People from three Pacific island nations have the right to live and work in the United States, thanks to a unique 1986 treaty. But a separate Congressional action 20 years ago means that they are not eligible for Medicaid -- even those who become taxpayers.
Many have settled in Oregon, where lawmakers will consider a bill in February that would require the state to subsidize medical care for people from these nations.
The Marshall Islands are an independent nation made up of more than 1,000 small islands near the equator, about 2,000 miles southwest of Hawaii.
Thousands of Marshall Islanders have made Oregon their home. They can live in the U.S. legally because of a decades-old treaty called the Compact of Free Association, or COFA. The treaty includes two other island countries in the Pacific: The Federated States of Micronesia and the Republic of Palau.
Many in those nations were uprooted when the U.S. military tested dozens of nuclear weapons in the mid-20th century.
An unfulfilled promise
"There was a promise that we will bring you back to your island and you'll be able to go back one day,” Oregon Marshallese Community President David Anitok said. He said that promise has never been fulfilled.
Conditions on some islands have never improved enough to allow residents to return. Jeik and Tadi Irujiman moved to Oregon about a decade ago from tiny Kili Island.
"It was hard for us,” Jeik said with Anitok serving as an interpreter. “There wasn't much of anything really on Kili to survive off of."
Kili Island is less than half of a square mile. Both Jeik and Tadi said their parents were moved there from Bikini Atoll in advance of the weapons testing and were never able to return. Jeik said he scratched out a living as a farmer and home builder. He and his wife moved to Oregon to seek out a better life for their kids.
There are eight churches in Salem that cater to the Marshallese. The congregations are largely invisible to the surrounding community, since they typically rent space from other churches. The songs sung during services might sound familiar to many American Christians, but the words are all in Marshallese -- the language spoken by people from the Marshall Islands.
Restoring lost benefits
Jeik said now he's facing a series of health problems.
"One is diabetes,” Jeik said. “Being diabetic and not able to afford my medicines makes it very challenging for me. And second is my leg is getting weaker and I can't stand on my own."
Tadi said she and her husband struggle to pay for his medical care. They're largely supported by their children.
"When they get paid they pay for the bills and other needs like food and for the car and those things,” Tadi said. “We don't have enough to pay for our own insurance."
It used to be that people who came to the U.S. under the COFA treaty could apply for Medicaid, the health care program for low-income Americans. But in 1996, Congress stripped that benefit as part of the overhaul of welfare programs.
But now Oregon state lawmakers will consider a measure that would essentially restore those benefits to 1,500 people at a cost of $1.8 million. Not through Medicaid, but by helping to pay for insurance through the Affordable Care Act. The bill has 42 co-sponsors.