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The Honolulu Advertiser
Posted on: Monday, March 1, 2010

Treatment of COFA residents intolerable

By Blaine Rogers and Elizabeth Dunne

Hawaii news photo - The Honolulu Advertiser

Lillian Koller, right, director of the state Dept. of Human Services, is forcing changes in health care for those covered by the Compacts of Free Association, much to the distress of COFA residents.


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Sometimes bad times bring out the best in people; sometimes, the worst. Unfortunately, the leadership of the Hawai'i Department of Human Services falls squarely is in the second category when it says people covered by the Compacts of Free Association between the U.S. and Palau, the Republic of the Marshall Islands and the Federated States of Micronesia are unwelcome in Hawai'i.

DHS' insensitive and inflammatory rhetoric with respect to COFA residents offers a glimpse into the flawed decision-making process of a troubled agency and belies DHS' stated mission of "empowering those who are the most vulnerable in our state to expand their capacity for self-sufficiency, self-determination, independence, healthy choices, quality of life and personal dignity."

On Feb. 4, DHS Director Lillian Koller testified before the House Committee on Human Services and House Committee on Health, in opposition to House Bill 2467, which would have before getting stuck in the House Finance Committee required DHS to cover dialysis and cancer treatments and more prescription drugs for COFA residents. Quoting from the Compact, Koller testified that "any alien who has been admitted under the Compact or the Compact, as amended, who cannot show that he or she has sufficient means of support in the United States, is deportable." She went on to say: "Individuals on any type of public assistance, including Hawai'i's state-only funded medical assistance for COFAs, do not have sufficient means of support."

Koller's efforts to silence this already marginalized population with the threat of deportation which is, incidentally, an exclusive power of the federal government is intolerable. Fraught with troubling anti-immigrant overtones, Koller's statement evinces a pronounced detachment from the difficulties faced not only by COFA residents, but also by Hawai'i residents generally.

Let's take a look at how we got here.

In June, facing budget shortfalls, DHS initiated a clandestine and illegal effort to halt health-care benefits to many COFA residents. In August, DHS escalated its campaign, announcing new rules that slashed the health care benefits provided to COFA residents already in Hawai'i. Among other things, DHS moved to eliminate coverage for life-saving treatments such as chemotherapy and dialysis and to withhold lifesaving prescription drugs. DHS gave notice of this change mere weeks before it was to be implemented, in English only, and with little to no guidance for health care providers. In short, DHS's haphazard efforts at cost-cutting led to panic in the COFA and medical communities and created a life-threatening situation.

Unfortunately for DHS, the rule of law prevailed, as the U. S. District Court issued a temporary restraining order restoring benefits to their previous levels because DHS was violating recipients' constitutional due-process rights. Their plan in shambles, DHS had no choice but to comply with Hawai'i law and initiated administrative rule-making on their proposed cuts. DHS issued draft rules on Dec. 24, and held public hearings on Jan. 25 and 26. Community leaders helped mobilize more than 100 COFA residents to testify. Final rules are expected soon.

While the level of public benefits available to needy Hawai'i residents in these difficult times is an open issue, the way in which we talk about these individuals should not be uncivilized. Callously referring to them in public testimony as deportable commodities that should be grateful for their mere continued presence in Hawai'i de-humanizes these individuals, diminishes public discourse on a complex subject and evinces a shocking lack of sensitivity on the part of DHS. Koller should know better.

DHS' Web site contains an article that quotes Koller as saying that "[i]t is not good enough to just live life for yourself." We hope that Koller will heed her own words, and the mission of her agency, when considering the plight of Hawai'i's COFA residents.