The budgetary impact on Hawaii is relatively smaller but can be expected to grow as Hawaii begins to absorb health care costs that were once covered by the U.S. government. Public health problems are also an important concern for all three U.S. island areas. Because the Compact allows FAS migrants who have limited financial means and ability to pay for health care to enter the United States with few restrictions, U.S. island areas are absorbing much of the health care costs of this poor population. Further, Guam, Hawaii, and the CNMI can be expected to continue to experience Compact impact as long as current poor economic conditions persist in the FSM and the RMI. Targeting future U.S. assistance to the FSM and the RMI for education and health purposes could reduce some of the motivation to migrate and improvements in migrant health and education status might be expected to reduce migrant impact in U.S. destinations. These surveys captured the number and characteristics of migrants from the Federated States of Micronesia (FSM), the Republic of the Marshall Islands (RMI), and the Republic of Palau in Guam (surveys for 1992 and 1997), Hawaii (survey for 1997), and the Commonwealth of the Northern Mariana Islands (CNMI) (surveys for 1993 and 1998).
What GAO Found

Migration from the Federated States of Micronesia, the Republic of the Marshall Islands, and Palau has had a significant impact on Guam, Hawaii, and the Commonwealth of the Northern Mariana Islands (CNMI). The health and education needs of these migrants have particularly affected the budgetary resources of Guam and the CNMI. The budgetary impact on Hawaii is smaller but is expected to grow as Hawaii absorbs health care costs once covered by the U.S. government. Public health is an important concern for all three U.S. island areas. Migrants from the region with limited financial means are able to enter the United States with few restrictions, and U.S. island areas are absorbing much of the health care costs of this population. Furthermore, Guam, Hawaii, and the CNMI can be expected to continue to experience migration as long as weak economic conditions persist in Micronesia and the Marshall Islands. Targeting future U.S. assistance to Micronesia and the Marshall Islands for education and health purposes could reduce some of the motivation to migrate. Improvements in migrant health and education status might be expected to reduce immigration to U.S. destinations.