Individuals from the three sovereign nations that have established Compacts of Free Association (COFAs) with the United States – Palau, the Marshall Islands, and the Federated States of Micronesia – are able to serve in the U.S. military; however, they have never qualified for U.S. veterans health services.
This situation altered in March 2024 when Congress enacted a law empowering the United States Department of Veterans Affairs (VA) to extend healthcare to veterans from the COFA nations, despite their non-citizen status. Services are not immediate, as the VA must initially negotiate with each country regarding the specifics of care delivery. Consequently, U.S. military veterans residing in these freely associated states still do not have access to VA health services, and they are likely to continue facing a lack of U.S. healthcare benefits for the foreseeable future.
The Veterans Administration offers health services to veterans across all states and territories, yet these services have not been available to U.S. veterans living in the freely associated states (FAS). While these FAS veterans may obtain medical care by traveling to a U.S. state or territory or even to Canada or the Philippines, there are no VA services present in the Republic of the Marshall Islands, Palau, or the Federated States of Micronesia, given their status as foreign nations.
Ambassadors from Freely Associated States Call for Immediate Action
During testimony before the House National Resources Committee on September 10, 2024, the ambassadors representing the three COFA nations urged Congress to quickly enact the VA health services law.
Ambassador Jackson Soram from the Federated States of Micronesia stated, “Regrettably, we are disheartened by the Department of Veterans Affairs’ (VA) limited engagement. The COFA Amendments Act specifies a one-year timeframe after its enactment for the VA to collaborate with the FAS governments to explore options for delivering necessary care to veterans living in the FAS. We are extremely alarmed that six months have passed without any advances on these critical initiatives for our veterans’ health. The FSM government is prepared to provide any necessary assistance.”
“The provisions cater to the needs surrounding the Marshall Islands more than ever, significantly enhancing and strengthening our nations’ association, with ours having once been a region under your administration but now a sovereign state loosely affiliated with yours,” added Charles Paul, the Ambassador of the Marshall Islands. “Negotiations for agreements are still ongoing, including a new agreement for certain U.S. services that we anticipate will be finalized soon this month, and another agreement that would grant our U.S. military veterans the ability to receive veterans’ healthcare on our islands or to travel for care, rather than being required to reside in the U.S., Canada, or the Philippines.”
Ambassador Hersey Kyota of Palau commented, “We eagerly await the Department of Veterans Affairs’ draft agreement concerning healthcare that U.S. military veterans residing in the freely associated states are entitled to under your law. Numerous veterans have been unable to return and contribute to our islands, having to stay in the U.S., the Philippines, or Canada to receive this care.”
U.S. Department of Veterans Affairs Commits to Support
At the same Congressional hearing, Miguel Lapuz, a Special Advisor at the U.S. Department for Veterans Affairs (VA), testified that the VA “is fully dedicated to ensuring U.S. Veterans in the FAS have access to hospital care, medical services, and beneficiary travel benefits. While we are in the process of finalizing next steps toward implementation, eligible Veterans in the FAS can enroll for VA health care [online] and continue to receive VA health care at VA facilities in the U.S. (including Guam) or in the FAS through the Foreign Medical Program (if eligible). Additionally, eligible Veterans can access other VA services, such as disability benefits, educational support, and pension services.”
Lapuz indicated that the current phase of studying VA health services would extend until the year’s end, followed by subsequent actions.
Puerto Rico’s Potential Free Association Status?
Among the potential political status alternatives for Puerto Rico is independence accompanied by a Compact of Free Association. While some proponents of this choice argue that free association is a distinct “best of both worlds” status, the current COFA nations are all — as emphasized by the Ambassador from the Marshall Islands — sovereign nations loosely connected to the United States.
All three nations reap benefits from their connection with the United States but under highly restricted conditions, evidenced by the ongoing lack of veterans health services to COFA citizens who have served in the U.S. armed forces. Meanwhile, the United States enjoys, as articulated by hearing witness Anka Lee, Deputy Assistant Secretary of Defense for East Asia Policy, U.S. Defense Department, “assured access guaranteed by the Compacts…for bilateral and multilateral [military] training and exercises.” The United States possesses the capability to establish military forces in the COFA states and to make defense decisions for these countries – rights that appear disproportionate while COFA citizens are excluded from veterans health care services.
Proponents of “sovereign free association” for Puerto Rico with the United States may hope that Puerto Rico’s relationship with the United States could differ significantly from that of the current FAS nations; however, there is no evidence to substantiate this assertion. As last week’s hearing demonstrated, there is a clear precedent in how any prospective future Freely Associated State can expect to be treated under U.S. law, and access to healthcare for U.S. veterans might not be included in the agreement.
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