In 2002, three of Hawaii’s hospitals (Queen’s, Straub,
and Kapiolani) provided $15 million in services that was never paid
for by Pacific Islanders, according to the Hawaii Health Survey conducted
by the Healthcare Association of Hawaii. With hundreds of health care
providers across the state, it is estimated that this $15 million
is just a small percentage of the total in uncompensated care provided
to Pacific Islanders.
Citizens of certain Pacific Island nations come to Hawaii as a
result of Compacts of Freely Associated States. The Compacts are
international treaties that spell out the rights and obligations
- unrestricted entry to the U.S.
- access to residence, education, health care and employment.
Hawaii continues to experience a significant influx of these citizens.
of Free Association Established in 1986
Federated States of Micronesia. Consists of four major
island groups: Pohnpei, Chuuk, Yap and Kosrae.
Republic of the Marshall Islands. Consists of two chains
of 1,152 islands and 30 atolls, including Majuro (the
capital); Ebeye Island, in Kwajalein Atoll; and Bikini
and Enewetok atolls.
Republic of Palau. Consists of six island groups totaling
more than 200 islands.
The 1996 Personal Responsibility & Work Opportunity Reconciliation
Act eliminated eligibility of all legal immigrants for any public
assistance. Federal funds may not be used to provide Medicaid benefits
for Pacific Island citizens in Hawaii. As a result, taxpayers and
the State of Hawaii underwrite the entire cost of QUEST and Medicaid
fee-for-service health care.
migrants tend to be poor, have limited work skills, and face language
and cultural barriers in Hawaii. They also come with a host of communicable
diseases, notably Hansen’s disease, tuberculosis, hepatitis,
and STDs,” according to Hawaii’s Special Needs, a September
2001 report. The report was prepared by the Statewide Strategic
Projects initiative of the nonprofit Hawai‘i Primary Care
Association, which advocates for access to quality primary care.
“Although most Compact migrants come for economic opportunities,
some also come specifically to get health care that is not available
to them at home,” the report stated. “This includes
people with chronic conditions, such as diabetes and cardiovascular
disease, and radiation-related illnesses, such as thyroid and other
Some experts anticipate that the number of Pacific Islanders in
Hawaii will continue to rise, further adding to Hawaii’s health
care issues. Factors contributing to this increase include:
- a growing and aging population of Pacific Islanders
- high rates of infectious and chronic disease
- a continued lack of health resources in these Pacific Island
Uninsured Project has assembled a committee of health care providers
and health coverage experts, along with representatives of Hawaii’s
congressional delegation and the federal government to explore this
issue and develop possible solutions.