Senator Akaka has established himself as the lead in the United States Senate for issues dealing with the Freely Associated States (FAS) and Pacific U.S. Territories. He has worked closely with the national governments, state governments, atoll governments, embassies, delegates, and representatives to address issues of concern to the Pacific Islands and FAS. Senator Akaka worked very closely with Hawaii’s Congressional delegation, Governor Linda Lingle and her cabinet, and the Bush Administration on legislation to codify the negotiations concerning Title II of the Compact of Free Association between the United States and the Republic of the Marshall Islands (RMI) and the Federated States of Micronesia (FSM).

Senator Akaka worked to include an additional $15 million to add to the annual amount of mandatory funding for Compact Impact which is shared by the affected jurisdictions of Hawaii, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands (CNMI). Senator Akaka was instrumental in ensuring that the Compact of Free Association Amendments Act of 2003 (P.L. 108-188) includes language authorizing reimbursements to health care institutions in the affected jurisdictions for costs associated with the migration of FAS citizens. Senator Akaka also worked to include provisions which enable referrals of FAS citizens to Department of Defense medical facilities on a space available and reimbursable basis; make Hawaii eligible for grants to address communicable diseases such as cholera, tuberculosis, and Hansen's disease; maintain federal funding for Pell Grants and the Individuals with Disabilities Education Act (IDEA) [eligibility for all other educational programs is converted to a cash grant and the Senate resolution mandates that those discretionary funds be added to the education sector grants]; retain eligibility for Job Corps; provide for a full inflation adjustment after 2015 for grants and the trust funds; and provide mandatory payments to Enewetak and Rongelap, two communities affected by U.S. nuclear weapons tests, to operate programs to import food and thus reduce the radiation dose from eating foods grown locally.

Senator Akaka continues to work closely with Senators Jeff Bingaman and Pete Domenici in addressing the Changed Circumstances Petition submitted by the Republic of the Marshall Islands. Senator Akaka joined Senators Frank Murkowski and Bingaman in requesting that the Bush Administration review the petition. In December 2003, Senator Akaka joined Senators Domenici and Bingaman in requesting that the Bush Administration respond to the request for a review of the Changed Circumstances petition. Senator Akaka has been working with his colleagues, the RMI, and medical experts in Hawaii to examine the medical programs established by section 177 of the Compact to provide medical care to RMI citizens affected by nuclear testing conducted by the United States in the RMI.