Congress faces growing health care crisis in Puerto Rico
Puerto Rico’s Medicaid funding crisis is deepening, adding yet another issue for Congress to deal with in what is sure to be a hectic December.
Hurricane Maria caused serious damage to Puerto Rico’s health-care system, and none of the federal disaster relief money to date has been earmarked for the Medicaid program.
A $44 billion supplemental payment request from the White House on Friday said the administration was “aware” that Puerto Rico needed Medicaid assistance, but it put the onus on Congress to act.
Efforts to provide the money through legislation have failed so far. Advocates and lawmakers are now eying the upcoming year-end spending bill as a solution, given that the bill may become a “Christmas tree” loaded up with policy provisions.
But there’s no guarantee that the Medicaid money will make it in, as lawmakers are grappling with several hot-button issues heading into December, including immigration, Trump’s proposed border wall, ObamaCare payments to insurers, and an extension of the Children’s Health Insurance Program.
Advocates are worried Puerto Rico could get left behind in the legislative frenzy to come.
“This could be the mother of all appropriations bill,” said Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities (CBPP).
“And if the Senate is focused on taxes when they get back from Thanksgiving … are they going to be able to get to all of these? Puerto Rico and the Virgin Islands could fall through the cracks,” Park said.
Some lawmakers blasted the Trump administration’s disaster request on Friday, saying $44 billion is not nearly enough.
In a joint statement, House Energy and Commerce Committee ranking members Frank Pallone Jr. (D-N.J) and Senate Finance Committee ranking member Ron Wyden (D-Ore.) called on the administration to “immediately provide additional funding and extend a one-hundred percent funding match for Medicaid in Puerto Rico and the U.S. Virgin Islands just as we did in the aftermath of Hurricane Katrina.”
The territory has grappled with funding shortfalls. Before the storm, the island had enough Medicaid money to last until April 2018.
Now, experts predict that unless Congress acts, federal funding will be exhausted in a matter of months. If that happens, Puerto Rico — already cash-strapped — will be responsible for covering all its Medicaid costs going forward.
The Puerto Rican government has asked Congress and the Trump administration for help staving off the crisis. In late October, Gov. Ricardo Rosello requested $1.6 billion a year over the next five years.
“The total devastation brought on by these natural disasters has vastly exacerbated the situation and effectively brought the island’s healthcare system to the brink of collapse,” Rosello wrote in a letter to congressional leaders.
Lara Merling, a research assistant at the Center for Economic and Policy Research, said the governor is asking for only a fraction of what’s really needed.
“It’s the bare minimum to keep the system afloat,” Merling said. The program cost almost $2.5 billion in 2016, so the reimbursement would only cover about 60 percent of the cost.
The House earlier this month passed legislation reauthorizing CHIP that would also give Puerto Rico $1 billion a year for the next two years, specifically aimed at shoring up the island’s Medicaid program.
Rosello said he supported using CHIP because he didn’t want lawmakers to be distracted with other issues.
Addressing the shortfall as part of CHIP “would also remove this matter from consideration in the year-end appropriations package where Congress will need to focus its energies on addressing Puerto Rico’s recovery and long-term reconstruction needs,” Rosello said in the letter.
Despite the progress in the House on CHIP, the Senate has not moved forward with its version of the legislation.
Sen. Marco Rubio (R-Fla.) has expressed general support in recent months for helping to mitigate Puerto Rico’s Medicaid woes, but has not endorsed any specific proposals.
The Senate Finance Committee passed a CHIP bill without Puerto Rico funding, and ever since, the upper chamber has been focused on ObamaCare repeal and tax reform.
Congressional aides and outside lobbyists acknowledge that CHIP will likely only pass as part of the spending bill.
A senior Senate Democratic aide said Democrats would be pushing to include Rosello’s full request in the bill. But Democrats are also demanding a series of concessions for Republicans to get their votes, presenting the opportunity for gridlock.
If Puerto Rico doesn’t get the $8 billion Rosello has asked for, CBPP’s Park said it’s not clear when or how the funding gap could be addressed.
There will likely be future disaster supplemental funding bills, but conservatives are likely to demand that the costs of those bills be offset, he said.
“So then offsets get problematic, it gets bogged down over time … does that make it harder to include Medicaid money in the future?” Park said.
If Puerto Rico’s federal Medicaid funding runs out, up to 900,000 people would likely be cut from Medicaid — more than half of total enrollment, according to federal estimates.