Senators and their staffs must pay attention to local issues, even in the midst of big national debates. That’s what led the Senate Judiciary Committee to back a Medicaid eligibility expansion Thursday, albeit a very narrow one.

During Tuesday’s immigration markup session at the Judiciary panel, freshman Sen. Mazie K. Hirono, D-Hawaii, won voice vote backing for an amendment making migrants from the remote Pacific islands of Micronesia, Palau and the Marshall Islands eligible for Medicaid.

“These islands are located in strategic areas that are important to our national security. One of these islands, Palau, is the closest island east of Guam, where the United States has significant military assets,” Hirono explained. “These islands also include Kwajalein Atoll, where a bloody battle was fought during the war, and where today the United States operates the Ronald Reagan Ballistic Missile Defense Test Site.”

Senators from Hawaii and Alaska have long dealt with unusual challenges in their non-contiguous states, sometimes provoking criticism from other parts of the country.

In this case, the circumstances of the remote islands are rather unique, since the U.S. has Compacts of Free Association in effect and approximately 50,000 citizens of the countries reside within the United States, mainly in Hawaii and Guam.

Hirono has an interest in the health care of these immigrants because, without Medicaid eligibility, Hawaii doesn’t get federal cost sharing for their coverage. Hirono said the state spends upward of $30 million per year on health care for this group.

“Because of their importance to our national security, when these three countries became sovereign, the United States signed bilateral national security agreements with each country. These agreements give us exclusive military rights to their lands. We can locate military bases there, but no other country can do so,” Hirono said. “In exchange for exclusive military rights, the United States gave the citizens of the COFA countries the right to live and work in the United States for an unlimited period of time, and without need for a visa. No other countries have these privileges.”