Letter U. S. Senate Committee on Energy and natural Resources to Assistant Secretary for East Asian and Pacific Island Affairs (Oct. 6, 2009).

United States Senate Committee on Energy and natural Resources Washington, DC 20510-6150 ENERGY.SENATE.GOV

October 6, 2009

The Honorable Kurt Campbell Assistant Secretary for East Asian and Pacific Affairs U.S. Department of State 2201 C Street N.W. Washington, DC 20520

The Honorable Anthony M. Babauta Assistant Secretary for Insular Affairs U.S. Department of the Interior 1849 C Street, N.W. Washington, DC 20240

Dear Secretaries Campbell and Babauta:

We are writing to request your assistance in developing policy options to manage the growing cost of providing healthcare to migrants to the U.S. from the Freely Associated States of the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau (the "FAS"). Section 141 of the Compact of Free Association Amendments Act 2003, ("CFAAA") (P.L. 108-188) continued the privilege, established under the Compact of Free Association of Act of 1985 (P.L. 99-239), for FAS citizens to be admitted into the United States "to lawfully engage in occupations, and establish residence as a nonimmigrant".

We believe that the fundamental policy of allowing FAS citizens to enter the U.S. for work, study, and residence is sound. However, the resources of local communities in the United States with high numbers of FAS migrants are increasingly stressed when providing health care to migrants, particularly those with communicable diseases or who need long-term treatment for conditions such as diabetes.

The Federal government has the responsibility to enforce the provisions of the Immigration and Naturalization Act (8 USC 1182(a) which, among other things, makes communicable diseases, and the likelihood of becoming a public charge, grounds for inadmissibility to the United States. However, enforcement of these provisions has not been more active because there are both practical problems and policy concerns. For example, it is impractical to deny entry to FAS migrants to the U.S. because it is difficult to book seats for those denied admission on the few, usually crowded return flights to the FAS. One possible solution to this problem would be to develop a mechanism to screen travelers for admissibility prior to their boarding a flight to the United States.

In addition. U.S. Compact assistance to the FAS for health care could be redirected to better target and enhance local health care services. Under the CFAAA, the U.S. provides significant financial and programmatic support to the FAS governments for healthcare programs and activities. Enhancing local health care services to focus more on reducing the prevalence of communicable diseases, or on improving the ability of the FAS to treat conditions such as diabetes, may reduce the number FAS citizens seeking health care in the U.S., as well as provide an alternative source of care if entry into the U.S. is denied.

We look forward to your agreement to work with our staffs to explore these and other options for reducing the cost burden of providing healthcare to the growing population or FAS migrants in the U.S. If you have any questions regarding this request, please feel free to contact Allen Stayman or Isaac Edwards of the Committee staff at 202-224-4971.


Lisa Murkowski Ranking Member Committee on Energy and Natural Resources

Jeff Bingaman Chairman Committee on Energy and Natural Resources

Daniel K. Akaka U.S. Senator

Daniel K. Inouye U.S. Senator


CC: The Honorable David Heyman, Assistant Secretary for Policy, U.S. Department of Homeland Security

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