SALEM, Ore. – Denied access to Medicaid more than 20 years ago, low-income Pacific Islanders in Oregon are gaining their coverage back.

People here under the Compact of Free Association, or COFA treaty from the Federated States of Micronesia, the Marshall Islands and Palau are granted legal status because the U.S. tested nuclear weapons near their home islands during the Cold War.

Last year, Oregon became the first state to cover residents once again, but dental care was left out. Senate Bill 147 would rectify that.

David Anitok, co-founder of the COFA Alliance National Network, says without dental coverage, these residents end up using emergency rooms and free clinics to get oral care.

"They provide cleaning and some base needs, but then when it really comes to what they need to operate on for oral care, they refer them to other places – only to get denied or potentially get through with the help of charity programs and whatnot," he relates.

SB 147 passed the state Senate unanimously and is now in the House Committee on Health Care.

Low-income COFA residents were stripped of Medicaid eligibility under President Bill Clinton's Personal Responsibility and Work Opportunity Act in 1996.

While Oregon is one of the few states taking care of COFA individuals, the community faces larger threats on the national level.

The GOP's recent attempt to overhaul health insurance would have reclassified COFA residents, making them ineligible for health care tax credits.

Joe Enlet, a policy analyst with the Health Equity Initiative, says COFA individuals' status is dependent on a treaty, and there's fear the rules might change under President Donald Trump.

"We don't know how the Trump administration would honor that or enforce the laws around that, because our islanders are still deportable,” he states. “So, we're just in this state of not knowing what the future holds for us."

Anitok says it's important for COFA residents to tell their stories and make their voices heard on issues that affect them.

"It requires efforts of the village and so, I'd strongly encourage our communities from the COFA populations – it is important that we continue to educate ourselves and raise our voices in some of these concerns," he advises.





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After more than 50 years of use, some Michigan lawmakers say naloxone may not be the best choice in an overdose situation.

Naloxone is sometimes called the "Lazarus drug" because of its powerful ability to seemingly resurrect people after a drug overdose.

Sen. Kevin Hertel, D-St. Clair Shores, and some of his colleagues have introduced a bill which would open the door for what they say are more costly, but more powerful, antidotes.

"Given the prevalence of fentanyl in our communities, and how much stronger some of these drugs that we're now seeing are, we believe -- and in talking with others -- that there should be other tools to respond to an overdose," Hertel explained. "To make sure we're doing everything we can to save somebody's life."

Not everyone is on board with the proposed legislation, Senate Bill 542. Opponents argued the more expensive naloxone alternatives are not necessary, and using them would only increase profits for the pharmaceutical industry.

Jonathan Stoltman, director of the Opioid Policy Institute in Grand Rapids, said while the naloxone alternatives do help in overdose situations, they can also cause nasty side effects.

"The newer approaches, they put people into more severe withdrawal," Stoltman pointed out. "That's a pretty profound negative side effect. The one approach is very inexpensive and works great; the other approach is far more expensive and has this strong negative side effect."

Sponsors of the bill say they're hoping to give Michigan residents a chance to chime in on the issue in a public hearing sometime in June. Michigan saw more than 3,000 opioid overdose deaths in 2021.


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New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.

Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.

"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained

Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.

Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.

"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.

Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.

New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.

The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.

"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.

Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.

Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."

"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.

Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.