Give Americans in Puerto Rico the health care they deserve

Give Americans in Puerto Rico the health care they deserve
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The disaster funding Congress recently approved for Puerto Rico will do a lot of good. Nearly two years after Hurricanes Maria and Irma wreaked havoc on the island, people here are still struggling to put their lives back together. Some of that money will be used to rebuild homes and critical pieces of our physical infrastructure; some will be used to help families put food on their tables. But this funding does nothing to alleviate the tremendous health-care disparities Americans in Puerto Rico have been facing for years — long before the hurricanes — and it's time for Congress to stop kicking the can down the road.

For years, Congress has underfunded federal health programs in Puerto Rico. This underfunding is particularly harmful because Americans on the island are poorer and sicker than the average mainlander. The aftermath of the hurricane, coupled with a lack of urgency in Washington, has exacerbated these disparities and nearly stretched our health care system to the breaking point.

Ongoing discussions in the House of Representatives have examined the looming Medicaid funding crisis, or Medicaid Cliff, that is set to hit Puerto Rico and other territories this fall if Congress doesn't take action. Reports from officials on the ground about what this means for Americans living in these areas were dire: millions will lose access to health coverage; Hepatitis-C patients will no longer receive their medication; critical life-saving services that saved a 30-year old nurse and mother of five will cease. Unfortunately, residents of the territories know these stories all too well. In Puerto Rico alone, nearly one million Americans stand to lose their coverage, but despite ringing the alarm bell every time we approach this cliff, there is still no long-term certainty in sight.


Our federal government can surely do better than this. It's time leaders in our nation's capital join Resident Commissioner Jenniffer González-Colón in her tireless efforts to fix federal funding disparities for Puerto Rico.

We need a comprehensive solution to this problem. That means addressing federal treatment of both Medicaid and Medicare on the island, so the Americans of Puerto Rico have the same access to care as their fellow citizens on the mainland. The people of Puerto Rico pay federal taxes, yet their per-capita Medicaid benefits are 70 percent below the U.S. average and their per-capita Medicare Advantage benefits are merely half of what people receive in the states.

Equal treatment would require using similar funding mechanisms – where money allocated to programs is not capped – and making funding formulas long-lasting, so that the health care community on the island is not constantly under threat of a funding shortage. It would also mean extending other benefits, like the Part D Low Income Subsidy (LIS), to island beneficiaries, who currently do not have access to the program.

The hurricanes that devastated Puerto Rico in 2017 put an additional strain on this already fragile and long-underfunded health care system. The humanitarian crisis that followed damaged the island's fiscal health and caused thousands of people, including hundreds of physicians, to flee the island. While there were eight trauma surgeons in Puerto Rico in 2015, only three remained in 2018.

We must incentivize physicians to stay on the island and encourage those who left to return. Stabilizing federal funding for the health care system will go a long way toward that goal, but we should also ensure that a percentage of any newly allocated funds go to providers, who are at the forefront of health care provision on the island.


Finally, a floor for Medicare Advantage payments must be established in order to ensure the program is adequately funded on a permanent basis. Seniors on the island elect benefits through Medicare Advantage at more than double the rate of seniors on the mainland, yet Puerto Rico's program only receives about half the funding that mainland programs receive.

The federal government's drastic underfunding of Medicaid and Medicare in Puerto Rico and the absence of a long-term, comprehensive funding solution puts the island at risk of another humanitarian crisis. The people of Puerto Rico have suffered enough. It's time for Congress to do its job and stand up for the American citizens of Puerto Rico who are perpetually unsure if they'll be able to access the care they need when they need it.

Jim O'Drobinak is the president of the Medicaid and Medicare Advantage Products Association of Puerto Rico (MMAPA), a nonprofit organization composed of the leading Medicaid and Medicare Advantage organizations operating on the island.