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In January, Robson Henry died at the age of 66. Chances are, you have never heard of Henry. He was not famous, rich, or powerful. In many ways, Henry was no different from the thousands of young men and women who, at the age of 18, chose to serve by enlisting in the U.S. Army. Nor does the fact that he stayed in the Army for the next 26 years, serving multiple tours of duty in the Middle East, meaningfully distinguish him. And yet, Henry was special: Unlike the vast majority of his fellow soldiers, he was not from the United States, but the Pacific island nation of the Federated States of Micronesia.

This fact meant that when he returned home as a veteran, Henry could not access the medical care from the Department of Veterans Affairs to which he was entitled. Although Congress changed the law in 2024 with an intent to begin to fix this problem and has subsequently unanimously supported additional efforts, the Trump administration has not acted, choosing instead to walk away from the negotiating table and maintain the sorry and inequitable status quo. Its political choice that both undermines U.S. interests in the region and breaks America’s promise and moral obligation to those who have honorably served it.

Micronesia, along with the Pacific island countries of the Republic of the Marshall Islands and the Republic of Palau, has a special relationship with the United States known as “free association.” The Compacts of Free Association that govern these relationships permit citizens of these three freely associated states to serve in the U.S. armed forces.

And serve they do: On a per capita basis, citizens from these countries serve in the U.S. military at among the highest rates of all U.S. states and territories. As of 2022, the Department of Veterans Affairs estimated that there were 240 veterans in the freely associated states, although local officials believed the actual number was higher. Once these Pacific islanders return home as veterans, they are entitled to medical care from the U.S. Department of Veterans Affairs.

However, until recently, federal law prevented the department from providing medical care outside of the United States. For the Micronesian, Marshallese, and Palauan veterans to receive services, they had to undertake lengthy and expensive travel — for which they had to pay themselves — to Hawaii or the continental United States. To place this in perspective, the distance between Palau and Hawaii is nearly twice the distance between Washington, D.C. and San Francisco, and there are no direct flights. The cost of the round-trip flight averages between $1,500 and $2,000, while the annual per capita income is around $13,000. For Micronesia and the Marshall Islands, flight costs are similar, while the average per capita income is even lower.

Moreover, because these veterans know about the challenges of obtaining Veterans Affairs services if they return home, many of them choose not to — instead staying within the United States, as they are entitled to do under the Compacts of Free Association. Micronesia, the Marshall Islands, and Palau are developing countries that would greatly benefit from the knowledge and skills servicemembers acquire in the ranks. That these veterans opt not to return home afterwards exacerbates a detrimental brain drain problem that hinders these countries’ development.

Although this might seem like an insignificant issue affecting only a few hundred individuals and three small islands in the middle of the Pacific Ocean, it has national security implications. The freely associated states are literally in between the United States and China, placing them in a geostrategic location within the administration’s “priority theater.” The Compacts of Free Association provide the United States with exclusive access for military purposes to certain areas within the freely associated states, as well as the right to exclude other militaries from those countries’ land and maritime territories that total more than 2.1 million square miles in the North Pacific Ocean.

American military activities in the three countries demonstrate their importance. In Palau, the United States is currently building a Tactical Multi-Mission Over-the-Horizon Radar and rebuilding and upgrading wharfs and airfields. In Micronesia, the United States plans to spend upwards of $2 billion on military projects to provide strategic, operational, and exercise capabilities for U.S. forces. And in the Marshall Islands, the United States has long operated the Ronald Reagan Space and Missile Test Range, a world-class range and test facility for technologies involved in long-range missile testing, missile defense, and space domain awareness. Should the United States need to engage in a military action in the western Pacific, the ability to control and use these territories is likely to be crucial. The recognition of this fact is part of why the United States recently renewed the Compacts of Free Association and agreed to provide the freely associated states with $7.1 billion over the next two decades. America’s failure to honor its promise to veterans from the freely associated states ought to be viewed in this light to properly appreciate the resulting shadow it casts on the relationship with three strategically vital partners.

Zooming out to the larger Pacific region, the Trump administration’s gutting of the U.S. Agency for International Development and pausing of foreign aid, imposition of tariffs and visa fees, and deprioritizing climate change — an existential threat to the region — have negatively impacted Pacific Islanders’ views of the United States, opening the door for China to make further inroads. China is aware of all of this and is taking advantage as it actively seeks to build its own influence in the region. For example, China’s ambassador to Fiji implicitly called out recent U.S. policy changes when he declared that, unlike other countries, China would remain a reliable partner offering “sincere, no-strings-attached assistance.” Likewise, China’s May 2025 Joint Statement with Pacific Island Countries called for “full and effective implementation of the [climate change-focused] Paris Agreement,” asked that “advanced economies” take the lead on climate mitigation, and promised that China would continue providing “help and support” to the Pacific Islands on climate issues. Adding into the mix the breaking of the promise to care for those who don an American uniform only further undermines U.S. efforts to maintain its influence in the region, while opening the door even wider for a Chinese counter-narrative. Within this context, the small number of veterans from the freely associated states means that this issue is an opportunity to earn — or lose — far more in value than the cost of their healthcare.

Henry was a longtime vocal advocate on this issue. Thanks to his and others’ hard work, Congress finally acted. In March 2024, with strong bipartisan support, Congress passed the Compact of Free Association Amendments Act of 2024, providing the Department of Veterans Affairs with new legal authorities to better provide medical services to Pacific Island veterans. Specifically, the law authorized the Department of Veterans Affairs to provide hospital care and medical services in the freely associated states, subject to agreements with each of the three countries. To facilitate the development of such agreements, the act required the Secretary of Veterans Affairs to, within one year of the act’s passage, “conduct robust outreach to, and engage with, each government of the Freely Associated States,” to “assess options for the delivery of care,” and to “increase staffing as necessary” to perform the required outreach.

Although the law did not mandate the provision of care, Congress’s subsequent actions provide a strong indication of its intent in this regard. In December 2025, the Senate passed — by unanimous consent — the Caring for Veterans and Strengthening National Security Act. And in May of this year, the House Committee on Veterans’ Affairs favorably reported out — again, unanimously — the U.S. Vets of the Freely Associated States Act. These two bills would change the law’s requirements from a “may” provide care to a “shall” extend telehealth and mail order pharmacy benefits to Pacific Island veterans.

Unfortunately, the Trump administration has not effectuated Congress’ intent to provide accessible care to these veterans. Some of the required outreach did occur during the one-year period, with regular meetings being held with each of the three freely associated states to address a range of technical issues. According to the Marshall Islands’ ambassador to the United States, in March 2025 the Department of Veterans Affairs indicated that the assessment phase of negotiations had been completed, and the next step was for internal U.S. interagency planning for a final agreement. The Marshall Islanders even hoped for a commencement of services by the summer of 2025.

However, instead of continuing with the work to negotiate and finalize agreements, the Trump administration abruptly terminated ongoing negotiations. Micronesia’s ambassador to the United States described this as unexpected and unilateral. Secretary of Veterans Affairs Doug Collins directed the department to simply “continue outreach to Veterans in [the freely associated states] under its routine process in the region” and indicated the department would “not expand coverage to a comprehensive approach for Veterans in the [freely associated states].” Secretary Collins explained his decision in an April 2025 memo: “[t]o ensure equity with all U.S. Veterans … [the Veteran’s Affairs Department] will treat Veterans in the [freely associated states] in the same manner as U.S. Veterans in any other region of the globe.” At present, there is a single local clinic in Palau with the ability to provide diagnostic services, including laboratory and X-ray services for veterans, but no other facilities there or in the other two freely associated states for veterans to receive their care.

Although Collins’ appeal to equity sounds reasonable on its face, a closer examination reveals that it is not because veterans in the freely associated states are not the same as veterans elsewhere. U.S. law prohibits an individual who is neither a U.S. citizen nor a U.S. national from enlisting in the U.S. military except in two circumstances: the individual is a lawful permanent resident or a citizen of one of the freely associated states. This means that citizens from the freely associated states are the only ones who can join the military — and thus become veterans — without an existing, lawful home in the United States. Put another way, they are the only service members who were recruited with promises of veterans’ benefits from homes outside the United States. Upon their separation from the service, all other veterans can return to their homes in the United States. For veterans from the freely associated states, however, home means an island thousands of miles away from U.S. territory and Veterans Affairs services. In order to take advantage of the promise that was made to them, they must travel not down the street to the nearest Veterans Affairs hospital, but thousands of miles across the ocean, hoping that the doctor is available to see them when they arrive. Thus, veterans from the freely associated states are the only veterans who must choose: stay in the United States to have access to care or lose access to care by returning to the homes from which they were recruited.

Of course, any veteran could choose to live outside the United States, as some 18,000 do, and take advantage of the Department of Veterans Affairs’ Foreign Medical Program, which will cover the cost of health care a veteran gets in a foreign country for a service-connected disability. But here, too, veterans from the freely associated states are at a disadvantage. The domestic healthcare systems in the freely associated states are still limited in their capabilities to provide care. Serious issues, such as those requiring surgery, must be treated off-island through medical referral programs. There are also almost no mental health care providers or facilities in the freely associated states, an important fact given the high rates of mental health and substance abuse issues among veteran populations. And the Foreign Medical Program does not send medicines by mail or cover mail-order medicines from the United States, meaning that the program does not address the limited availability of prescription medications in the freely associated states.

Collins’ decision is also unreasonable when considering the limited costs of providing the promised services to uniquely placed veterans from the freely associated states. Earlier this year, Department of Veterans Affairs Press Secretary Pete Kasperowicz asserted that although the Compact of Free Association Amendments Act of 2024 provided authority to the department, it did not provide funding — insinuating that part of the department’s reason for not continuing to work towards agreements with the freely associated states is the cost. To be sure, expanding Veterans Affairs services to all parts of the globe would be a costly endeavor. But only expanding them to the three freely associated states — which have a relationship with the United States that is unique among every other country in the world — would not be.

According to the Congressional Budget Office, fully implementing the authority that Congress granted in the Compact of Free Association Amendments Act would increase direct spending by $47 million over the 2024 to 2033 period, less than $5 million per year for a department with an annual budget in excess of $430 billion. Yes, it will require overcoming difficult regulatory, technical, and operational challenges endemic to standing up operations in remote island locations. But using these challenges as an excuse to stop trying both belies the department’s claim to Congress that it is “laser-focused on customer service and convenience and delivering timely access to the highest quality care and benefits for every eligible Veteran” and devalues the moral obligation the United States has to the veterans from the freely associated states who were promised care.

Equally as important, though, this cost can also be seen as an investment in current military capabilities. Should a conflict break out in the region, the cost of having set up capable medical facilities ahead of time will likely be less than having to do so on an urgent basis in the heat of battle, and certainly will be less than the value those facilities will be able to provide to troops requiring emergency care. Nor are concerns about setting a costly precedent persuasive because the unique nature of the United States’ relationship with the freely associated states — and the unique status of veterans from those countries among the larger veteran population — means that the situation is sui generis.

Even if a comprehensive solution cannot be quickly achieved, there are several steps that could be quickly taken that would have almost no cost, such as expanding telehealth and creating a way for prescription medication to be sent through the U.S. Postal Service — which includes the freely associated states in the same zone as other U.S. territories. Although these initial steps would not provide a complete fix, they would be — and be seen to be — a move in the right direction.

While the secretary’s unfortunate and unnecessary policy decision was bad enough, what makes it even worse is that it does not appear that the secretary’s conclusion was explained to those in the freely associated states. According to an April 2026 letter from Micronesia’s Ambassador to the United States to the U.S. Government Accountability Office, “[i]n April 2025, after negotiations were underway, the Department of Veterans Affairs unexpectedly suspended the discussions,” and despite requests for a “resumption of the talks with the hope of finally enhancing the [Department of Veteran Affairs’] provision of the health care of freely associated states citizens who have served in the U.S. military,” no resumption has occurred. Today, there is no evidence of any further movement towards actually helping the veterans of Vietnam, Korea, Afghanistan, Iraq, or other deployed theaters get the care they need and deserve.

The Trump administration should realize the important national security — and moral — implications of failing to expand Veterans Affairs services to the freely associated states. Rather than providing additional fodder for China’s propaganda mill and risking relations with the freely associated states, the administration should use the authority that was granted in the 2024 Compact of Free Association Amendments Act, return to the negotiating table, and continue working to find ways to efficiently and effectively provide medical care to veterans in the freely associated states. At the same time, it should support the passage of the two bills that are now pending in the House and establish telehealth and mail-order pharmaceutical services at a negligible cost. While it is unfortunate that Henry will never get to experience the access he long fought for, hopefully those risking their lives for the American flag today will have the access when they need it tomorrow.

Daniel Mandell is currently a visiting assistant professor at the Chicago-Kent College of Law. He previously served as legal counsel to the Office of the President of the Republic of Palau and was a Council on Foreign Relations International Affairs Fellow in Japan.

Image: Samantha Jetzer via Wikimedia Commons