Comparative Well-Being in U.S. Destination States
TO CITE: Wheeler, B.L., Fitzpatrick, J., van der geest, K., and Burkett, M. (2020). Marshallese Migration: Comparative Well-Being in U.S. Destination States. Policy Brief of the Marshall Islands Climate and Migration Project. University of Hawai‘i at Mānoa. Available at www.rmi-migration.com
Cover Image: Marshallese children in California participate in May Day 2019 celebrations. Komol tata, Marshallese Youth of Orange County and Kelani Silk, for sharing this image for this publication. To learn more about the youth empowerment, cultural preservation and awareness, health, and educational support work of the Marshallese Youth of Orange County in California and across the country, please visit https://www.facebook.com/myocorg/.
Comparative Well-Being in U.S. Destination States
Introduction: How are the Marshallese doing in the United States?
The 2020 U.S. Census is currently being undertaken, and by all accounts it will reflect the rapidly growing Marshallese population living in the United States (US GAO 2020). From Hawai‘i to Arkansas, and many places between, the Marshallese are making their lives in both new ways and on increasingly well-worn paths created by their fellow COFA citizens. [1] Their experiences in the U.S. are reflected in the emergence and expansion of NGOs and community groups serving Marshallese communities across the country [2], in the attention of numerous media outlets to topics such as the nuclear legacy and the climate futures the Marshallese face [3], and in the academic focus on the Marshallese people’s ongoing struggles to gain access to health care [4], maintain cultural practices (Allen 2001, Schwartz 2017, Heslin 2019), or transform their livelihoods (McClain et al. 2019a, 2019b).
This brief contributes first-hand information from 79 Marshallese respondents living in Hawai‘i, Oregon, and Washington, who have compared their well-being in these destination states to that of their previous lives in the Republic of the Marshall Islands (RMI). In addition, they reflect on how their sense of well-being relates to their concerns about a changing environment at home. Altogether, these Marshallese perspectives provide multi-locational, context-specific information that indicate how their lives are unfolding today, and may be best supported going forward.
This brief has three main components. It begins by providing a background on the Marshallese respondents who informed this study (Living in Hawai‘i and the Pacific Northwest: A Snapshot of Respondents), and information about the data collection process (Data Collection with the Marshallese: Studying Well-Being in the Context of Climate Change). Second, the brief reports findings on comparative well-being (Well-Being Findings: Relating Life in the RMI & U.S.), offering both qualitative and quantitative information provided by Marshallese individuals. This section also focuses further on the context of climate change (A Climate Change Analysis), attempting to understand differential well-being in a changing environment. Finally, the brief closes with final thoughts on the experience of Compact migration to the United States (Further Discussion: Compact Migrants and Legal Futures), reflecting on some of the current and future opportunities and barriers facing Marshallese communities, including the legal challenges of COFA status in destination states and the outsized impact of COVID-19 [5].
Living in Hawai‘i and the Pacific Northwest: A Snapshot of Respondents
Respondents in Hawai‘i and the Pacific Northwest (Juno Fitzpatrick)
For the U.S.-based portion of our study, the Marshall Islands Climate and Migration Project (MICMP) surveyed households across the three states: Hawai‘i (40 respondents), Oregon (36), and Washington (3). [6] The latter two states are represented together in the findings (and in this brief) as the Pacific Northwest (PNW). About 64 percent of respondents in the Pacific Northwest resided in Salem, Oregon at the time of their interview, and 21 percent of respondents in Hawai‘i resided in urban Honolulu.
Most respondents were born in the Marshall Islands (100 percent in Hawai‘i and 87 percent in the PNW), and of those born in the RMI, 70 percent primarily originated from Majuro (the capital of the RMI) or Ebeye (the most populated island of Kwajalein Atoll). Many of the Marshallese in both locations had traveled extensively as children between various locations in the RMI, U.S. commonwealth and associated states, Hawai‘i, and the continental U.S. A majority spoke English (75 percent in Hawai‘i and 62 percent in the PNW), and had lived in the United States for, on average, 15 years (Hawai‘i) and 12 years (PNW), with those in the PNW having a higher rate of more recent migration overall. In Hawai‘i, the most common forms of employment for respondents were jobs in legal aid, and working as cleaners, airport staff, and supermarket cashiers. In the PNW, participants were translators, community advocates, direct care providers, canners in factories, and supermarket cashiers.
The three destination states focused on in this study were selected due to their high concentration of Marshallese residents, and support from community-based organizations that were able to facilitate introductions and translation assistance. In Hawai‘i and the Pacific Northwest, the study aimed its outreach toward NGOs, the Marshallese Consulate (Hawai‘i), and known community leaders, with the goal of building relationships and exchanging information with the community so as to minimize research fatigue and increase willingness to participate. Another aim of participant selection was to find a broad demographic spread of individuals with differing insights into how ecological stressors associated with climate change may have led to the decision to migrate to Hawai‘i and the Pacific Northwest.
Data Collection with the Marshallese: Studying Well-Being in the Context of Climate Change
The MICMP posed three research questions, and this brief discusses the answers to two of them:
To answer this question, the MICMP asked Marshallese participants a set of survey questions to compare their current state of well-being in terms of employment, education, health care, housing, and other factors with the situation at home in the RMI, before they migrated. Participants were asked to score each of the indicators of well-being from 1 (low level of well-being) to 5 (high level of well-being). Alongside these indicators, the survey asked questions about their rationales for migration, migration processes and community integration, current living conditions (housing and living standard, and livelihoods), remittances, government support, and future migration intentions.
The box to the left shows one question about previous living standards that was asked of participants during the survey, and the response from one interviewee in Honolulu. Here, the participant noted that housing, purchasing power, safety, and employment formed a positive part of their standard of living in the RMI, but that social services, health care, and education contributed to a lower living standard in the RMI.
To answer this question, the MICMP used Q methodology, a process in which individual respondents rank statements based on their agreement with them. The 40 statements presented to the Marshallese included a range of topical issues: push and pull factors driving migration, effective migration strategy (development and well-being), government response, migration behaviors (expectations of future habitability), environmental change, non-economic loss and damage, and Marshallese culture and social cohesion. In contrast to a survey, where questions are assessed based on agreement with an individual question, with Q methodology all the statements must be considered and ranked in relation to one another, and placed into a pre-formed grid arranged from least to most agreement. In this way, we can learn about well-being in the context of environmental change, as participants must consider which statements weigh most heavily upon them.
Figure 2 (left) features five of the forty statements Marshallese respondents in all destination states were asked to rank [7], and a depiction of the grid (Figure 3, below) that was used by participants to sort their reactions to the statements.
Well-Being Findings: Relating Life in the RMI & U.S.
Survey Results: A snapshot of well-being in Hawai‘i and the Pacific Northwest
Both tables below show the way that Marshallese respondents in Hawai‘i and the Pacific Northwest ranked well-being indicators. They are sorted from the most positive change (after moving to the United States) to the most negative change (see last column of each table).
The general results of this ranking are similar for both the Marshallese living in Hawai‘i and those in the PNW. Marshallese migrants reported the most positive changes to their well-being in the areas of health care, employment, social services, and education. These responses mirror the findings for the primary drivers of migration noted elsewhere in the MICMP study. Respondents in both destination areas also reported substantial improvements in food security compared to their situation in the RMI. Respondents were more ambivalent or negative about changes in safety, housing, and purchasing power. Collectively, they see the impact of their migration on family at home in the RMI as substantially more positive (in terms of well-being and economic situation) than respondents living in the RMI.
Looking more closely, however, we can use these findings to better understand and contextualize the economic landscape and health outcomes for the Marshallese in destination states, both of which are highly relevant in the current context of an economic downturn and a global pandemic.
Respondents’ perceptions of improvement in access to quality health care and food security (to a lesser degree) are critical to understanding migration rationales and resulting well-being. The Marshallese have clear concerns about the state of “extreme health issues” in the RMI, considering nuclear testing, radiation, and poor hospitals and care (R-149, Hawai‘i). The Marshallese described a triad of issues that contribute to food insecurity in the RMI: a weakening of agricultural practices, a reliance on food imports, and a resultant increase in the prevalence of obesity and diabetes among islanders. Despite improvements upon migrating, there also appears to be great room for improvement, as 42.5 percent of the Marshallese in Hawai‘i and 52.5 percent of those in the PNW reported utilizing government support, including food stamps. In addition, challenges to access to health care in destination states remain. For example, the Marshallese became unable to utilize Medicaid following the Personal Responsibility and Work Opportunity Reconciliation Act (1996), though they are subject to state, federal, and local taxes. Some states, including the three surveyed in our study, do have state-sponsored programs to assist the Marshallese, but there have also been 21 unsuccessful bills that have been introduced since 2001 to reinstate COFA citizens’ Medicaid eligibility (Asian Pacific Islander American Health Forum 2019). A recent study focused on Hawai‘i (between 2012 and 2018) found that mortality rates for COFA migrants increased after the expiry of Medicaid benefits even though the state has made inroads toward funding and providing access to health-care (Molina et al. 2020). In light of this complex picture of health care in the United States, it is little surprise that Marshallese communities and their advocates across destination states are calling, again, for access to Medicaid during the COVID-19 pandemic [8].
The Marshallese perceive that their overall economic situation has improved (77.5 percent in Hawai‘i and 53.85 percent in the PNW), and unemployment for participants in the PNW was only 2.56 percent (12.5 in Hawai‘i). At the same time, however, roughly a third of the Marshallese in the PNW noted that they faced barriers to finding employment, and 64 percent had had issues within their workplaces. These collective problems include language barriers, non-applicable work experience, issues with creating resumes, the lack of a commercial driving license, low pay, and disrespect or discrimination. Further, the median household income for both Hawai‘i and the PNW was reported by respondents to be between only $25,000-$35,000, with more disparity in Hawai‘i (22.5 percent of households earn less than $15,000).
“We depend on imported food. This affects our health and we migrate to the U.S. for health services.”
Respondent 122, Hawai‘i (above top), Honolulu, 2017 (above, bottom)
These findings on economic well-being also provide context for understanding statistics on housing, beyond the single indicator in Tables 1 and 2. In the PNW, for instance, 33 percent reported an improvement in housing, but 26 percent stated it was worse, and 41 percent noted no major change. Those living in Hawai‘i perceived a stronger improvement (47.5 percent said that it was better). Further, the great majority of the Marshallese live in rented properties (72.5 of respondents in Hawai‘i and 84.62 in PNW), with an average of more than six persons per household. As Meetu Kelen, a community health worker at the West Hawai‘i Community Health Center, has recently noted, pre-existing socio-economic struggles are influencing health outcomes in the pandemic. “A lot of our families live in affordable housing,” she says, “which are not built for this COVID-19” (Hawai‘i Public Radio 2020).
“We are in a state of emergency. The government relies on Japan, U.S., Australia, and Taiwan for infrastructural support. In this way, other countries are spoon-feeding the RMI as opposed to maintaining resources and sustainable development.”
The economic health of the Marshallese community in destination states is also integrated with the remittances that are sent to the RMI. Remittances may affect the economic fabric at home and possible migration in the future. In Hawai‘i, 70.0 percent of those surveyed said they sent remittances, and 84.6 percent in the Pacific Northwest did so. Several respondents noted that they send additional remittances to the RMI after economic and environmental shocks, which, under current circumstances, begs the question of whether COVID-19 may impact their ability to do so at expected times, such as the period following U.S. federal tax returns. The RMI, despite having no cases of COVID-19 at present (as of July 2020), is already projected to lose $14-20 million on account of the “projected impact on tax revenues, employment, and job loss coupled with potential significant reductions in fisheries revenues” (U.S. Department of the Interior 2020).
Quote at left: Respondent 134, Big Island (Hawai‘i)
Q method findings: Shared thinking among the Marshallese in destination states
Marshallese Living in Hawai‘i
The results of the Q sort, performed by the Marshallese in both Hawai‘i and the Pacific Northwest, identify shared and dissimilar views that exist across the locations in which they live. This section clarifies the ways the Marshallese considered and ranked the importance of topics ranging from environmental concerns, to rationales for migration, to strategies for governance. For both Hawai‘i and the Pacific Northwest, the MICMP indicated groups of shared thinking that help us find meaningful patterns of agreement or related experience across respondents. In Hawai‘i, most participants could be grouped into Habitability Pessimists (45 percent) or Migration Optimists (37.5 percent), and in the Pacific Northwest, most respondents could be represented by the grouping Health Care Migrants (30.8 percent), Community Supporters (28.2 percent), or Climate-Concerned Migrants (25.6 percent) [9].
One of the largest points of distinction between these two groups living in Hawai‘i was their reaction to the statement, “Marshallese people are scattered, and the survival of our unique culture, lifestyle, and even our language may be lost forever.” Habitability Pessimists strongly agreed with this (averaging 4, where the highest level of agreement was 5), whereas Migration Optimists ranked it, on average, -3 (a -5 ranking signals the most disagreement). Migration Optimists were more confident about cultural preservation, responding positively (3) to the statement, “Participation in Marshallese activities in Hawai‘i helps me feel connected to home,” whereas Habitation Pessimists ranked this statement neutrally (0). There was also a great deal of disagreement concerning healthcare in the state, with Migration Optimists agreeing relatively strongly with the statement, “Health care in Hawai‘i is accessible and affordable,” and Habitability Pessimists disagreeing relatively strongly.
There are a number of other statements upon which the two groups were in more agreement, some varying in their degree of agreement/disagreement, and others evidencing degrees of relative neutrality about a statement. For instance, the statement, “It is difficult to integrate into the “U.S. way of life” due to language barriers” ranked 1 (Habitability Pessimists) and 0 (Migration Optimists), suggesting a similar experience with integration, and also that other concerns may be a more important focus (whether through agreement or disagreement). Both groups also saw the statement, “One of our biggest problems in the Marshall Islands is the lack of facilities, such as good schools, clinics, and reliable electricity” similarly, agreeing fairly strongly with only 1 point of distinction (3 for Habitability Pessimists and 4 for Migration Optimists). Both groups also had substantive agreement with the statement, “In the future, more and more Marshallese will be displaced by environmental factors and forced to flee their home atolls” (3 for Habitability Pessimists and 2 for Migration Optimists).
Marshallese Living in the Pacific Northwest
Here, because there are three groups, some groups share concerns, while in other cases, all three groups disagree substantially. Overall, the Marshallese living in the Pacific Northwest most agreed with the statement, “Seeking better health care is one of the main reasons the Marshallese move to the U.S.,” followed by “In the future, more and more Marshallese will be displaced by environmental factors and forced to flee their home atolls.” Like the Marshallese in Hawai‘i, they mostly do not see migration as an option open only to the wealthy. They disagreed most with the statement, “There is a lack of job opportunities for the Marshallese in Oregon,” closely followed by disagreement with “Our reefs are healthy, so there is no reason to worry about climate change,” and “Climate change is God’s punishment for our sins.”
Other statements, such as, “Marshallese fishermen will suffer in the future because there will be almost no fish in the sea” garnered the most divergence, with Health Care Migrants strongly agreeing (4), Climate-Concerned Migrants expressing neutrality (0), and Community Supporters strongly disagreeing (-4). Still others, like the statement, “The Marshallese government does all it can to improve the living conditions in the country,” indicate that both Health Care Migrants (-4) and Climate-Concerned Migrants (-4) sharply disagreed with this statement, but that Community Supporters (1) showed slight agreement.
A Climate Change Analysis
The framing of climate change, and its impacts on daily life and decision-making about migration, take a number of forms in the RMI and in destination states. The RMI’s National Climate Change Policy Framework states that the “RMI believes that climate change is real and is the greatest threat to our low lying atolls and people” (Government of the RMI 2011). The country also developed a Joint National Action Plan for Climate Change Adaptation & Disaster Risk Management (2014 - 2018) [10], and passed Resolution 83, which requested that the Nitijela [Parliament] “declare National Climate Crises as a Low-Lying Coral Atoll Nation” (RMI Parliament 2019). Former President Hilda Heine expressed the conundrum of the Marshallese during U.N. negotiations in Madrid, when she said, “It’s a fight to death for anyone not prepared to flee. As a nation we refuse to flee, but we also refuse to die” (Reuters 2019). Marshallese youth movements, such as Jo-Jikum, based in the RMI, or Wavement, in California, both formed in part after young persons who studied or lived in the U.S. returned to the RMI to visit or live, and now wish to raise awareness and take action against climate change. [11] There are also acute concerns about the immediate and ongoing health impacts of climate change in the RMI, and the country’s limited health services. In January 2020, the first national Republic of the Marshall Islands (RMI) Climate Change and Health Dialog took place in Majuro, in which participants discussed crises such as dengue outbreaks, and linked them to climate and weather events like king tides, droughts, and heat waves (Pacific RISA 2020).
With this study, we can begin to understand how concerns regarding climate change ‘rank’ among the many issues facing the Marshallese living in destination states, despite respondents not citing climate change as their primary rationale for migration. For instance, in the PNW, all three groups in the Q study agreed, to varying degrees, with the statement, “In the future, more and more Marshallese will be displaced by environmental factors and forced to flee.” In Hawai‘i, this was the second most agreed upon statement. In the PNW, this phenomenon of cross-group agreement occurred to a lesser degree with the statement, “Climate change is worsening existing environmental issues caused by nuclear testing,” though in Hawai‘i, this statement was met with more neutrality, indicating that these residents found other statements more pressing. In both Hawai‘i and the Pacific Northwest, the second most disagreed with statement was, “Our reefs are healthy, so there is no reason to worry about climate change,” indicating that these Marshallese migrants have witnessed environmental change and connect it to the phenomenon of climate change.
“Our reefs are healthy, climate change affects the reefs, which are dying.”
Through this data, and the way in which it was collected, it is also possible to consider how climate change may be recognized and reported by the Marshallese. For instance, the statement, “I have never heard of any Marshallese migrating because of climate change,” found uneven responses from the Marshallese. Respondents living in Hawai‘i largely disagreed with this (suggesting they have heard of Marshallese migrating because of climate change), though it was not among the most disagreed with statements. In the PNW, this statement was among the most disagreed with statements overall. Nonetheless, those in the PNW who saw climate as a future driver, and noted that climate change would affect their decision to return to the RMI (Climate-Concerned Migrants), had very high agreement with this statement (4), confirming that their concerns about the climate are future-oriented.
Lastly, we can consider the comparison in views between the Marshallese living in destination states, and those in the RMI. Many more respondents in the United States (43 percent) stated that environmental factors played a role in their decision to migrate than those in the Marshall Islands (0.6 percent). An even higher proportion (62 percent) stated that environmental factors will play a role in their decision of whether to move back to the Marshall Islands. Altogether, these findings help us begin to disambiguate a complex history, present, and future for the Marshallese by listening to their multi-locational experience, rather than prescribing or assuming the meaning of climate change or decision-making around migration to them.
Further Discussion: Compact Migrants and Legal Futures
With the findings of the MICMP, we have gained first-hand insight into the well-being of a number of the Marshallese living in certain destination states, and their reflections on areas of improvement and remaining difficulty (van der Geest et al. 2019). Whether in light of climate change, nuclear legacies, the difficulty or maintaining a livelihood in the RMI, or any other combination of factors, questions are increasingly being raised about whether the Compact of Free Association (COFA) can fully support the needs of the Marshallese in the U.S. (Morris et al. 2019, Thomas 2019, Dema 2012). Questions of material support in destination areas are also connected to municipal and state level decision-making regarding the Marshallese, where local policies have great impact on access to health care, language support, and other areas key to well-being. These concerns are also debated on the federal level, particularly with regard to appropriate levels of Compact Impact funding, as well as funding made available to the Marshallese outside of “affected jurisdictions,” [12] such as Arkansas (U.S. Department of the Interior 2019).
Understanding the legal landscape into which the Marshallese move, and in which their lives unfold, will be critical for gaining a more complete understanding of their well-being going forward. Emily Mitchell-Eaton, in her work with the Marshallese in Arkansas, has emphasized the critical nature of legal status, legal relationships, and legal awareness, and their impact on Marshallese lives, writing that, “...the peculiarity of COFA status plays out in both quotidian and dramatic ways in sites of Marshallese resettlement, shaping...eligibility for social programs, community advocacy efforts, administrative and bureaucratic encounters, and legal interventions made by state actors at a number of scales” (Mitchell-Eaton 2016:173).
“There’s no services that prepares us to come into Hawai‘i, like how to fill out important forms in order to get a job, filling out social security forms, forms to enroll to health care[...]. We don’t have services that gets Marshallese migrants ready in order to move here.”
Though the MICMP survey questionnaire and Q method interviews did not directly discuss policy or the explicit legal implications of COFA status in the United States, we see indicators of its presence in their statements regarding other topics. The Marshallese, for instance, cite their struggle with completing the many legal documents that compose a part of migrant life, despite their special non-immigrant status.
The role of the law is also reflected in the Marshallese responses that mention discrimination, language barriers, and desire for access to the U.S. health care system, all of which are addressed in different ways by the courts of various destination states, by civil service groups, and by the Marshallese themselves (who often form support networks within and across destination areas). The Marshallese help form local and national policies, partnering with other Pacific peoples for events such as the Asian American and Pacific Islander Legislative Day [13] held in Washington state, where residents share their concerns with the governor, state representatives, and senators. They also form part of the implementation of laws such as Hawai‘i’s Language Access Law (2006) [14], which responds to those who are limited English proficient (LEP), a lack of proficiency which studies have shown affects health outcomes for the Marshallese (Williams and Hampton 2005, Hallgren et al. 2015, Ayers et al. 2018). Finally, with COVID-19 disproportionately affecting the Marshallese where they live now, and Medicaid still elusive for many residents, the way that law and well-being overlap will continue to be highly visible and, in the absence of equity, life-threatening. This study allows us to see the positive aspects of resettlement, but also what remains to be improved in U.S. destination states, in order to attain a legal landscape that best supports well-being.
Footnotes
[1] While this study focuses on the United States (and within it, three “destination states”), it is important to contextualize Marshallese migration from the RMI more generally. The U.S. Government Accountability Office (GAO) estimates that 50 percent of Compact migrants (including the Marshallese, and citizens of Palau and the Federated States of Micronesia) lived on the U.S. mainland in the years 2013-2018. Historically, and today, the Marshallese also migrate to Hawai‘i, Guam, and the Commonwealth of the Northern Mariana Islands (CNMI) (US GAO 2020).
[2] For instance, organizations such as the Compact of Free Association–Community Advocacy Network (COFA-CAN), the Asian Pacific American Network of Oregon (APANO), We Are Oceania (WAO), the Arkansas Coalition of Marshallese, and numerous others serve the Marshallese community.
[3] See The New York Times (2015) “The Marshall Islands Are Disappearing.” Available at https://www.nytimes.com/interactive/2015/12/02/world/The-Marshall-Islands-Are-Disappearing.html, The Washington Post (2015) “A ground zero forgotten.” Available at https://www.washingtonpost.com/sf/national/2015/11/27/a-ground-zero-forgotten/, The Los Angeles Times (2019) “Marshall Islands, low-lying U.S. ally and nuclear testing site, declares a climate crisis.” Available at https://www.latimes.com/environment/story/2019-10-11/marshall-islands-national-climate-crisis, and The New Yorker (2020) “The Cost of Fleeing Climate Change.” Available at https://www.newyorker.com/news/dispatch/the-cost-of-fleeing-climate-change-marshall-islands-arkansas, among many others.
[4] These references are too numerous to list, but much work has been undertaken in the last decade by Pearl A. McElfish, and other scholars have worked on health issues with regard to neo and postcolonialism (Michael R. Duke and others), especially with Marshallese migrants in Arkansas and Hawai‘i.
[5] These impacts are being felt across destination states and among Pacific Islander communities more generally. See Honolulu Civil Beat (2020) “Hawai‘ians, Pacific Islanders Confront High Rates Of COVID-19 In Many States.” Available at https://www.civilbeat.org/2020/05/Hawaiians-pacific-islanders-confront-high-rates-of-covid-19-in-many-states/, Northwest Arkansas Democrat Gazette (2020) “Marshallese hit hard by covid-19.” Available at https://www.nwaonline.com/news/2020/jun/14/marshallese-hit-hard-covid-19/, The Spokesman (2020) “Marshallese people represent 1% of Spokane County’s population and nearly a third of its COVID-19 cases.” Available at https://www.spokesman.com/stories/2020/jun/28/marshallese-people-represent-1-of-spokane-countys-/, and Telegraph Herald (2020) “Family: COVID-19 deaths among Dubuque Marshallese still climbing.” Available at https://www.telegraphherald.com/news/public_announcements/article_bf7b483b-c253-5f9a-9a8b-4ad38b139851.html.
[6] This sample is not statistically significant, but is drawn from areas in which there are large communities of the Marshallese in the United States, for reasons described in the brief’s section on data collection.
[7] The location, which in this example is Oregon, was changed based upon the residence of the interviewee.
[8] See 4029News (2020) “Arkansas Marshallese leaders pushing to gain access to federal Medicaid.” Available at https://www.4029tv.com/article/arkansas-marshallese-leaders-pushing-to-gain-access-to-federal-medicaid/32886248#, Des Moines Register (2020) “We bombed their homeland, hurt their health, cut off their health care. Then comes COVID-19.” Available at https://www.desmoinesregister.com/story/opinion/columnists/rekha-basu/2020/06/26/iowa-should-pay-health-care-marshellese-united-states-displaced/3256243001/, and Politico (2020) “Lawmakers push to restore Medicaid for islanders affected by nuclear tests.” Available at https://www.politico.com/news/2020/04/16/coronavirus-uninsured-pacific-islanders-190979.
[9] The percentages do not add up to 100 percent because some respondents did not fit any of the shared views. For more detail on this analysis, please see our full Case Study Report, available at: https://rmi-migration.com/full-case-study-report.
[10] Republic of the Marshall Islands (2014). Available at https://www.preventionweb.net/english/policies/v.php?id=58465&cid=109.
[11] To read about these organizations, see https://jojikum.org (Jo-Jikum) and https://www.sacbee.com/opinion/california-forum/article235939252.html (Wavement).
[12] At present the State of Hawai‘i, Guam, the Commonwealth of the Northern Mariana Islands, and American Samoa receive grants, as “affected jurisdictions,” to “aid in defraying costs incurred as a result of increased demands...due to the residence of qualified immigrants from the Republic of the Marshall Islands, the Federated States of Micronesia, or the Republic of Palau” (U.S. Department of the Interior 2020b). Some argue that this framing by states, however, emphasizes the burden of COFA citizens, leaving out their contributions, including the taxation of their work in the U.S. (See, for instance, Shek and Yamada, (2011). "Health Care for Micronesians and Constitutional Rights." Hawaii Med J., 70 (11 Suppl 2): 4–8.)
[13] For more information, visit: https://capaa.wa.gov/apa-legislative-day/
[14] For more information, visit: https://health.hawaii.gov/ola/what-is-the-law/#:~:text=In%202006%2C%20the%20legislature%20recognized,state%2Dfunded%20services%20in%20Hawaii.
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