The document discusses the Compact of Free Association (COFA) and its implications for residents from Micronesia, Palau, and the Marshall Islands, particularly focusing on healthcare access and the impending expiration in 2023. It emphasizes the need for sustainable solutions that integrate cultural perspectives and encourages collaboration between state and federal governments to address associated challenges. Economic sustainability, social integration, and educational partnerships are highlighted as essential strategies for improving outcomes for COFA residents in the U.S.

1. James Cadaoas & Elena Farden
MBA 741- Governmental Relations
June 10, 2014
Compact Of Free Association

2.  Todaysmeet.com/COFA2014
 Complex Issue: Collaborative & Creative Dialogue
 Data Accountability, Standardization
 Cultural Perspective & Approach > 3BL

3. Triple Bottom Line
RMI
Three Spheres of
Sustainability
3BL framework
with a cultural
perspective
to guide
sustainable
solution(s)

4. Our Unique Relationship
FSM RMI
Republic of
Palau
USA
Political
Economic
Military

5. Looking Ahead
COFA Expiration in 2023
Military Significance
 American vs Chinese Interest
Renewal?
 Yes
 Unsustainable at preset projections

6. Looking Ahead

7. Today’s Impact
8401
~15000
0
2000
4000
6000
8000
10000
12000
14000
16000
1980 1990 2000 2010
PopulationGrowth
Decade
COFA Resident Distribution By Key US State
California
Florida
New York
Texas
Washington
Hawaii
* http://pidp.eastwestcenter.org/pireport/special/COFAReportFinal12-14-11.pdf

8. Today’s Impact
Example: Education Cost

9. Court Cases
Comprehensive Healthcare Reform (1996)
 States are no longer required to provide healthcare to non-pregnant,
aged >19 years, lived in the states for <5 years (“new residents”)
 States may still provide healthcare if they want to
Hawaii keeps Medicaid equivalent programs for new residents
Korab v Koller (2010)
 Hawaii Adopts BHH program due to budget crisis
 BHH provides less than Medicaid equivalent healthcare
 Plaintiffs argue: BHH is discriminatory/based on national origin, in
violation of 14th amendment and ADA
 Defense: Adhering to federal standards

10. Court Cases
Korab V Fink (April 2014)
“Congress has authorized states to do exactly what Hawai‘i has
done here—determine the eligibility for, and terms of, state benefits
for aliens in the narrow third category, with regard to whom
Congress expressly gave states limited discretion. Hawai‘i has no
constitutional obligation to fill the gap left by Congress’s withdrawal
of federal funding for COFA Residents.”
- California Circuit Court Judge, Margret McKeown
http://cdn.ca9.uscourts.gov/datastore/opinions/2014/04/01/11-15132.pdf

11. Court Cases
COFA residents eligible for Medicaid if*
 18 or under
 Pregnant female
 Lawful resident living in the state for 5 years and meets income
requirements
Otherwise, BHH eligible
Discourages immigration specifically for medical treatment
Ethical?
* http://aspe.hhs.gov/hsp/11/ImmigrantAccess/Eligibility/ib.shtml#Medicaid

12. Introduction to the Solutions
No silver bullet solution
 Complex problem with many different
variables
Required Government Action
 State
 Federal
 COFA independant
Solutions will cost money in the
short run, but save in the log run
Overall goal: To achieve parity
between COFA and Hawaii
residents

13. Social Change & Education
State level solution
COFA residents have a strong cultural identity that doesn’t translate
well into western workplaces
 More state-funded nonprofits focused on social integration
 Turn the cultural diversity from disadvantage, into an advantage
Access to these programs may
require green-card registration
 Focus on getting COFA
residents into the workforce
and contributing via taxes

14. Economic Sustainability
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
Pacific
Islands
Eastern
Pacific
West Africa Western
Indian Ocean
MetricTons
World’s Major Tuna Fishing Areas
* Food and Agriculture Organization of the United Nations

15. Economic Sustainability
25%
$2 B
$20 M

16. Economic Sustainability

17. Confluence of culture &
economic sustainability

18. Economic Sustainability
What Is Food
Security?

19. Food Sovereignty > Food Security

20. 3BL Framework
Fossil-Free
Voyaging
Food Access
>Diet-related
illnesses
Increase
Jobs
Boost
Sustainability
Economic
self-
sufficiency
Foreign oil
Independence
Sustainable energy
Source
Food sovereignty
Higher quality food
Ag-led economies
Blend of
traditional/ western
practices
Food security
Market viability
Capital for
infrastructure
Empowerment

21. Federal Incentives
Increased awareness is imperative
 Hawaii’s residents can play a role
 Goal of awareness is not for the awareness itself to solve the
problem, but for the new ideas generated to breathe life into the
situation
Increased funding, split between COFA nations and COFA affected
states
 Creates incentive for COFA nations to take care of their citizens
 Solves the funding gap in Hawaii and other states
 Much easier to increase funding by $50 million, than by $3.6
billion

22. Multilayered Strategy
Economic
sustainability
Educational
Partnerships
Social Services
Initiatives and
Models
Cultural
Integration
Community
Engagement
Social
Entrepreneurialism
Global Natural
Resources
Mgmt
Cultural
Business
Models
Health
Equity
Housing
solutions

23. Systematic Social Improvement

25. #samecanoe

26. More Information & Sources
Sources:
• Slide 3
• Slide 4
• Slides 5, 6
• Slide 7
• Slide 8
• Slide 9, 10
• Slide 11
• Slide 14, 15
• Slide 16
• Slide 17
• Slide 18, 18a, 18b
• Slide19