Compact of Free Association
A Compact of Free Association (COFA) defines the relationship that each of three sovereign states—the Federated States of Micronesia (FSM), the Republic of the Marshall Islands (RMI) and the Republic of Palau—have entered into as associated states with the United States.
Now sovereign nations, the three freely associated states were formerly part of the Trust Territory of the Pacific Islands, a United Nations trusteeship administered by the United States Navy from 1947 to 1951 and by the United States Department of the Interior from 1951 to 1986 (to 1994 for Palau). Under the COFA relationship, the United States provides guaranteed financial assistance over a 15-year period administered through the Office of Insular Affairs in exchange for full international defense authority and responsibilities.
The freely associated states actively participate in all Office of Insular Affairs technical assistance activities. The U.S. treats these nations uniquely by giving them access to many U.S. domestic programs, including disaster response and recovery and hazard mitigation programs under the Federal Emergency Management Agency, and services provided by the National Weather Service, the United States Postal Service, the Federal Aviation Administration, the Federal Communications Commission, and U.S. representation to the International Frequency Registration Board of the International Telecommunication Union. The Compact area, while outside the customs area of the United States, is mainly importable duty-free.
Most citizens of the associated states may live and work in the United States, and most U.S. citizens and their spouses may live and work in the associated states. In 1996, the U.S. Personal Responsibility and Work Opportunity Act included removing Medicaid benefits for resident aliens from these states. (Most other resident aliens have a five-year waiting period.)
The COFA allows the United States to operate armed forces in Compact areas, to demand land for operating bases (subject to negotiation), and excludes the militaries of other nations without U.S. permission. The U.S. in turn becomes responsible for protecting its affiliate nations and responsible for administering all international defense treaties and affairs, though it may not declare war on their behalf. It is not allowed to use nuclear, chemical, or biological weapons in Palau territory. In the territories of the Marshall Islands and the Federated States of Micronesia it is not allowed to store such weapons except in times of national emergency, state of war, or when necessary to defend against an actual or impending attack on the U.S., the Marshall Islands, or the Federated States of Micronesia.
Commentators have noted that the ongoing presence and recruitment efforts of the U.S. military in the Compact areas may have resulted in the high level of military enlistment by Compact citizens. For example, in 2008, the Federated States of Micronesia had a higher per-capita enlistment rate than any U.S. state, and had more than five times the national per-capita average of casualties in Iraq and Afghanistan.
In 2003, the Compacts with the RMI and FSM were renewed for 20 years. These new Compacts provided US$3.5 billion in funding for both nations. US$30 million will also be disbursed annually amongst American Samoa, Guam, Hawaii, and the Northern Mariana Islands in "Compact Impact" funding. This funding helps the governments of these localities cope with the expense of providing services to immigrants from the RMI, FSM, and Palau. The U.S. usage of Kwajalein Atoll for missile testing was renewed for the same period. The new Compacts also changed certain immigration rules. RMI and FSM citizens traveling to the U.S. are now required to have passports. The U.S. Postal Service was given the option to apply international postage rates for mail between the U.S. and RMI/FSM (phased in over five years). The USPS began implementing the change in January 2006, but decided to resume domestic services and rates in November 2007.
The renewed Compact (commonly called "Compact II") for FSM took effect on June 25, 2004, and for RMI on June 30, 2004.
The economic provisions of the Compact for Palau which provided $18 million in annual subsidies and grants, expired on September 30, 2009, and the renewal talk was expected to conclude in early 2010. U.S. financial support for Palau is currently based on a continuing resolution passed by the U.S. Congress. The Compact Trust Fund set up to replace US financial aid underperformed due to the recession. The military and civil defense provisions will remain until 2015.
U.S. fulfillment of commitments
The United States' administration of the former trust territories now covered under the Compacts of Free Association has been subject to ongoing criticism over the past several decades. A 1961 United Nations mission report initially noted deficiencies in "American administration in almost every area: poor transportation, failure to settle war damage claims; failure to adequately compensate for land taken for military purposes; poor living conditions[;] inadequate economic development; inadequate education programs; and almost nonexistent medical care."  In 1971, congresswoman Patsy Mink further noted that "[A]fter winning the right to control Micronesia, [the U.S.] proceeded to allow the islands to stagnate and decay through indifference and lack of assistance. . . . [T]he people are still largely impoverished and lacking in all of the basic amenities which we consider essential – adequate education, housing, good health standards, modern sanitation facilities." 
After the compacts, criticism was also received by the United States House Foreign Affairs Subcommittee on Asia and the Pacific with regards to the unfulfilled commitments of the United States to address the impacts of U.S. nuclear testing in the Marshall Islands, which were included as part of the Pacific Proving Grounds. Speakers noted that while section 177 of the Compact of Free Association recognized the United States' responsibility "to address past, present and future consequences of the nuclear testing claims," less than $4 million was awarded out of a $2.2 billion judgement rendered by a Nuclear Claims Tribunal created under the RMI Compact, and the United States Court of Claims had dismissed two lawsuits to enforce the judgement. With respect to these unaddressed claims, medical practitioners also noted the potential widespread impacts of nuclear testing within the Pacific Proving Grounds, indicated by the prevalence of both radiogenic diseases, as well as heart disease, diabetes, and obesity associated with "[a] forced changed in dietary patterns and lifestyle" resulting from U.S. administration after the testing. In 2011, lawmakers further noted that the U.S. Congress had continuously failed to cover the costs of promised medical care and services to displaced Compact citizens who migrate to the United States for health care, education, and employment opportunities, particularly since the passage of the Personal Responsibility and Work Opportunity Act.
Questions regarding U.S. responsibility have also been raised regarding the issue of numerous derelict war ships and oil tankers abandoned or destroyed by the U.S. military in atolls and islands throughout the Compact area.
Health care issues
In 2009, the State of Hawaii, under the administration of then governor Linda Lingle, attempted to restrict health care access for Compact citizens by eliminating all Compact residents of Hawaii from QUEST, the state’s comprehensive Medicaid coverage plan. COFA residents were instead subject to Basic Health Hawaii, a limited health care plan under which "transportation services are excluded and patients can receive no more than ten days of medically necessary inpatient hospital care per year, twelve outpatient visits per year, and a maximum of four medication prescriptions per calendar month. . . . BHH covers dialysis treatments as an emergency medical service only, and the approximate ten to twelve prescription medications dialysis patients take per month are not fully covered. BHH . . . caus[es] cancer patients to exhaust their allotted doctors' visits within two to three months".
Noting that such a policy likely constituted unlawful discrimination in violation of the Equal Protection Clause, federal district court judge John Michael Seabright issued a preliminary injunction against the implementation of Basic Health Hawaii. In finding a high likelihood of irreparable harm, Judge Seabright took note of the "compelling evidence that BHH's limited coverage . . . is causing COFA Residents to forego much needed treatment because they cannot otherwise afford it". Lingle's successor, Governor Neil Abercrombie indicated that he might continue the State's appeal of the injunction to the United States Court of Appeals for the Ninth Circuit.
Vote at UN General Assembly
- Palau COFA 1986, Title 1
- Palau COFA 1986, Sections 241–242
- Palau COFA 1986, Section 141
- Federated States of Micronesia COFA, Section 141.
- House Health Bill Would Help Pacific Island Migrants
- "FSM COFA, Section 324".
- Uncle Sam wants Micronesians for U.S. Military; see also A Micronesian Paradise – for U.S. Military Recruiters
- BUSH SIGNS $3.5 BILLION PACIFIC COMPACT – December 18, 2003 at archives.pireport.org
- USPS Postal News: USPS Delivers in the Pacific at www.usps.com
- Expiration of economic provisions for Palau
- Compact Trust Fund underperforms
- Compact of Free Association with the Republic of Palau
- McHenry, Donald F. (1975). Micronesia: Trust Betrayed -- Altruism vs. Self Interest in American Foreign Policy. Carnegie Endowment for International Peace. ISBN 0-87003-000-0.
- Mink, Patsy T. (1970–71). "Micronesia: Our Bungled Trust". Texas Int'l Law Forum 6: 181–208. Retrieved December 12, 2011.
- Oversight on the Compact of Free Association with the Republic of the Marshall Islands (RMI): Medical Treatment of the Marshallese People, U.S. Nuclear Tests, Nuclear Claims Tribunal, Forced Resettlement, Use of Kwajalein Atoll for Missile Programs and Land Use Development
- Id. (testimony of Neal H. Palafox, M.D.); see also Yamada, Seiji (2004). "Cancer, Reproductive Adnormalities, and Diabetes in Micronesia: The Effect of Nuclear Testing". Pacific Health Dialog 11: 216–21. Retrieved December 12, 2011.
- Hawaii lawmakers ask feds to front Medicaid costs of COFA citizens
- Trevor Gilbert; Sefania Nawadra, Andy Tafileichig, Leonard Young (April 2003). "Response to an Oil Spill from a Sunken WWII Oil Tanker in Yap". 2003 International Oil Spill Conference. Vancouver, B.C., Canada. Retrieved December 12, 2011. "The problem of more than 1000 WWII shipwrecks, amounting to over 3 million tons sunk across the pacific, has been with us for 60 years and will not fade away by continuing to ignore the issue"; see also WWII wrecks ‘threaten Micronesia’; Assessing potential oil spills from WWII Wrecks
- Korab v. Koller, 2010 WL 4688824 (D. Haw Dec. 10, 2010).
- Id. ("Defendants fail to show any particular State interest that is advanced by their decision to exclude COFA residents from the Old Programs. . . . [W]hile the court recognizes that BHH was created in response to the State's budget crisis, when applying strict scrutiny, the 'justification of limiting expenses is particularly inappropriate and unreasonable when the discriminated class consists of aliens'")
- Id.; see also Judge Dismisses Hawaii’s Request for Dismissal of Suit against Basic Health Hawaii ("Micronesian community representatives reported that elimination of medical benefits has impacted many, including 27 who have died since Sept. 1, 2009")
- Korab v. Koller, Civ. No. 10-c00483-JMS-KSC (Jan. 10, 2011)
- General Assembly - Overall Votes - Comparison with U.S. vote lists COFA countries with the high coincidence of votes. With all members in the top 4.
- "Compact of Free Association". Republic of Palau. 10 January 1986. Retrieved 29 March 2012.
- "Micronesia, Marshall Islands and Palau" is found at: 48 U.S.C. ch. 19