Going Off-Island: Marshallese Seeking a Better Life (and Better Healthcare) in a Place Not So Remote

Posted by Allison S. Bybee

In January, National Public Radio, in partnership with Kaiser Health News, aired a story on the access issues that Marshallese immigrants face in obtaining health care while living and working on the U.S. mainland. While most immigrants to the U.S. are eligible for Medicaid eligibility after a five year waiting period, those citizens of the Compact of Association States are not.

Located approximately halfway between Hawaii and Australia, the Marshall Islands are a remote set of 29 atolls consisting of approximately 1,000 islets and roughly 54,000 human inhabitants. Today there are only three tertiary level health care facilities in the country (two in the capital city of Majuro and one on the island of Ebeye). Due to the low number of medical personnel, sub-standard hospitalization care, and poor rural medical infrastructure, the quality and quantity of health care that is currently available to the Marshallese is of significant concern. Due to low per capital income levels (estimated at just around US$2,500 per year), a high unemployment rate of 30%, and increasingly higher costs of living, most Marshallese Islanders can ill afford costly medical attention.

While an independent country for the last 14 years, the relationship between the Marshall Islands and America is one of mutual benefit. In exchange for the current American military presence on the Kwajalein Atoll and its surrounding waters, the recently renewed Amended Compact of Association, allows Marshallese citizens to travel to and work in the United States without undergoing the standard lengthy immigration process. In 2008, three percent, or some 1600 citizens, of the Marshall Islands left behind their beloved white sand beaches to travel across thousands of miles to America hoping to find access to better paying jobs, higher education, and health services. To escape the cyclical poverty, the Marshallese, like many of America’s new and historic immigrants, come to the mainland United States to seek a better life. Yet when they arrive in the U.S. and choose to settle (primarily choosing the states of Arkansas, Hawaii, California, and Oregon) what awaits is sometimes a surprise. Yet while the Marshallese are allowed to work and live in the United States, there are denied Medicaid eligibility.

The current version of the House reform bill, HR. 3960: Affordable Health Care for America Act, aims to equalize some of this inequality. On page 1082 in section 1736, a seemingly small, but nonetheless important amendment to the 1996 Personal Responsibility and Work Opportunity Reconciliation Act grants Medicaid eligibility for the citizens of the Freely Associated States of the Republic of the Marshall Islands, the Republic of Palau, and the Federated States of Micronesia. This would be a God-send for the thousands of Marshallese immigrants currently residing in the United States, most of whom while working full time, are unable to afford preventive and chronic medical care insurance and/or other health related costs. Whether or not this provision will make it into the final health care reform package is a matter that only time will tell. As for now, there is no mention of the provision or the Marshallese in the Senate’s version of the health reform bill.