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Insuring Ozark Islander Children Access Quality Healthcare

J. Froelich
Arkansas Public Media


Thousands of Pacific Islander children now inhabit northwest Arkansas. The youngsters are lawfully residing Marshallese migrants, brought here by their parents. Many families arrive impoverished, but with help from extended kin, parents settle in, take up factory and slaughterhouse jobs, and enroll the children in public school. 

But enrolling into the American healthcare insurance system is a major challenge for low and even middle- income Marshallese, who cannot afford workplace coverage policies or Obamacare premiums. Marshallese adults are barred from Arkansas Medicaid, known as the Private Option. And their children don’t qualify for "ARKids First!" the state's implementation of the federal children’s insurance program. But Northwest Arkansas lawmakers, along with a state children's advocacy organization, are determined to help.

As many as fourteen thousand Marshallese live in Benton, Washington, Madison and Carroll Counties. Republic of the Marshall Island natives are able to move to the United States with just a passport, under a Compact of Free Association. In exchange, the U.S. maintains strategic military operations on the islands, located in the North Pacific, routinely conducting intercontinental ballistic missile tests.


Credit U.S. Atomic Energy Commission Archives
Operations Crossroads Baker Test on Bikini Atoll July 1946 Marshall Islands

The Marshall Islands, initially a U.S. territory, served as a Cold War thermonuclear and atomic bomb test site in the late 1940s and early 50s. And Marshallese living downwind served as nuclear test subjects.

Because of their nuclear legacy, Arkansas Republican State Representative Jeff Williams, District 89-Springdale, says America is obligated to accommodate and medically entitle Marshallese migrants. 

“It’s the right thing to do,” Williams says, “and we can also make the case that they are suffering from illness primarily due to exposure to nuclear testing.”

U.S. environmental surveys tracing back to the 1970s and studies by the National Cancer Institute reveal the persistent presence of man-made radioactive nuclides in the islands. As a consequence Arkansas health experts who work with Marshallese speculate certain islanders may be immune compromised. Tuberculosis and Hansen’s Disease is prevalent, as is obesity, diabetes, heart disease and stroke. While indigenous Marshallese subsisted on tropical plant cultivars and fish, islanders today consume a low-cost high carb, high sugar western diet. And without routine primary medical care, both Marshallese children and adults suffer.


Credit Jeff Williams
State Rep. Jeff Williams (R-Springdale)

That's why Representative Jeff Williams wants to enroll all low-income Marshallese children in ARKids First! -- Arkansas’s federally funded insurance program. 

"We were able to come to an agreement with the Governor’s office, and he's decided to support these changes," Williams says.

Gov. Asa Hutchinson declined an interview for this report. Spokesman JR Davis says his office continues to gather information on endeavor.

Representative Williams says if given the go-ahead, the state will issue a formal request to the federal Centers for Medicare and Medicaid Services for authorization of inclusion of Marshallese. The request must also undergo legislative review. If approved, Williams says the Arkansas Department of Human Services could implement the change before the end of 2017. 


Laura Kellams, Northwest Arkansas's director for Arkansas Advocates for Children and Families, has been lobbying the state legislature for nearly seven years to get low-income Marshallese children on Medicaid. 

"We have long had support from the Springdale delegation," Kellams says, including newly elected state Sen. Lance Eades (R-Springdale), who also approached Governor Hutchinson last autumn.


Credit Laura Kellams
Laura Kellams, northwest Arkansas director for Arkansas Advocates for Children and Familes

“Since 2009 states have had the option to extend Medicaid coverage to lawfully residing immigrant children,” she says, referring to the Children’s Health Insurance Program Reauthorization Act. Thirty-one states have opted in. Kellams hopes Arkansas is the 32nd.

She estimates that several thousand Marshallese children will immediately qualify for ARKids if approved, alleviating much of the physical and  financial burden carried by public school health nurses, free clinics, community clinics and public health clinics. The cost of entitlement, she says, is covered, in the near future, by the federal government.


Arkansas Advocates for Children and Families say if low-income Marshallese children receive routine medical care, they will thrive in their community and the schools. The newly established Center for Pacific Islander Health, based at the University of Arkansas for Medical Sciences' Northwest Arkansas campus also supports ARKids First for Marshallese youngsters. The Center is also investing millions of research dollars to improve global Pacific Islander health care and delivery--addressing health disparities in minority populations and rural communities, using a community-based participatory approaches. Nia Aitaoto, a native Samoan, serves as co-director. 


Credit J. Froelich
Dr. Nia Aitaoto, PhD Pacific Islander community health specialist.

Aitaoto sees lots of Marshallese children needlessly suffering with conditions like asthma and chronic ear infections. 

“And that’s related to not going to the doctors office,” she says. “Islanders are forced to handle illness at home. And when things escalate they will often end up in local hospital emergency rooms.”

The Marshall Islands is made up of two necklaces of coral atolls that narrowly breach the sea. The vast Pacific archipelago has always been susceptible to devastating typhoons as well as drought. As a consequence, Marshallese have always traditionally celebrated kemen — an infant's first birthday — with a community feast to mark baby's first year survival.

Providing Ozark islander babies, toddlers, children, teens as well as pregnant moms with secure no-cost health care for many could also be a cause for celebration.


Credit J.Froelich
Ozark Marshallese Girl Scout Troupe, Springdale Arkansas.

This story is produced by Arkansas Public Media, a statewide journalism collaboration among public media organizations. Arkansas Public Media reporting is funded in part through a grant from the Corporation for Public Broadcasting, with the support of partner stations KUAR, KUAF, KASU and KTXK and from members of the public. You can learn more and support Arkansas Public Media’s reporting at Arkansas Public Media is Natural State News with Context.

Jacqueline Froelich is an award-winning senior news reporter for KUAF-91.3 FM in Fayetteville where she is a long-time station-based correspondent for NPR in Washington D.C. She covers energy, business, education, politics, the environment, and culture. Her work is broadcast locally on KUAF’s daily news magazine, “Ozarks At Large,” and statewide on Arkansas’s three public radio affiliates.