Why It Matters

Veterans from three Pacific nations who served in the U.S. military are struggling to access the health care benefits they earned, and a new Government Accountability Office (GAO) report on VA health care in the Freely Associated States finds the Department of Veterans Affairs (VA) is only now moving toward partial delivery of services Congress authorized in 2024. The three countries, the Federated States of Micronesia (FSM), the Republic of the Marshall Islands (RMI), and the Republic of Palau, are collectively known as the Freely Associated States (FAS), and their citizens can enlist in the U.S. military under compacts of free association with the United States.

FAS veterans face limited availability of specialty services such as mental health care and cardiology, an inability to use telehealth services with VA health providers, and no reimbursement for the travel required to reach VA facilities in U.S. states or territories. Round-trip flights between Palau and Guam, for example, were estimated at more than $1,100 in fiscal year 2024, according to a prior GAO report. In August 2026, VA confirmed it was pursuing partial implementation of its authorities, but did not provide a timeline for doing so.

The Big Picture

The legislative foundation for expanding FAS veteran health care is the Compact of Free Association Amendments Act of 2024, enacted as Public Law 118-42, the Consolidated Appropriations Act, 2024, and signed into law on March 9, 2024. The law gave VA discretionary authority to expand health care services for eligible FAS veterans by providing hospital care, medical services, and beneficiary travel payments, and it also contained a mandate for the GAO to examine implementation of those benefits.

VA completed a range of assessments from March 2024 to March 2025, including an environmental scan of the health care landscape in the FAS and an analysis of policy implications of changes to FAS veteran benefits. Those assessments described potential costs and regulatory requirements for implementation options ranging from maintaining the status quo to full implementation, and VA noted that changes to reimbursement and beneficiary travel benefits would require additional staffing to process claims.

Despite that preparatory work, VA stated in an April 2025 memo to Congress that it would not exercise its new authorities, asserting the decision was "to ensure equity with all U.S. veterans." VA then confirmed in June 2026 that it had concluded its engagement with the FAS entirely, before reversing course the following month, when VA officials told GAO in July they intended to resume engagement.

In December 2025, the Senate Veterans' Affairs Committee introduced legislation that would require, rather than merely authorize, VA to furnish health services in the FAS, reflecting dissatisfaction with VA's pace.

Sen. Brian Schatz (D-Hawaii) and Sen. Lisa Murkowski (R-Alaska) had long championed expanding VA services for FAS veterans. The House Subcommittee on Indian and Insular Affairs held an oversight hearing on implementation of the Compact of Free Association Amendments Act of 2024 on Jan. 14, adding another layer of congressional scrutiny to VA's handling of the issue.

The Bottom Line

VA confirmed in August that it was pursuing partial implementation of its authorities, including telehealth services, delivery of pharmaceutical and medical surgical products, reimbursements for care in the Freely Associated States, and beneficiary travel benefits to service-connected veterans, but did not provide a timeline for doing so. The GAO report was mandated by the same law that granted VA its new authorities, meaning Congress built in an oversight mechanism from the start, and the findings now give lawmakers a documented record of the agency's implementation history to weigh as they consider next steps.

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