the bill, which would require hospitals to hire community health care workers.

Kaiser Permanente and The Queen’s Health Systems testified in support but cited concerns about financially providing these services for COFA migrants.

Since the beginning of the pandemic, non- Hawaiian Pacific Islanders in Hawaii were hit harder than any other ethnic group. They make up 22% of COVID-19 cases despite being only 4% of the population.

Even so, COFA migrants had faced disparities before the pandemic. When Medicaid was stripped from COFA migrants, a University of Hawaii study from last year reported that COFA migrants had higher visits to emergency rooms.

Another report in 2019 from the UH Myron B. Thompson School of Social Work revealed there was bias against Micro­nesians in the workplace and health care facilities.

Neal Palafox, a physician and professor at the UH John A. Burns School of Medicine, testified in support. He has worked directly with COFA migrants while studying health disparity issues.

“I’m glad the bill went this far,” Palafox said. “To me it’s unfortunate because these issues that are described in the bill are really statewide. To be narrowed in the Big Island doesn’t bring as much equity as it should. It further suggests that the issues are only on the Big Island when it’s statewide.”

He added that the bill, despite recent amendments, is a step toward health equity after Medicaid was stripped from COFA migrants for nearly 25 years.

Medicaid access for COFA migrants was revoked in 1996 by Congress and then-President Bill Clinton. But Hawaii continued to fund it.

Because of the costs, former Gov. Linda Lingle in 2009 kicked COFA migrants off of Medicaid and onto Basic Health Hawaii, which had restrictions to certain health services and prescription drugs.

Some COFA migrants who arrive to Hawaii have preexisting health issues, such as cancer or diabetes. So those who are on dialysis or chemotherapy need more than four prescription drugs a month.

In December the U.S. Congress signed a bill that would make COFA migrants eligible to sign up for Medicaid, and applications were available by January.

Josie Howard, a Chuukese program director at We Are Oceania, has been in the forefront of the COVID-19 pandemic. We Are Oceania is an organization in Kalihi run by Micronesians in Hawaii.

She and her staff have worked closely with COFA communities, providing serv­ices such as translations in Chuukese, Marshallese and other Micronesian languages.

Howard and other supporters of the bill echoed Palafox’s comments on health equity.

“I know that in the long run if we fight for equity for the marginalized groups, it’s good in the long run for all,” Howard said. “Just like in a family. When one family member is affected, everyone is affected. It’s in our culture as Pacific Islanders.”