American Samoa's Governor has called on the Trump Administration to be mindful that small economies such as American Samoa cannot afford any reduction in federal Medicaid funding.
Lolo Matalasi Moliga's plea comes as the Republican controlled Congress and the White House forge ahead with plans to repeal and replace the Affordable Care Act, which includes provisions for additional Medicaid funding for the territories.
Congress and the Trump administration have also hinted at possible changes to Medicaid, which is the main source of primary health insurance cover for the people of American Samoa.
Mr Lolo said the local hospital did not have many diagnostic services or medical specialists, so many patients required off island medical referral, which was paid through Medicaid.
He said since its creation in 1985 Medicaid was the only health insurance provider for the majority of people in American Samoa.