The federal government must act now to save Puerto Rico’s healthcare system

There is a healthcare crisis facing over 3.5 million Americans, and you probably haven’t heard anything about it. Why? Because these 3.5 million Americans live on the small island of Puerto Rico, and sadly, Washington doesn’t seem to care. 

Puerto Ricans are U.S. citizens, but although we pay the same Medicare and Social Security tax as mainland residents, we get dramatically less federal funding for healthcare. This chronic underfunding is causing the Island’s healthcare system to collapse, jeopardizing care for millions of U.S. citizens. And because the healthcare industry represents 20 percent of Puerto Rico’s GDP, this collapse will have a catastrophic effect on Puerto Rico’s already fragile economy. 

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Sixty percent of the Island’s population - over 2 million patients -– receives their care through Medicare, Medicare Advantage or Medicaid. The inequity in federal funding for these programs is startling. Puerto Rico’s Medicaid reimbursement rate is 70 percent lower than any other mainland state. The Medicare Advantage (MA) program is paid just 60 percent of the average rate in the states, despite having the highest enrollment percentage in the U.S.  

As if the situation wasn’t dire enough, this funding gap is due to get even worse when the Center for Medicaid and Medicare Services (CMS) implements an 11 percent cut to Puerto Rico’s MA premiums next month. If you doubt that discrimination isn’t at play, consider this: while CMS approved these drastic cuts for Puerto Ricans, it increased rates to the 50 mainland states by three percent. 

Crisis is not too strong a word for the situation facing the Island. Puerto Rico’s Medicare Advantage program will no longer be viable next year if funding to insurers isn’t restored by June 1 - less than three weeks from now.  If Washington refuses to act, Puerto Rico will suffer the immediate loss of half a billion dollars to the healthcare system: hospitals will lose $150 million, doctors will lose $115 million, pharmaceutical companies will lose $65 million and Mi Salud, the Island’s Medicaid program, will suffer a loss of $400-800 million. But these aren’t just numbers, these cuts will result in a loss of services and access to care, ultimately putting real people – mothers, fathers and children - who need help at further risk. That’s bad for our Island and it’s bad for America.  

What’s worse is that this is just the first domino, as the consequences of grossly inadequate federal funding isn’t confined to the MA plans. Mi Salud’s disastrously low reimbursement rates are being temporarily supplemented by a federal grant that will soon expire. This program is already experiencing severe cash flow problems and, without intervention, the government of Puerto Rico will have to come up with $1.8 billion in 2018 or dramatically reduce eligibility and services, putting healthcare out of reach for hundreds of thousands of families. This is utterly unacceptable and must be fixed.  

It’s time to put an end to this blatant discrimination. Puerto Ricans are not asking for special treatment, we are asking for equal treatment. We pay the same Medicare and Social Security taxes as those on the mainland. Access to quality healthcare is not a privilege; it is a right for every American -- no matter where you live. We are asking to be treated with the fairness and dignity that all U.S. citizens deserve.

Rivera is a nationally recognized healthcare leader and serves as the chairman of the Puerto Rico Healthcare Crisis Coalition.