“Every American should have access to affordable health care coverage for themselves and their families, and the four million U.S. citizens in Puerto Rico are no exception.”
~ Governor Luis Fortuño
Health Care
Americans should have access to health care that is affordable, builds on the current system, and uses existing providers, doctors, and plans to help patients make the best choices for themselves and their families. Governor Fortuño is working to make this ideal a reality.
Health care is one of the most important issues facing Americans today, and residents of Puerto Rico are no exception. Today, even with scarce resources, Puerto Rico has a coverage rate of 95% of the population. However, to achieve an improved system, the financial structure must be based on the principles of fairness and parity.
In Governor Fortuño’s view, nowhere are the inequities confronting the Island more glaring than in the operation of health care programs like Medicaid (jointly financed by the federal and state governments) and Medicare (financed exclusively by the federal government). This lack of parity presents an additional obstacle as the federal government considers using these programs as the “building blocks” for national health care reform.
In the governor’s view, federal funding disparities are an inevitable byproduct of Puerto Rico’s current political status and the fact that the Island’s residents have no genuine voice in the federal government that enacts the laws that govern their lives.
Equality in Health Programs
Health Care System Reform – In Washington, reform is something all sides agree must take place at the national level. The Governor and his Administration are focused on ensuring Puerto Rico is included in any national improvements to the system.
President Obama has proposed health reform that builds on current federal programs and creates new programs to enable all Americans to have health care insurance or otherwise have access to good health care. In the past, the President pledged to include Puerto Ricans in a reformed health system as well as to treating Puerto Ricans equally in existing health programs, in some cases through phase-ins of benefits. The President referenced this commitment in a letter to Governor Fortuno for his Inauguration. Governor Fortuno is working closely with the White House, federal agencies, and Members of Congress to achieve his health care reform goals for Puerto Rico.
Medicaid - Medicaid is an existing program that grants federal assistance to States and territories to help provide health care to low-income individuals. It pays for 50 to 83 percent of the cost, with a higher share of funding being provided to states with lower per capita incomes. There are two limits on federal assistance to U.S. territories such as Puerto Rico. One limits the federal contribution to 50 percent, while the other limits the federal contribution to a specific dollar amount or a “cap.” There are no such limitations for States.
In response to requests from Governor Fortuno and Resident Commissioner Pierluisi for funding equal to that provided in the States, the American Recovery and Reinvestment Act increased the limit on federal Medicaid assistance in Puerto Rico from $272.4 million for federal fiscal year 2009 (October 1, 2008 – September 30, 2009), about 17% of the cost of Puerto Rico’s program, to $354.1 million, about 22%. The $354.1 million will be increased for fiscal year 2010 by the percentage of medical inflation and further increased for the first quarter of fiscal year 2011.
President Obama has promised to work to phase-out the cap on Medicaid funding in Puerto Rico and the other territories and to phase-in funding equal to the States. Governor Fortuno and Resident Commissioner Pierluisi are working to have Puerto Rico treated equally with the States in Medicaid.
Medicare – Medicare pays health care providers for services to the elderly and the disabled. The program is partially paid for by a federal tax on income that Puerto Ricans pay. Unfortunately, Puerto Ricans do not currently receive benefits equal to those provided in the States. Governor Fortuno and Resident Commissioner Pierluisi are working to have Puerto Ricans treated equally with the States in Medicare.
- Unlike residents of the States, Puerto Ricans are not automatically enrolled in Medicare Part B which pays for out-patient doctor and other services.
- Puerto Rico receives less funding for prescription drug benefits for Medicare program participants eligible for Medicaid because the territory receives block grant funding, rather than funding based on need as is the case in the States.
- Puerto Rico hospitals receive lower payments for in-patient hospital services than hospitals elsewhere in the nation -- including in the adjacent U.S. territory of the Virgin Islands -- because Puerto Rico payments are based only 75% national rates for services and are 25% based on local costs, primarily wages.
- Puerto Rico hospitals receive much less Disproportionate Share Hospital (DSH) funding for serving large numbers of low-income patients than hospitals in the States. This is because Supplemental Security Income (SSI), the program that provides assistance to the needy, elderly, and disabled which is used to calculate DSH funding in the States and the Commonwealth of the Northern Mariana Islands, does not apply to Puerto Ricans
Resident Commissioner Pierluisi has introduced bills in the U.S. House of Representatives for Medicare to pay for in-patient hospital services in Puerto Rico at 100% national rates. H.R. 1501, and to treat Puerto Rico hospitals more equally with hospitals in the States in the calculation of DSH payments for serving low-income patients, H.R. 1502.
Children’s Health Insurance - The Children’s Health Insurance Program (CHIP) provides States and territories with a portion of the cost of providing health care coverage for children from low and middle income families that do not receive care through the Medicaid program. Funding in territories is limited by caps. No caps exist in the cases of the States. Governor Fortuno is working to have Puerto Rico treated equally with the States in CHIP.
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