What Happened?

Veterans from the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau served in the U.S. military, but many still cannot fully access the VA Pacific veterans' health care benefits Congress authorized in a law signed March 9, 2024.

A new Government Accountability Office (GAO) report finds the Department of Veterans Affairs (VA) is only now moving toward partial delivery of those services.

The three countries, collectively called the Freely Associated States (FAS), have compacts with the U.S. that allow their citizens to enlist in the American military. Congress gave the VA authority to expand health care for eligible FAS veterans when it passed the Compact of Free Association Amendments Act of 2024.

More than two years later, the GAO found the VA had yet to fully act on that authority, leaving veterans in the FAS without the full range of services the law made possible.

Why Does it Matter to Me?

FAS veterans currently face limited access to specialty care such as mental health services and cardiology, cannot use telehealth with VA providers, and receive no reimbursement for travel to reach VA facilities in U.S. states or territories.

For veterans living on islands far from the nearest VA facility, that gap is not just an inconvenience; it is a financial barrier to care they earned through military service. A prior GAO report estimated round-trip flights between Palau and Guam at more than $1,100 in fiscal year 2024, meaning veterans must absorb this cost entirely out of pocket.

As of August 2026, the VA confirmed it was pursuing partial implementation, including telehealth services, pharmaceutical and medical supply delivery, reimbursements for care within the FAS, and beneficiary travel benefits for service-connected veterans, but gave no timeline for when those services would be available.

Both Sides, Now

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

Dissatisfied with that pace, the Senate Veterans' Affairs Committee introduced legislation in December 2025 that would require, rather than merely allow, the VA to furnish health services in the FAS. Sen. Brian Schatz (D-Hawaii) and Sen. Lisa Murkowski (R-Alaska) have both championed expanding VA services for FAS veterans, reflecting bipartisan concern over the issue.

What Happens Next?

The GAO report, mandated by the same 2024 law that granted the VA its new authorities, gives Congress a documented record of the agency's implementation history to weigh as lawmakers consider next steps. The House Subcommittee on Indian and Insular Affairs held an oversight hearing on 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.

If the Senate Veterans' Affairs Committee bill advances, it would shift the VA's role from optional to mandatory, removing the agency's ability to delay or decline. The VA has not announced a timeline for completing even the partial services it said in August it was pursuing. No vote on the Senate bill is currently scheduled.

The report's findings leave a central question: When will eligible veterans have access to the full range of care Congress authorized?

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