By now, anyone who’s been following the health care battle in Congress knows that the gulf between aspiration and reality has become a chasm, and even the marginally progressive elements, like a broad public health program, may be scrubbed from the final bill now being negotiated. And the notion of covering all immigrants was dead to begin with, of course. But nestled in the 2,000-page House bill is a tiny sliver of health justice for a certain group of migrants, one of the few that America is willing to admit it owes something to.
The House bill, reports NPR and Kaiser Health News, would allow immigrants from the Marshall Islands, along with the Federated States of Micronesia and the Republic of Palau, to qualify for Medicaid immediately. That means that roughly 20,000 people, many of them living in poor and isolated communities, will have significantly greater access to public health programs. And not a day too soon. The United States took over the islands after World War II and exploited them as pacific military outposts. Although the islands eventually became independent, the inhabitants continue to enjoy the fruits of colonization: the military domination remains, and they get to migrate to America for work.
The Marshall Islands themselves are engulfed in their own health crisis, besieged by nuclear fallout, climate catastrophe, and epidemics of poverty and suicide. And after hosting the Pentagon’s largess for generations, NPR reports that the diaspora has encountered hostile territory in the stateside health system, shut out of Medicaid and forced to rely on community clinics (generally, immigrants of both legal and illegal status face broad exclusions from federal benefits):
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 Sandy Hainline Williams, a county health worker, says few Marshallese can afford that.
So if they have any medical coverage at all, it’s often payback for labor in a noxious, often hazardous industry.
While the House bill could deliver marginal relief to the Marshallese and other Pacific Islanders, it leaves us with an even starker picture of how medical apartheid works in America. In an interview with NPR, Mark Krikorian of the xenophobic think tank Center for Immigration Studies used the crisis facing the Marshallese to trumpet his usual line: “mass immigration is incompatible with a modern society.” One wonders if a system that pushes people to die needlessly in emergency rooms is somehow more compatible.
So we’re back where we started. Depending on the quirks of Washington’s foreign policy, the legacy of American imperialism can be a boon or a blow to immigrants’ health. Economic refugees from south of the border are deemed undeserving of equal health care. Migrants from a distant Pacific atoll may finally receive basic coverage as a reward for toiling silently for generations under U.S. hegemony. Don’t ask why. For an outsider in a society of low expectations, you take what you can get.
Image: Micronesians protest health care crisis in Hawaii. (Eugene Tanner / AP)