Although it appears COVID-19 is indiscriminate in who it infects, we know that minority communities are disproportionately affected because of pre-established health disparities.
Within Hawaii, Native Hawaiians, Pacific Islanders, and Filipinos make up 59% of active cases. Under the category of “Pacific Islanders,” Micronesians are one of the most vulnerable minority groups that reside in Hawaii.
Micronesians possess a special immigration status that prohibits them from accessing Medicaid, leaving them with two options: attempt to navigate the confusing, arduous process of state-based health insurance, or end up with no insurance at all. The result of a complex, user-unfriendly interface for Micronesians is low enrollment in health insurance, higher cases of hospitalizations, and increased risk of developing preventable diseases.
With the COVID-19 pandemic ongoing, the health disparities the Micronesian community faces from a lack of health care equity will be exacerbated and expand upon the need for adequate health insurance for COFA immigrants.
In 1982, the Compact of Free Association was signed into law, granting the U.S. military access to the Federated States of Micronesia, Republic of Marshall Islands, and Palau in exchange for economic assistance and special immigration privileges. Under COFA, immigrants from the FSM, RMI, and Palau are considered to be non-immigrants who pay taxes and can reside, work, and learn in the United States without a visa. COFA immigrants were granted access to Medicaid until the 1996 Personal Responsibility and Work Opportunity Reconciliation Act excluded them.
To this day, COFA immigrants do not have access to Medicaid and are obligated to enroll in state-based health insurance or private insurance, both of which are not easily accessible. PRWORA forced many COFA immigrants to lose health insurance in the U.S., reverting them to the vulnerable state they experienced in their home country. Inadequate access to health insurance results in a higher prevalence of diseases that can be preventable which in turn leaves Micronesians vulnerable to the effects of COVID-19.
We Are Oceania
With minimal access to health insurance, Micronesians experience higher rates of preventable disease and infrequent visits to a family doctor, resulting in more ER visits that could be avoided with appropriate access to health insurance.
A 2016 study found that Micronesians were more likely to be hospitalized for severe illnesses and disease at a younger age than any other ethnic group in Hawaii. Micronesians possessed higher cases of cancer, substance abuse, and cardiac and infectious diseases than other ethnic groups. Without health insurance, access to health care becomes difficult, and often preventive care is neglected, resulting in an ER visit.
Micronesian immigrants, much less anyone regardless of status, should not be forced to wait to see a doctor until a dire situation occurs. Health care is a universal human right and there needs to be a change in how we approach the immigration status of COFA immigrants that prevents them from accessing health insurance.
Advocating for COFA immigrants is one way of supporting their needs and We Are Oceania, a local organization, does an incredible job of providing resources and help to the Micronesian community. Dayna Wilson, a Program Assistant at We Are Oceania, spoke recently at length about the services and programs that they provide for the community.
One crucial service they provide is “enrolling Micronesians in health insurance,” which is significantly difficult for those who are jobless, a common consequence in today’s pandemic. Social care workers, or Kokuas, take care of immigrants needing to enroll and apply for MedQuest, Hawaii’s state-based health insurance, translating English into native languages for better comprehension.
Healthcare is a universal human right.
Wilson said in addition to helping immigrants enroll, they do a lot of community outreach via “social media or door to door programming,” where they hand out flyers with “translations in each language that detail the dates, required forms, and hours of operation.”
We Are Oceania also prioritizes Micronesian youth, hosting a Micronesian Youth Summit that “empowers the youth based on Career, Community, and College” with guest speakers and workshops to supplement.
We Are Oceania is just one example of how we can better assist and navigate the difficult path for Micronesian immigrants to obtain health insurance and health equity.
I had the opportunity to speak with Dr. Wilfred Alik, a family medicine physician at Kaiser Permanente in Hilo, where we discussed extensively the barriers Micronesians confront. Dr. Alik relayed the biggest challenge Micronesians face is “accessing health care” and a set of policies that “render Micronesians ineligible to partake in public assistance programs.”
Social determinants of health also influence access to health care for the Micronesian community. For example, Micronesians are poor working class people in frontline industries “like the airport, hotels, fast food restaurants, and car rentals,” which makes them vulnerable and “highly exposed to others.” This increases their risk of contracting COVID-19 on top of their inability to access health insurance.
Dr. Alik also mentioned many Micronesians don’t have access to the internet because they “don’t own a computer or are illiterate.” Oftentimes, they don’t own an email account or know how to create one.
Compounding these social factors, Micronesians are challenged with racial discrimination, slandered as lazy people who take advantage of the resources from government assistance programs. However, this is an inaccurate portrayal of the Micronesian population.
Dr. Alik reminded me that “Micronesians are in the workforce, paying taxes, and contributing to the communities they live in,” the complete opposite of what rumors say. It is essential to dispel harmful stereotypes and microaggressions against any racial/ethnic group — the Micronesians are no exception.
As a Micronesian and Native Hawaiian, I find it pertinent to support the vulnerable Micronesian community and offer ways in which we can help them. Expanding the legislation to include COFA immigrants as a group of people that are eligible for Medicare and Medicaid would solve the obstruction of health insurance and allow them to access quality health care.
Altering the narrative surrounding Micronesians to a more positive and truthful portrayal will allow others to see they are just a group of people who are striving to attain a better life for themselves.