236996 Health care for Micronesians in Hawaii and Constitutional rights

Monday, October 31, 2011: 4:30 PM

Seiji Yamada, MD, MPH , John A. Burns School of Medicine, University of Hawaii, Honolulu, HI
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.

Learning Areas:
Advocacy for health and health education
Diversity and culture
Provision of health care to the public
Public health or related public policy

Learning Objectives:
1. Describe four approaches to advocate for equity in access to health. 2. Explain the demonstrated success of the legal approach.

Keywords: Health Care Access, Asian and Pacific Islander

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a physician serving Micronesian patients, and I have assisted the legal team that successfully challenged denial of care for them.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.