Cold War nuclear legacy leaves high health costs

HONOLULU – The legacy of Cold War-era nuclear testing in the Pacific has left behind a health care problem that is costing U.S. states and territories far more money than the federal government reimburses, according to figures obtained by The Associated Press.

Pacific islanders from three former U.S.-administered territories in the test region suffer higher rates of cancer and kidney disease as a result of the atomic explosions. The treatments they require, like chemotherapy and dialysis, are largely unavailable on the tiny island nations, forcing residents of Micronesia, the Marshall Islands and Palau — with open migration access to the U.S. from a federal treaty — to travel thousands of miles to get help.

"Health is a big incentive to move to a different place," said Dr. Wilfred Alik, a family medicine doctor originally from the Marshall Islands who now works at a clinic on Oahu's North Shore. "If we don't have that kind of care in the Marshall Islands, people will continue to migrate to the United States to get this kind of care."

But, aside from forcing sick people away from their homes and families in search of treatment, the dilemma has left states like Hawaii and Arkansas and the territory of Guam facing a financial burden: These three governments spend more than $170 million a year combined on health care for migrants from Micronesia, the Marshall Islands and Palau, but the federal government distributes only $30 million annually to help offset those costs. The expense figures were acquired from open records requests, government agencies and publicly available documents.

There are at least 32,600 people from the three nations living in the U.S., according to 2008 Census estimates — although Hawaii's government has said the number of migrants using state services indicates the count was too low. Proposals that would reduce the local expense are focused on decreasing the number Pacific islanders who migrate to the U.S.

A letter sent in March by members of Congress from affected areas to Secretary of State Hillary Clinton and Secretary of the Interior Kenneth Salazar suggests that the U.S. government consider establishing facilities in the Pacific nations to provide dialysis treatment, health screenings and education about the open migration policy.

In addition, a bill recently introduced by Sen. Daniel Akaka, D-Hawaii, seeks to restore federal Medicaid funding for these migrants that was cut when the government enacted a welfare overhaul law in 1996. Hawaii, unlike most states, is required to provide this coverage after a federal judge ruled that reducing the state's health plans to these migrants would be discriminatory. The state is appealing that ruling.

"Obviously, this is not going to be an easy task," said Nikolao Pula, director for the Office of Insular Affairs, which is scheduled to recommend options to Congress by October. "Ultimately, if things don't happen soon enough to help the situation, then the law or even the treaty could possibly have to be re-looked at."

The three nations are beneficiaries of the Compact of Free Association, a 1986 pact that grants the U.S. the right to use defense sites in exchange for financial assistance and migration rights after Washington used the Pacific islands for nuclear weapons testing from 1946 to 1958.

Hawaii's government spent more than $52 million in the 2010 fiscal year on more than 17,000 Compact of Free Association migrants' human services — including health plans for low-income residents, welfare programs, public housing and homeless support, according to Department of Human Services figures provided under an open records request.

In addition, education costs exceeded $55 million to pay for the instruction of nearly 5,500 compact students, and total costs to the state were $115 million, according to a state impact report released last week.

Guam's expenses for education and social services of more than 18,000 migrants reached nearly $54 million in the 2009 fiscal year, according to the territory's most recent compact impact report.

And in Arkansas, where about 4,000 people from the Marshall Islands live and work, the state Department of Health estimated it spent more than $1 million to provide services to the compact migrant community in the 2011 fiscal year. Many of the migrants moved to Arkansas to work in Springdale, the headquarters of Tyson Foods Inc.

"The Marshallese bring a lot of value to the state of Arkansas," said Arkansas Department of Health spokeswoman Ann Wright. "We have and will continue to look at multiple funding sources to help offset any costs the state incurs." The federal government splits its $30 million in annual funding based on a 2008 census of where the compact migrants live. Guam's 18,300 counted migrants draw nearly $17 million a year; Hawaii's 12,200 migrants bring in about $11 million; and the Northern Mariana's 2,100 migrants result in $1.9 million.

Arkansas wasn't included under the terms of the treaty, and it only received one-time federal funding of about $250,000 to create a satellite clinic, Wright said.

"Affected jurisdictions have reported large and increasing costs associated with compact migration over the past years," said David Gootnick, director for international affairs and trade in the U.S. Government Accountability Office. "While there are costs associated, they are to varying degrees employed, they pay taxes, they consume in the economy and they receive remittances from home."

The GAO is preparing a report due in September or October that will evaluate the strengths and limitations in how compact migrants are counted and how their impact is measured, Gootnick said.

The idea of opening clinics to treat cancers and provide dialysis would ease the strain on states like Hawaii, said Patricia McManaman, director for the Department of Human Services.

"Whatever services can be provided in people's home countries may be of great benefit to those individuals," she said. "Do people always want to travel to distant lands to get needed medical services? No, I don't think so."