每个托管国参与所有岛屿事务办公室(英语:Office of Insular Affairs)的专项援助行动。美国则分别对待每个国家,提供大量美国国内项目[5],包括联邦紧急事务管理署下的灾难响应恢复与灾害移民项目,由美国国家气象局、美国邮政署、美国联邦航空管理局、联邦通信委员会提供的服务,以及在国际电信联盟国际频率登记委员会中由美国代表[6]。协定涉及地区,尽管位于美国海关边界以外,大部分进口货物仍然免税[7]。
大部分托管国公民获准在美国境内居住和工作,同时大部分美国公民及配偶也可以在托管国居住和工作[8][9]。1996年,美国个人责任与工作机会法案(英语:Personal Responsibility and Work Opportunity Act)取消了对境内居住外国人的医疗补助计划(英语:Medicaid),尽管他们当中的许多人已经完成了五年的等候时间[10]。
协定签订之后,美国众议院亚太地区外交事务委员会(英语:United States House Foreign Affairs Subcommittee on Asia and the Pacific)也因未能履行承诺解决美国核试验对马绍尔群岛(属于太平洋试验场的一部分)的影响而备受批评。发言人表示,尽管《自由联系条约》的第177章节规定美国有义务“解决过去、现在和将来的核试验索赔”,核试验索赔法庭(根据与马绍尔群岛之间的协定而成立)裁决的22亿美元赔偿中只有不到4百万获得了支付,并且美国联邦申诉法院(英语:United States Court of Claims)驳回了两项关于强制执行的申诉。[21]除了尚未解决的索赔,医学从业者同时注意到美国太平洋试验场核试验所带来的潜在影响正在扩散,例如放射性疾病;此外,核试验之后美国的管理带来了饮食结构和生活方式的强制改变,从而导致了心脏病、糖尿病和肥胖的出现。[22]有些协定涉及地区的居民为获得更好的医疗保障、教育和工作机会而移民到美国,美国此前也曾承诺会提供相应的医疗保障和服务;然而2011年,立法委员进一步注意到美国国会并未就此拨款,尤其是在个人责任与工作机会法案获得通过之后。[23]
2009年,夏威夷州(时任州长为琳达·林格尔)曾试图通过取消居于夏威夷州的协定区居民的综合医疗保障计划来限制后者的医保;取而代之的是一项被称为夏威夷基本医保(英语:Basic Health Hawaii)的限制医疗保障计划,“交通服务被排除在外,病人每年可以享受不超过十天的必要医疗住院服务,不超过十二次的门诊服务和每月最多四次的医疗处方。…该计划将透析视为紧急医疗服务,并不能完全涵盖透析病人每月所需的约十至十二次的透析治疗。…癌症病人会在两至三个月内就用完到指定医生处就诊的额度。”[25]
联邦地区法院法官约翰·麦克·西布莱特(英语:John Michael Seabright)对夏威夷基本医保的实行发出了初步禁令,表示这一政策涉及非法歧视并违反了平等保护条款[26]。西布莱特注意到“强有力的证据显示,夏威夷基本医保…导致许多协定区居民因无力负担而被迫放弃必要的治疗。[27]”林格尔的继任尼尔·阿伯克龙比州长表示,会向美国联邦第九巡回上诉法院就这一禁令继续提出上诉[28]。
^The Christian Science Monitor (5 May 2010). "Uncle Sam wants Micronesians for US military". The Christian Science Monitor. Retrieved 2 January 2016..
^BUSH SIGNS $3.5 BILLION PACIFIC COMPACT – December 18, 2003 at archives.pireport.or.
^USPS Postal News: USPS Delivers in the Pacific at www.usps.com.
^ 15.015.1"Compact of Free Association". Retrieved 2 January 2016.
^"Compact of Free Association with the Republic of Palau: Assessing the 15-year Review". U.S. Department of State. Retrieved 2 January 2016.
^"The Continued Free Association with the Republic of Palau Act of 2012". U.S. Department of State. Retrieved 2 January 2016..
^"Compact of Free Association with the Republic of Palau". Retrieved 2 January 2016..
^McHenry, Donald F. (1975). Micronesia: Trust Betrayed -- Altruism vs. Self Interest in American Foreign Policy. Carnegie Endowment for International Peace. ISBN 0-87003-000-0..
^Mink, Patsy T. (1970–71). "Micronesia: Our Bungled Trust". Texas Int'l Law Forum. 6: 181–208. Retrieved December 12, 2011..
^Oversight on the Compact of Free Association with the Republic of the Marshall Islands (RMI): Medical Treatment of the Marshallese People, U.S. Nuclear Tests, Nuclear Claims Tribunal, Forced Resettlement, Use of Kwajalein Atoll for Missile Programs and Land Use Development.
^Id. (testimony of Neal H. Palafox, M.D.); see also Yamada, Seiji (2004). "Cancer, Reproductive Adnormalities, and Diabetes in Micronesia: The Effect of Nuclear Testing" (PDF). Pacific Health Dialog. 11: 216–21. Retrieved December 12, 2011.
^The Hawaii Independent. "Hawaii lawmakers ask feds to front Medicaid costs of COFA citizens - Pasifika Media Association". Retrieved 2 January 2016..
^Trevor Gilbert; Sefania Nawadra; Andy Tafileichig; Leonard Young (April 2003). Response to an Oil Spill from a Sunken WWII Oil Tanker in Yap (PDF). 2003 International Oil Spill Conference. Vancouver, B.C., Canada. Retrieved December 12, 2011. The problem of more than 1000 WWII shipwrecks, amounting to over 3 million tons sunk across the pacific, has been with us for 60 years and will not fade away by continuing to ignore the issue; see also WWII wrecks ‘threaten Micronesia’; Assessing potential oil spills from WWII Wrecks.
^Korab v. Koller, 2010 WL 4688824 (D. Haw Dec 10, 2010)..
^Id. ("Defendants fail to show any particular State interest that is advanced by their decision to exclude COFA residents from the Old Programs. . . . [W]hile the court recognizes that BHH was created in response to the State's budget crisis, when applying strict scrutiny, the 'justification of limiting expenses is particularly inappropriate and unreasonable when the discriminated class consists of aliens'").
^Id.; see also Judge Dismisses Hawaii’s Request for Dismissal of Suit against Basic Health Hawaii ("Micronesian community representatives reported that elimination of medical benefits has impacted many, including 27 who have died since Sept. 1, 2009").
^Korab v. Koller, Civ. No. 10-c00483-JMS-KSC (Jan. 10, 2011).