Compact of Free Association
[2] Under the compacts, the US federal government provides guaranteed financial assistance over a 15-year period administered through its Office of Insular Affairs in exchange for full international defense authority and responsibilities.
US$30 million will also be disbursed annually among American Samoa, Guam, Hawaii, and the Northern Mariana Islands in "Compact Impact" funding.
The economic provisions of the Compact for Palau which provided $18 million in annual subsidies and grants, expired on September 30, 2009, and the renewal talk was concluded in late 2010.
Ambassador Yun signed Palau's COFA extension on May 22, 2023, with the island government previously requesting to advance their date more in line with the other two countries.
[32] Marshall Islands' Minister of Foreign Affairs and Trade, Jack Ading alongside Ambassador Yun signed RMI's agreement on October 16, 2023.
[36] Kiribati is another state that may consider a CFA, as it would be a way to gain immigration access to escape rising sea levels, as it has been a stalwart U.S. ally in the Pacific.
The CFA would be a way to give additional options for island difficulties and get extra development aid with limited natural resources, and unify it with other Micronesian people living in the Pacific (this includes FSM, Marshall, Guam, etc.).
[37] Although the COFA are very expensive, support for the alliances has been popular in the US, and considered mutually beneficial, with the small island nations warning the US of dangers in the Pacific regions, such as global warming and influence of foreign powers.
According to Zellen, "Greenlandic Inuit, who suffer from a long legacy of neglect and whose colonial experience, despite recent gains in autonomy, has not been entirely positive, may indeed stand to benefit in many ways" from this arrangement.
[42] The United States' administration of the former trust territories now covered under the Compacts of Free Association has been subject to ongoing criticism over the past several decades.
A 1961 United Nations mission report initially noted deficiencies in "American administration in almost every area: poor transportation, failure to settle war damage claims; failure to adequately compensate for land taken for military purposes; poor living conditions[;] inadequate economic development; inadequate education programs; and almost nonexistent medical care.
"[43] In 1971, congresswoman Patsy Mink further noted that "[A]fter winning the right to control Micronesia, [the US] proceeded to allow the islands to stagnate and decay through indifference and lack of assistance.
[T]he people are still largely impoverished and lacking in all of the basic amenities which we consider essential – adequate education, housing, good health standards, modern sanitation facilities.
[45] With respect to these unaddressed claims, medical practitioners also noted the potential widespread impacts of nuclear testing within the Pacific Proving Grounds, indicated by the prevalence of both radiogenic diseases, as well as heart disease, diabetes, and obesity associated with "[a] forced change in dietary patterns and lifestyle" resulting from US administration after the testing.
[48] Questions regarding US responsibility have also been raised regarding the issue of numerous derelict war ships and oil tankers abandoned or destroyed by the US military in atolls and islands throughout the compact area.
[50] COFA residents were instead subject to Basic Health Hawaii, a limited health care plan under which "transportation services are excluded and patients can receive no more than ten days of medically necessary inpatient hospital care per year, twelve outpatient visits per year, and a maximum of four medication prescriptions per calendar month.
[51] Noting that such a policy likely constituted unlawful discrimination in violation of the Equal Protection Clause, federal District Court Judge John Michael Seabright issued a preliminary injunction against the implementation of Basic Health Hawaii.
[52] In finding a high likelihood of irreparable harm, Judge Seabright took note of the "compelling evidence that BHH's limited coverage .
When the United States Supreme Court refused to hear the case, the Abercrombie administration removed most COFA residents from Med-QUEST and transferred them onto Affordable Care Act plans.
