Have a Heart for Kids Day 2020

Improve Family and Community Health

Pass House Bill 1291 / Senate Bill 5683

Provide premium and cost-sharing assistance to Washingtonians from Compact of Free Association (COFA) nations to improve health equity for Pacific Islander families.  

Kids do better when their parents and caregivers do better. When parents and loved ones are chronically or critically ill, or die young because of inadequate health care, children suffer. For kids whose families come from Pacific Island nations with Compacts of Free Association with the United States, the scales are tipped unfairly toward this suffering.

Since 1996, migrants from COFA nations in Washington state and across the U.S. have been denied basic federal programs like Medicaid and food stamps. Many Washingtonians from COFA nations suffer with life-threatening and chronic health problems resulting both from inadequate access to health care and from the devastating impacts of U.S. nuclear testing in their homelands. The uranium used in those nuclear experiments was created in Washington state, at the Hanford Nuclear Reservation.

Who are COFA migrants?

People from the Republic of the Marshall Islands, the Republic of Palau, and the Federated States of Micronesia are sometimes referred to as COFA migrants because their countries have Compacts of Free Association (COFA) with the United States. Through the compacts, the U.S. has strategic military access to the region. Residents of COFA nations travel freely to the U.S. They live here and work, pay taxes and serve in the U.S. military in high numbers. Estimates of the COFA population in Washington vary greatly. For this bill, the Office of Financial Management estimates the population is 6,500 people, and an estimated 2,500 would be eligible to enroll in the premium and cost-sharing assistance program.

What will HB 1291 / SB 5683 do?

  • This bill would provide premium and cost-sharing assistance for COFA migrant parents and other adults, who would otherwise be eligible for Medicaid, to purchase health coverage through the Washington Health Benefit Exchange.
  • The bill describes cost-sharing and premium assistance as: “Within amounts appropriated for the specific purpose, the authority shall pay the premium cost for a qualified health plan and the out-of-pocket costs for the coverage provided by the plan for an individual who is eligible for the premium assistance program.”


Issue Background

  • In 1996 the U.S. Congress passed the Personal Responsibility and Work Opportunity Reconciliation Act. Also known as “welfare reform,” this legislation redefined which immigrants are eligible for federal programs. COFA migrants are not included in the list of “qualified non-citizens.” More than 20 bills in Congress have sought to restore coverage, but none have become law.
  • There are significant health disparities in maternal and infant child health for Pacific Islander families. Washington has a program to provide health coverage to pregnant women. However, lack of continuous health coverage decreases the chances of women having health coverage during their first trimester, and contributes to health risks for pregnant women and babies.


Supporters include the Children’s Alliance, the Washington State Commission on Asian Pacific American Affairs, the Pacific Islander Health Board, the Asian Pacific Islander Coalition, as well as many individual families, teachers, health care providers, and others who have a connection to families impacted by the Medicaid ban.

For more information: Litonya Lester, Health Policy Director, or (206) 324-0340 ext. 15.