All Things Considered

House Health Bill Would Help Pacific Island Migrants

By Jenny Gold

January 6, 2010 11:00 AM

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Here in the self-described "chicken capital of the world," an enclave of unlikely migrants — 6,000 people from the Marshall Islands — is watching the health care debate with heightened interest.

Under an accord negotiated two decades ago involving three Pacific Island nations, the Marshallese can travel and work freely in the United States. But many have low-paying jobs and high numbers are uninsured.

Years ago, they were eligible for immediate coverage under Medicaid, the federal-state health insurance program for the poor, but that benefit was revoked in 1996 as part of welfare reform. The result is they aren't eligible for Medicaid — even after the five-year waiting period that applies to most other immigrants.

That's unfair, say advocates who argue that the Marshallese are contributing to the American economy by working and paying taxes and should have the same access to government programs as other legal immigrants. "It's like going to a party and you're bringing your potluck dish of rice and fried chicken and fried fish, but you're not eating anything," said Marshallese Consul General Carmen Chong.

Now, the health care legislation being debated in Congress might provide some relief. Under the House bill, a little-noticed provision sponsored by Rep. Neil Abercrombie, D-Hawaii, would restore the migrants' eligibility for immediate Medicaid coverage. The Senate bill doesn't have a similar provision.

Besides the Marshallese, the House provision also would apply to migrants from the Federated States of Micronesia and the Republic of Palau. The three strategically located archipelagos about 2,000 miles southwest of Hawaii came under U.S. control following World War II as part of a United Nations-designated trust. The United States created military installations in the region and used several of the Marshall Islands as nuclear test sites.

The three nations received their independence in the 1980s and agreed to host U.S. military facilities. In exchange, their citizens are allowed to work in the United States without a visa.

Rough estimates suggest there are about 20,000 islanders from the three countries living in the United States, mostly in Hawaii. There are no estimates of how many are uninsured.

On a recent Wednesday night, about 50 Marshallese gathered at King's Chapel for a rock-and-roll prayer service. Waston Attari, 40, sat in the front row, poring over a Bible. He says sometimes the American dream feels more like a myth. "Living in the U.S. is a challenge for every one of us," he says. He described many in his community who are living paycheck to paycheck.

For Attari, the most difficult part has been getting health care for his diabetes. He's a self-employed tax adviser and doesn't have health insurance. A community clinic has helped him get free insulin, but he explains that he can't go to a doctor "because I don't have the money to pay for the bills." He believes he would qualify for Medicaid services under the legislation and could see a doctor regularly.

Many Marshallese are offered health insurance through the poultry plants. At Tyson's Chicken, for example, a family health insurance plan costs about $120 a month. But few Marshallese can afford that, says Sandy Hainline Williams, a county health worker.

Williams explains that 20 migrants might live in a single house, and "you may only have one or two out of 20 working. They're bringing home $300 a week and trying to pay rent and utilities, and buy food and everything else." Health insurance often doesn't seem as pressing as the daily costs of living.

The Community Clinic at St. Francis House sees about 1,000 Marshallese patients each year, more than any other health provider in the region. That's less than 4.5 percent of the clinic's patients, says executive director Kathy Grisham, but it takes a great deal of the clinic's time and resources. Because so many of the patients are uninsured, much of that care is uncompensated.

Mark Krikorian, executive director of the Center for Immigration Studies, a think tank in Washington that favors tighter immigration controls, says it's hard to argue that the Marshallese shouldn't have access to Medicaid. The burden, he says, is falling to federally funded clinics like the St. Francis House and to certain emergency rooms, masking the actual cost of treating the islanders. But he says Medicaid access isn't really the point.

"The bigger issue is should we be letting in people with little education from under-developed countries … because there's no way to avoid the costs" of their health care, he says. The root of the problem, he explains, lies in using immigration as a bargaining chip with other countries, because "mass immigration is incompatible with a modern society."

But for many here, immigration policy is less important than solving the problem at hand. The Medicaid provision in the House bill "would shift the burden from the Marshallese and their inability to pay for care," said Grisham. "It would give us a payer source for the care we're already providing. … I'm not holding my breath, but I do hope health reform will bring that to us."

This story was produced through collaboration between NPR and Kaiser Health News (KHN), an editorially independent program of the Henry J. Kaiser Family Foundation, a nonpartisan health-care policy research organization. The Kaiser Family Foundation is not affiliated with Kaiser Permanente. Copyright 2010 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.

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MICHELE NORRIS, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Michele Norris.

MELISSA BLOCK, host:

And I'm Melissa Block.

Springdale, Arkansas calls itself the chicken capital of the world. Tyson's Chicken is by far the town's biggest employer. Springdale also has another distinction: about 1 in 10 residents moved to the town from a string of tropical islands in the middle of the Pacific Ocean: the Marshall Islands.

NORRIS: That distinction gives Springdale a particular stake in the health care overhaul and how the House and the Senate merge their bills. The House bill would give Marshall Islanders in Springdale health insurance coverage.

Reporter Jenny Gold visited Springdale and brings us this story.

JENNY GOLD: Marshall Islands Consul General Carmen Chong Gum says people come to Springdale because there are jobs at the poultry plants, good schools and because they have family here.

Ms. CARMEN CHONG GUM (Consul General, Marshall Islands): We're able to travel this way, which is a passport, and we can also live, go back to our country whenever we want to. So, with that privilege, you know, why not?

GOLD: Right after World War II, the U.S. used the Marshall Islands as a nuclear test site. The country has been independent since the 1980s, but the U.S. still maintains a military presence there. And in exchange, the Marshallese are allowed to come live in the U.S. if they want to. Now, somewhere around 6,000 of them live in Springdale. And just as they do at home, the Marshallese often live in big, extended families. The women still wear long, flowery muumuus, but now over jeans and flip-flops, a perfect blend of their current and former environments. Carmen Chong Gum says her countrymen tend to be warm, generous people, quick with a smile, a little bit shy and very religious.

(Soundbite of music)

GOLD: There are about 20 Marshallese churches in Springdale - King's Chapel is one. It's in the office space off a fast food-lined highway that runs the middle of town. On a Wednesday night, about 50 people gathered for a prayer service.

(Soundbite of music)

Unidentified People: (Singing) (unintelligible)

GOLD: Forty-year-old Waston Attari sits in the front row pouring over a Bible. He moved here to seek a better life for his family. But sometimes, he says, the American dream feels more like a myth.

Mr. WASTON ATTARI: I've seen some people struggle with their day-to-day, you know, the lifestyles. And so, you know, people live paycheck to paychecks trying to take care of their family, trying to put food on their tables.

GOLD: For Attari, the biggest challenge has been getting health care. He's self-employed, helping other Marshallese do their taxes among other things. But he can't afford private health insurance. And the Marshallese don't qualify for Medicaid. Attari suffers from diabetes. He's been able to get free insulin from a local clinic, but it's not enough.

Mr. ATTARI: I cannot do any physical exams and go to see a doctor because I don't have the money to pay for the bills.

GOLD: What will you do if you get really sick?

Mr. ATTARI: I don't know. I don't know what I can do. Just keep praying.

GOLD: Some Marshall Islanders could get health insurance through the poultry plants. At Tyson's, a family plan costs about $120 a month. But they earn just over minimum wage and few of them can afford that premium.

County health worker Sandy Hainline Williams says many elderly parents, nieces, nephews and cousins in the Marshallese household wouldn't be covered under such a family health insurance plan anyway.

Ms. SANDY HAINLINE WILLIAMS (County Health Worker): It just makes me so sad to see them and know that they need to go see a doctor. I can't find a doctor for them. No one will see them. And St. Francis House is absolutely full.

This is our newly remodeled dental clinic. We've got nine operatories...

GOLD: The St. Francis House is a community health clinic that offers health and dental care on a sliding scale. Executive Director Kathy Grisham says St. Francis House sees about 1,000 Marshallese patients a year - more than any other health care provider in the region. Right now, the clinic is doing a lot of that care for free.

But a provision in the health care overhaul bill, recently passed by the U.S. House of Representatives, could bring relief. It would give Medicaid eligibility to the Marshallese, as well as migrants from Palau and Micronesia who are in a similar situation.

Kathy Grisham is all for the bill passing.

Ms. KATHY GRISHAM (Executive Director, St. Francis House): It would be an excellent thing. I'm not holding my breath, but I do hope health reform will bring that to us.

GOLD: But Mark Krikorian says Medicaid access isn't the solution. Krikorian is executive director of the Center for Immigration Studies, a Washington think tank that wants to reduce immigration. He supports the Medicaid provision in the overhaul bill, too, because, he says, right now the burden is falling unfairly to emergency rooms and federally funded clinics like the St. Francis House.

Mr. MARK KRIKORIAN (Executive Director, Center for Immigration Studies): The bigger issue is should we be letting in people with little education from underdeveloped countries into a modern post-industrial welfare state, because there's no way to avoid the costs. We're not going to let people die on the steps of the emergency room.

GOLD: Consul General Carmen Chong Gum in Springdale says the Marshallese are contributing to the economy by working and paying taxes. She says they should have the same access to government programs as everyone else.

Ms. GUM: It's like going to a party and you're bringing your potluck, you're bringing a dish of rice or fried chicken and fried fish. And you bring the food to the party and you're just sitting there not eating anything.

GOLD: The provision that could help them is just a tiny insert in the 2,000-page House health bill. There's still a long way to go before it could become law.

For NPR News, I'm Jenny Gold.

NORRIS: And that story was produced by Kaiser Health News, a nonprofit news service. Transcript provided by NPR, Copyright National Public Radio.

Source: NPR

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