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Migration from the Federated States of Micronesia, the Republic of the Marshall Islands, and Palau has had a significant impact on Guam, Hawaii, and the Commonwealth of the Northern Mariana Islands (CNMI). The health and education needs of these migrants have particularly affected the budgetary resources of Guam and the CNMI. The budgetary impact on Hawaii is smaller but is expected to grow as Hawaii absorbs health care costs once covered by the U.S. government. Public health is an important concern for all three U.S. island areas. Migrants from the region with limited financial means are able to enter the United States with few restrictions, and U.S. island areas are absorbing much of the health care costs of this population. Furthermore, Guam, Hawaii, and the CNMI can be expected to continue to experience migration as long as weak economic conditions persist in Micronesia and the Marshall Islands. Targeting future U.S. assistance to Micronesia and the Marshall Islands for education and health purposes could reduce some of the motivation to migrate. Improvements in migrant health and education status might be expected to reduce immigration to U.S. destinations.

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Recommendations for Executive Action

Agency Affected Recommendation Status
Department of State The Secretary of State should direct the U.S. Compact Negotiator to consider how to target future health and education funds provided to the FSM and the RMI in ways that also effectively address adverse migration impact problems identified by Guam, Hawaii, and the CNMI. For example, the U.S. Negotiator could consider whether a specified portion of the health sector assistance should be targeted at treating and preventing the communicable diseases in the FSM and the RMI that are a public health concern in Guam, Hawaii, and the CNMI.
Closed - Implemented
GAO recommended (Foreign Relations: Migration From Micronesian Nations Has Had Significant Impact on Guam, Hawaii, and the Commonwealth of the Northern Mariana Islands, GAO-02-40, October 5, 2001) that, in the context of negotiating future U.S. Compact assistance to the Federated States of Micronesia (FSM) and the Republic of the Marshall Islands (RMI), the U.S. Department of State Compact Negotiator should consider how to target future health and education funds in ways that effectively address adverse FSM and RMI migrant impact problems (such as education and health costs) identified by Guam, Hawaii, and the Commonwealth of the Northern Mariana Islands. The Department of State (in close cooperation with the Department of the Interior) took subsequent action to respond directly to GAO's recommendation. In a key subsidiary agreement to the amended Compacts, which went into effect on June 25, 2004 for the FSM and May 1, 2004 for the RMI, problem areas identified by the three U.S. areas are addressed. For example, the agreement requires that education sector grants shall emphasize advancing a quality basic education system by, for example, raising the level of staff quality. It also states that the health sector grants shall, among other things, prioritize establishing sustainable funding mechanisms for operating a community-based system with emphasis on prevention, primary care, mental health, substance abuse prevention, and the operation of hospitals to provide secondary care at appropriate levels and reduce reliance on medical referrals abroad.

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