Sustainable Health-Care Insurance for the COFA Micronesian Migrants in Hawai‘i: A Challenge for Hawai‘i and for Its COFA Residents

Developing a rationale and sustainable health-care insurance program for vulnerable Micronesian Migrants from the US Compact of Free Association (COFA) Pacific Island nations residing in Hawai‘i has been challenging. Our goal is to assess the operationalization and impact of the current plan to provide health-care coverage for the COFA migrants through the Affordable Care Act (ACA), the Hawai‘i Health Connector (HC), and the Hawai‘i Department of Human Services (DHS) The assessment is made in the context of the HC/DHS efforts to: provide comprehensive health-care insurance coverage, achieve the stated $27 million dollars cost savings for the State of Hawai‘i, and to solve the practical challenges of implementing health insurance coverage through the HC. A descriptive narrative regarding the process and outcomes of HI's effort to provide health-care insurance for the COFA migrants will include, (1) the history of the COFA, (2) the history of health-insurance coverage for the COFA migrants in the United States, (3) the 2015 dialogue and problem solving that is taking/took place between HC/DHS and the COFA migrants, (4) the impact on Hawai‘i's general population and health system, (5) the impact on the COFA migrants, and (6) the sustainability of the HC/DHS plan. The justification of this assessment is to illustrate how implementation of the HC/DHS plan requires comprehensive planning and active participatory engagement of the COFA community to ensure success.

Conflict of Interest

The authors report no conflicts of interest.