Health care for Micronesians in Hawaii and Constitutional rights

Under the Compacts of Free Association (COFA), people from the Freely Associated States - the Republic of Palau (ROP), the Republic of the Marshall Islands (RMI), and the Federated States of Micronesia (FSM) – have been migrating to the U.S. in increasing numbers. Prior to July 2010, the State of Hawai‘i had included these COFA migrants in its Medicaid program. In the face of budget constraints, the State removed these people from its Medicaid rolls. We examine different approaches used to advocate for reinstatement of Medicaid. We consider the cost-effectiveness, reparations, human rights, and legal perspectives. We suggest that we in public health take a social justice approach – one that is geographically broad and historically deep. However, it was a legal challenge to the denial of equal protection of the laws (i.e. the Fourteenth Amendment to the U.S. Constitution), that was successful in reinstating health care to the COFA migrants in January 2011. Regardless of social justice arguments that may be marshaled in favor of delivering health care to the people, it was an appeal to the judicial system that succeeded.