[Congressional Record Volume 157, Number 120 (Tuesday, August 2, 2011)]
[Senate]
[Pages S5264-S5265]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. AKAKA (for himself, Mr. Inouye, and Mr. Bingaman):
  S. 1504. A bill to restore Medicaid eligibility for citizens of the 
Freely Associated States; to the Committee on Finance.
  Mr. AKAKA. Mr. President, I rise today to introduce the Medicaid 
Restoration for Citizens of Freely Associated States Act of 2011. This 
bill would reinstate eligibility for critical Federal health benefits 
for citizens of certain Pacific Island nations who have been invited by 
the Federal Government to live in the United States, but for whom the 
costs of services have fallen to individual states, Hawaii in 
particular. I would like to thank Senators Inouye and Bingaman for 
joining me in introducing this bill.
  The Freely Associated States, the Republic of the Marshall Islands, 
the Federated States of Micronesia, and the Republic of Palau, are 
island nations that have a unique political relationship with the 
United States.
  At the end of World War II, the United Nations established the 
``Trust Territory of the Pacific Islands,'' which was administered by 
the United States between 1947 and 1986. It included the islands that 
now make up the FAS nations, as well as other Pacific islands liberated 
from Japan after World War II.
  This U.S. Trusteeship presented the Federal Government with new 
strategic and military opportunities, allowing the United States to 
establish military bases and station forces in the Trust Territory and 
close off areas for security reasons. It also bestowed upon the United 
States the responsibility to promote economic development and self-
reliance for the territory.
  In the 1980s, the United States entered into a new phase in its 
relationship with the FAS through the Compact of Free Association and 
the Palau Compact of Free Association. The Compacts allow FAS citizens 
to freely enter, reside, and work in the United States and authorize 
their participation in certain Federal programs.
  As a part of the Compacts, FAS citizens were extended Medicaid 
eligibility.
  Unfortunately, when the Personal Responsibility and Work Opportunity 
Act of 1996 was enacted, FAS citizens lost many of their public 
benefits, including Medicaid coverage.
  Subsequently, state and territorial governments have been the sole 
sources of funding for meeting the social service and public health 
needs of this ever growing population. And FAS migrants to Hawaii often 
arrive with serious medical needs, requiring costly health care 
services such as dialysis and chemotherapy.
  These costs will continue to rise, even as the State's resources are 
increasingly constrained.
  Restoration of Medicaid eligibility for these individuals is crucial 
for states where many FAS citizens reside. In the Pacific, this 
includes Hawaii, Guam, and the Northern Mariana Islands.
  In the continental U.S., this includes California, Oregon, 
Washington, and Arkansas. Health care providers that operate in areas 
with high rates of uninsured are having difficulties meeting the health 
care needs of their communities. Uninsured FAS citizens who seek health 
care services contribute to the uncompensated costs that are creating 
an ever-greater burden on health care providers.
  I ask my colleagues for their support of the Medicaid Restoration for 
Citizens of Freely Associated States Act of 2011. The decision to allow 
citizens of the Freely Associated States to come to the United States 
was a federal decision, with national benefits.
  That we also accept the cost of that decision is a matter of fairness 
and responsibility.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 1504

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Medicaid Restoration for 
     Citizens of Freely Associated States Act of 2011''.

[[Page S5265]]

     SEC. 2. MEDICAID ELIGIBILITY FOR CITIZENS OF FREELY 
                   ASSOCIATED STATES.

       (a) In General.--Section 402(b)(2) of the Personal 
     Responsibility and Work Opportunity Reconciliation Act of 
     1996 (8 U.S.C. 1612(b)(2)) is amended by adding at the end 
     the following:
       ``(G) Medicaid exception for citizens of freely associated 
     states.--With respect to eligibility for benefits for the 
     program defined in paragraph (3)(C) (relating to medicaid), 
     paragraph (1) shall not apply to any individual who lawfully 
     resides in the United States (including territories and 
     possessions of the United States) in accordance with--
       ``(i) section 141 of the Compact of Free Association 
     between the Government of the United States and the 
     Government of the Federated States of Micronesia, approved by 
     Congress in the Compact of Free Association Amendments Act of 
     2003;
       ``(ii) section 141 of the Compact of Free Association 
     between the Government of the United States and the 
     Government of the Republic of the Marshall Islands, approved 
     by Congress in the Compact of Free Association Amendments Act 
     of 2003; or
       ``(iii) section 141 of the Compact of Free Association 
     between the Government of the United States and the 
     Government of Palau, approved by Congress in Public Law 99-
     658 (100 Stat. 3672).''.
       (b) Exception to 5-Year Limited Eligibility.--Section 
     403(d) of such Act (8 U.S.C. 1613(d)) is amended--
       (1) in paragraph (1), by striking ``or'' at the end;
       (2) in paragraph (2), by striking the period at the end and 
     inserting ``; or''; and
       (3) by adding at the end the following new paragraph:
       ``(3) an individual described in section 402(b)(2)(G), but 
     only with respect to the designated Federal program defined 
     in section 402(b)(3)(C).''.
       (c) Definition of Qualified Alien.--Section 431(b) of the 
     Personal Responsibility and Work Opportunity Reconciliation 
     Act of 1996 (8 U.S.C. 1641(b)) is amended--
       (1) in paragraph (6), by striking ``or'' at the end;
       (2) in paragraph (7), by striking the period at the end and 
     inserting ``; or''; and
       (3) by adding at the end the following:
       ``(8) an individual who lawfully resides in the United 
     States (including territories and possessions of the United 
     States) in accordance with a Compact of Free Association 
     referred to in section 402(b)(2)(G).''.
       (d) Conforming Amendments.--Section 1108 of the Social 
     Security Act (42 U.S.C. 1308) is amended--
       (1) in subsection (f), in the matter preceding paragraph 
     (1), by striking ``subsection (g)'' and inserting 
     ``subsections (g) and (h)''; and
       (2) by adding at the end the following:
       ``(h) The limitations of subsections (f) and (g) shall not 
     apply with respect to medical assistance provided to an 
     individual described in section 431(b)(8) of the Personal 
     Responsibility and Work Opportunity Reconciliation Act of 
     1996.''.
       (e) Effective Date.--The amendments made by this section 
     take effect on the date of enactment of this Act and apply to 
     benefits for items and services furnished on or after that 
     date.
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