Letter to Governor Reynolds Regarding Healthcare Coverage for MarshalleseCopyrighted
June 1, 2020
City of Dubuque Consent Items # 4.
ITEM TITLE: Letter to Governor Reynolds Regarding Healthcare
Coverage for the Marshallese Residents in Iowa
SUMMARY: Correspondence to Governor Reynolds from Mayor Buol
requesting the Governor's advocacy and support for
extending State Medicaid benefits to Iowa's Marshallese
residents.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File
ATTACHMENTS:
Description Type
Mayor Roy Buol Letter to Governor Kim Reynolds
requesting Medicaid coverage for Marshallese Supporting Documentation
Community in Iowa
Human Rights Commission Support for COFA Act Supporting Documentation
Masterpiece on the Mississippi
Honorable Kim Reynolds
Iowa State Capitol
1007 E Grand Avenue #101
Des Moines, IA 50319
Dear Governor Reynolds,
Dubuque
bitrid
Ail-ivaerica Eitr
111111
2007.2012.2013
2017*2019
May 28, 2020
Office of the Mayor
City Hall
50 West 13th Street
Dubuque, IA 52001-4845
www.cityofdubuque.org
As Mayor and on behalf of my City Council colleagues and the citizens of Dubuque, I am writing to
request your advocacy and support for extending State Medicaid benefits to Iowa's Marshallese
residents.
Since the late 1980's, the Compact of Free Association (COFA) has defined the relationship between
the United States and the independent governments of the Freely Associated States (FAS) including
the Republic of the Marshall Islands, the Federated States of Micronesia and the Republic of Palau.
Under the Compact, the United States was granted access to strategic military bases in the Pacific
and, in exchange, the United States government would provide broad migration privileges for COFA
citizens, including the Marshallese. Currently there are nearly 70,000 COFA citizens residing in the
U.S. and an estimated 800-900 in Dubuque.
In 1996, with the passage of welfare reform legislation in Congress, COFA citizens were statutorily
barred from access to Medicaid in what was considered an egregious oversight. Previously included
in Medicaid eligibility rolls, this nearly twenty -five-year lack of access to medical coverage for COFA
citizens has had a devastating impact and is especially evident now during the global pandemic of
COVID-19.
Nationally, the Marshallese population is experiencing rapid population growth primarily in the
Midwest and the South. The U.S. Census indicates that the following states have populations more
than 1,000: Hawaii, California, Texas, Washington, Oregon, Utah, Oklahoma, Florida, Arkansas,
Missouri, and Arizona. These numbers will continue to increase as the islands become uninhabitable
between 2030 and 2050 because of climate change.
https://www.latimes.com/environment/story/2019-10-11 /marshall-islands-national-climate-crisis
Between 2000 and 2010, Dubuque experienced a 279% population growth in the Pacific Islander
population according to the U.S. Census. While the results of the 2020 Census are not complete,
over a period of three days during the COVID-19 crisis in April, City of Dubuque staff members
working with community leaders were able to identify 600 Marshallese residents in need of food
assistance within the City of Dubuque limits, suggesting our numbers will continue to climb.
In addition, 19.6% of Pacific Islanders in the U.S. live in poverty, compared to 15% of the overall
population. Ineligibility for Medicaid, even when income requirements are met, creates an almost
insurmountable barrier to prosperity for Marshallese. Locally here in Dubuque, Crescent Community
Health Center (Crescent) saw 263 patients in 2019 who identified themselves as being Pacific
Islanders. Of these patients, 93 are diagnosed with diabetes representing 35% of the patient
population. For comparison, about 8% of the general patient population at Crescent has a diagnosis
of diabetes. In addition, 72 of these patients, or 27%, are diagnosed with hypertension. This
compares to 16% of the general patient population. Fifty-two patients have both diagnoses. As a
result, many members of the population are at high risk for significant negative outcomes if they
contract COVID-19. Within the past three weeks, at least three Marshallese community members
have died from COVID-19 in Dubuque and several are in intensive care.
Governor Reynolds, I urge you to correct the injustice that was created by an oversight in 1996 and
provide access to healthcare through the State of Iowa Medicaid Program to our Marshallese
neighbors in Dubuque.
Through this global crisis, the City of Dubuque has reaffirmed its identified goal to "create an equitable
community of choice" by demonstrating and building greater resiliency, sustainability, equity and
compassion into the lives of our residents and in the Dubuque community writ large. We value and
depend upon your partnership to achieve this goal of healthcare access for the Marshallese in
Dubuque, throughout Iowa and the country.
Sincer,ly,
i L-19
Roy. Buol
Mayor
Masterpiece on the Mississippi
Dubuque
A*•America Cilj
2007.2012.2013
2017*2019
TO: Michael C. Van Milligen, City Manager
FROM: Kelly Larson, Human Rights Director
DATE: May 12, 2020
SUBJECT: Human Rights Commission Support for Health Care for Compact of Free
Association Migrants, Including the Marshallese
The purpose of this memo is to forward to the City Council the Human Rights
Commission's support for State and Federal solutions to provide health care coverage
for community members from the Marshall Islands, as well as other community
members who are covered by the Compact of Free Association (COFA).
At its regularly scheduled meeting on May 11, 2020, the Human Rights Commission
discussed the impact COVID-19 is having locally on our Marshallese community
members, including concerns regarding the lack of Medicaid coverage for this
population. Art Roche, a community member and retired employee of Mercy One who
is actively involved in leading the Dubuque Pacific Islander Health Project Advisory
Committee, provided background on the health conditions facing our local population,
their legal status, and the efforts that have been underway to address a gap in their
healthcare coverage. Assistant City Manager Teri Goodmann provided information
related to the City Council's support of state and federal action to address this gap as
part of its legislative priorities.
At the conclusion of the conversation, the Commission voted in favor of forwarding a
memo to the City Council expressing its support for a letter from the Mayor to State and
Federal officials encouraging actions to grant healthcare coverage to the COFA
population via Medicaid or through other means. This memo serves as their statement
of support for taking action to advance healthcare coverage for this population,
particularly during this time of COVID-19.
Cc: Teri Goodmann, Assistant City Manager