They Served the United States. The Nearest VA Care May Be an Ocean Away.

The missing seat is in three Pacific nations

The three countries are known collectively as the Freely Associated States. They are sovereign nations, not U.S. states or territories. Their relationships with the United States are governed by separate compacts.

Those agreements provide the United States with important security and defense rights in the Pacific. The Department of the Interior says the United States is responsible for security and defense matters involving the three nations and has extensive military access, including the authority to deny access to other countries' military forces.

Citizens of all three countries may enlist in the U.S. armed forces. Interior has also said that people from these nations serve across every branch and have among the highest rates of military service per person when compared with U.S. states and territories.

The relationship is valuable to the United States. It provides military service, strategic access and a strong American position in the Pacific.

But the healthcare arrangement for veterans living there has not matched that importance.

What GAO found

GAO examined the difficulties veterans face in the three nations and the VA's response to authority Congress granted in 2024.

The report identifies several barriers. Specialty care such as mental health and cardiology is limited. Veterans cannot currently use VA telehealth with VA providers from these locations. To use their VA health benefits, they generally must travel to a VA facility in a U.S. state or territory.

Then comes the part that should stop people.

VA does not reimburse these veterans for that travel.

A benefit that can be reached only by buying a plane ticket is not equally accessible to everyone who earned it. A veteran with enough money, physical strength, family help and time may be able to make the trip. A veteran without those things may delay care or go without it.

GAO did not say that every veteran in the Freely Associated States has been denied treatment or that no local healthcare exists. The documented problem is more precise: eligible veterans face serious access barriers, some needed specialty services are limited, VA telehealth is unavailable to them and travel to use VA benefits is not covered by VA.

That is enough to demand an answer.

Congress opened the door. VA chose not to walk through it.

Congress acted in 2024. The Compact of Free Association Amendments Act gave VA discretion to work with the three governments to provide hospital care, medical services and travel payments for eligible veterans.

The word “discretion” matters. Congress authorized VA to act. It did not require full implementation on a fixed date.

VA studied several options between March 2024 and March 2025. According to GAO, the department considered choices ranging from keeping the existing system to fully implementing the new authority. VA identified costs, regulatory changes and staffing needs.

In April 2025, VA told Congress that it would not use the new authority. The department said that decision was made “to ensure equity with all U.S. veterans.” In June 2026, VA confirmed that it had ended its engagement with the three nations.

That explanation creates a basic question.

How does leaving one group of veterans with an international flight between them and VA care ensure equity?

Equal rules do not always create equal access. If one veteran can drive to a clinic and another must cross an ocean without travel reimbursement, treating their situations as if they are the same protects the rule, not the veteran.

That is an editorial inference based on the documented difference in access. GAO reports VA's stated reason, but the report does not conclude that VA acted unlawfully or intentionally discriminated against these veterans.

VA changed direction, but the care is not delivered yet

The story did not end with VA's refusal.

In July 2026, VA officials told GAO that they planned to restart discussions. In August, VA said it was pursuing partial implementation. The ideas included VA telehealth, delivery of medicine and medical supplies, reimbursement for care obtained in the three nations and travel benefits for veterans with service-connected disabilities.

Those steps could make a real difference.

But GAO reported that VA supplied no implementation timeline.

That means these are plans, not completed services. “Pursuing” telehealth is not the same as a veteran attending an appointment. Discussing travel reimbursement is not the same as paying for the flight. Considering medicine delivery is not the same as medication arriving on time.

The public should not call this problem solved until veterans can use the promised services and the results can be measured.

Who benefited, who held power and who carried the burden?

The United States benefited from the service of citizens of Micronesia, the Marshall Islands and Palau. It also benefits from its defense authority and strategic access across a large part of the Pacific.

Congress held the power to authorize a broader healthcare arrangement and used that power in 2024.

VA held the power to decide whether and how to use the new authority. It first declined, then later began pursuing only part of what Congress allowed.

Veterans and their families carried the practical burden. They faced limited specialty care, unavailable VA telehealth, long-distance travel and the cost of reaching a VA facility.

The three Pacific governments also carried responsibility for serving their citizens while negotiating with a much larger partner that controls access to VA care.

This is what the missing seat looks like. The people who did the serving were far from the room where the government decided whether bringing healthcare closer was worth the cost and work.

Why should an ordinary person care?

Because “support the troops” is easy to say before the bill arrives.

The real test comes afterward, when a veteran needs a cardiologist, mental healthcare, medication or help paying for the trip to treatment.

It also matters because government often treats authorization as accomplishment. Congress passes a law. An agency announces a plan. Officials point to both as evidence that the problem has been handled.

But a benefit does not exist in a veteran's life until the veteran can actually use it.

This story is also a warning about distance. Governments increasingly rely on websites, hotlines and telehealth to close access gaps. Those tools can help, but only if people have permission to use them, reliable connections, trained providers, medicine delivery and a system for in-person care when a screen is not enough.

Pull Up a Chair

Congress and VA should publish a public implementation table for each of the three nations.

It should show which services VA has agreed to provide, what remains under negotiation, the deadline for each step, who is eligible, how veterans enroll, how prescriptions will arrive, which care can be delivered through telehealth and what travel expenses will be reimbursed.

The table should also report results. How many veterans requested care? How many received it? How long did they wait? How many had to travel? How much did they pay themselves? How many reimbursement claims were approved or denied?

Veterans and their families can help build the missing receipt now. Document travel distance, airfare, lodging, delayed appointments, unavailable specialists, internet problems, medication delays and reimbursement decisions. Send those records to VA, the governments of the three nations and the House and Senate Veterans' Affairs Committees.

The United States knew how to reach these communities when it needed people to serve.

It should know how to reach them when those veterans need care.

Who is missing?

Ally = Action. 🪑

Sources and Receipts

• U.S. Government Accountability Office, “Compacts of Free Association: VA Is Pursuing Partial Implementation of Health Care Authorities in the Freely Associated States,” GAO-26-109152, published and publicly released September 25, 2026.
• U.S. Department of the Interior, Office of Insular Affairs, “Freely Associated States.”
• U.S. Department of the Interior, Office of Insular Affairs, statement on the military contributions of citizens of the Freely Associated States.
• U.S. Department of Veterans Affairs, overview of VA telehealth services.

Verification Notice

The central factual findings come from GAO's September 25, 2026 report, which relies on VA assessments and interviews with VA and Freely Associated States officials. VA's 2026 partial-implementation measures had no reported completion timeline when GAO published its report. They are therefore described as plans in progress, not delivered care. The article does not claim that every veteran in the three countries lacks all healthcare, that every eligible veteran experienced the same barrier, or that GAO found unlawful discrimination. The conclusion that identical rules can produce unequal access where travel burdens differ is The Missing Seat's evidence-based editorial inference.