What are the Compacts of Free Association (COFA)?

...through the COFA Dental Program put forward to Oregon legislators this session, we are a step closer to ensuring optimal health for all Oregonians.”
— Lilian Ongelungel
Map of the Compact of Free Associations (COFA) Islands.

Map of the Compact of Free Associations (COFA) Islands.

“Throughout my time in the military, I encountered service members from all walks of life. Occasionally, I would cross paths with fellow Micronesian soldiers and immediately feel a sense of connection and familiarity with them. Even as a civilian, coming across other Micronesian people stirs a sense of pride and validation in recognizing each other.

But when I became a Company Commander, I started seeing the depth of the systemic issues that severely impacted enlisted service members from Palau, the Marshall Islands, and the Federated States of Micronesia. These were concerns outside the realm of a commander’s capacity to change, but rather, areas needing voices and stories from the community to make a difference.

I remember working at a Medical Soldier Readiness Processing (Medical SRP) where I spoke with a young enlisted Yapese soldier in the Army Reserve about his journey from the islands to the military. He recounted that he joined to seek better job opportunities in the United States and to follow a pathway for US citizenship. But after not being selected for Active Duty, he was scrambling to find a civilian job because his monthly check as an Army Reservist was his only consistent income. Unfortunately, this Medical SRP was also the only place where he could access medical and dental care, as he couldn’t afford the Army’s TRICARE Reserve Select insurance program designed for service members on reserve duty. This service member lived just under 150 miles from the reserve center that hosted his unit’s annual Medical SRP. He wasn’t eligible for travel reimbursement to and from his monthly duty station. If he missed the Medical SRP for any reason, he would have to wait another year to receive basic services such as immunizations, hearing and vision tests, teeth cleaning, dental fillings, and more.

Access to quality medical and dental care is a right, not only for Micronesians serving in the military, but for all Micronesians who’ve landed in Oregon and beyond. As a Company Commander, I did not have the agency or influence to provide that to all soldiers. But through the COFA Dental Program put forward to Oregon legislators this session, we are a step closer to ensuring optimal health for all Oregonians.”

—Lilian Ongelungel, a Palauan woman born and raised in Portland, Oregon who served as a Commissioned Officer in the US Army.

In the case you didn’t already know, here is a brief history of the Compact s of Free Association.

Photo of nuclear testing on Marshall Islands Bikini Atoll

Photo of nuclear testing on Marshall Islands Bikini Atoll

The Compacts of Free Associations (COFA) was an agreement made between the United States and the islands of Micronesia, Palau, and the Marshall Islands. The United States gained exclusive military occupation, access to nuclear testing on the islands (specifically in Micronesia and the Marshall Islands), and strategic military placement in the Pacific from the COFA agreement. The COFA residents were, in return, promised protection, the ability to move freely to the United States and territories with legal non-immigrant status, access to the US federal government benefits, and the ability to work and live in the US.  

However, in 1996, during the welfare reform, COFA communities were cut from their access to “most federal benefits, including Medicaid. Many COFA migrants suffer from chronic diseases and health conditions that can be linked to medical effects of US nuclear testing in the region.” An example of the severity of US military occupation negatively impacting the COFA islands is the nuclear testing conducted after World War 2 in Bikini Atoll. The testing has left Bikini Atoll so contaminated that the native islanders still cannot return to their homeland thus displacing native islanders for the last 73 years.

In 2016, COFA communities in Oregon were re-granted access to Medicaid and now are fighting for access to dental care. Dental care, like health care access, are avenues for all people to live healthy lives in the ways they choose to live.  In Oregon’s 2019 legislative session, OHEA has prioritized advocating for House Bill 2706 which would ensure COFA residents also had access to dental care coverage.

Health equity requires all of us to learn and recognize the history of Oregonians, particularly Oregonians who continue to face health disparities and inequities today due to barriers that are often out of their control. Our histories and livelihoods are very much so interconnected. Certain communities are afforded particular benefits, often at the cost of another community’s well being, so we must fight for each other’s access and well-being in the ways we would do for our own. If you are down for health equity, part of doing the work is to understand the history of the communities most impacted, where your part in undoing harm is and fighting with and for one another.

Latest update on HB 2706: https://cann.us/2019/04/08/update-on-hb-2706-cofa-dental-program-in-oregon/?fbclid=IwAR33NZKDqac9fS7WM-NbzUvHAqFxTytUWtNRaRCUyyTDPR9zT2DryQQasOo

Additional resources:

https://www.bikiniatoll.com/

https://pasquines.us/2018/03/13/challenges-arise-from-compact-of-free-association-with-the-us-in-states-and-territories/

http://stream.aljazeera.com/story/201810021036-0025720

https://www.apiahf.org/focus/health-care-access/cofa/

https://olis.leg.state.or.us/liz/2019R1/Downloads/CommitteeMeetingDocument/172299

Yian Saechao