Ending Puerto Rico’s Health Care Crisis

The headlines have faded from national news, but a year after Hurricane Maria wreaked devastation on the island of Puerto Rico, thousands of U.S. citizens still face a terrifying humanitarian crisis. While progress has been made — power was recently restored across the island — many Puerto Ricans still live in unacceptable conditions. ¬†

The most urgent priority is access to basic health care. As chief executive of MMM, a leading Medicare Advantage organization in Puerto Rico, and president of the Medicaid and Medicare Advantage Products Association of Puerto Rico, I know just how fragile Puerto Rico’s underfunded health care system was before last year — and how much worse it is today.

The hurricanes and their aftermath exacerbated problems that have consistently plagued the Puerto Rican health care system. Puerto Ricans enrolled in federal health care programs, such as Medicare and Medicaid, have long dealt with insufficient funding. In 2016, federal Medicaid per capita spending in Puerto Rico was just 37 percent of the lowest state and 26 percent of the mainland average — a significant gap when you consider that Medicaid and the Children’s Health Insurance Program cover 1.67 million people in Puerto Rico, or about 50 percent of the population.

The Medicare Advantage situation is equally dire. Since implementation of the Affordable Care Act, Puerto Rico has faced an aggregate funding loss of $5 billion in the MA program. Federal funding for Puerto Rico’s MA beneficiaries is 43 percent below the national average and 39 percent below the lowest state. It is even 25 percent below the U.S. Virgin Islands, which shares Puerto Rico’s territorial status.

When Hurricane Maria hit a health care system under immense strain, it inflicted enormous physical and mental harm on the population and undermined the infrastructure required to deliver care. Tens of thousands of Puerto Ricans have fled the Island, including many health care professionals, to seek stability on the mainland.

By now, we’re all familiar with the escalation of the official death toll following Hurricane Maria. While it’s important to accurately account for the storm’s toll, something was lost in the polarizing debate about the numbers. The storm took the lives of dozens of Puerto Ricans, but many more died in subsequent months because of the island’s hobbled health care delivery system. After the storm, seven in 10 health centers reported patients were more likely to have suicidal thoughts or attempts, as well as alcohol or other substance abuse disorders.

Unless Congress and the local government enact policy changes, nothing will prevent this tragic loss of life from occurring again following a future storm.

Without the appropriate resources, the system cannot meet the immediate needs of Puerto Ricans and is unable to advance long-term priorities. Wellness initiatives, disease prevention and chronic disease management have been pushed to the back burner. Investments in these areas pay off in the long run. Patient outcomes, demands on the health care system and overall costs will all improve if we invest in preventive and chronic care today.

That’s why we need bipartisan Congressional action to pass bills like H.R. 6809, the Puerto Rico Integrity in Medicare Advantage Act, which will stabilize Medicare coverage for these Americans. The act will establish a floor for federal MA payments to ensure a more appropriate level of resources is committed to solving this crisis.

It will also bolster MA’s ability to deliver a high-quality, coordinated care model to more than 580,000 of the most vulnerable Puerto Ricans. PRIMA will require Medicare Advantage plans in Puerto Rico to spend at least 50 percent of the new funds on provider payments, incentivizing physicians to stay or return to the island.

Leaders in the Puerto Rican health care system are committed to helping those on the island access high-quality care. We’re also doing what we can to speed recovery from Hurricane Maria and rebuild the island’s medical infrastructure. Given the current level of federal funding for the Puerto Ricans enrolled in Medicare and Medicaid, we can only do so much.

Puerto Rico may not be part of the continental United States, but its residents are American citizens who need and deserve Congress’ help. We call on lawmakers to pass the PRIMA Act and pursue other long-term solutions to create a sustainable health care system in Puerto Rico. Without them, Puerto Ricans will continue to leave the island for the mainland in search of stability, and the crisis will only deepen.


Dr. Rick Shinto is president of Medicaid and Medicare Advantage Products Association of Puerto Rico, a not-for-profit association comprised of the leading Medicaid and MA organizations in Puerto Rico (First Medical, Humana, MCS, MMM/PMC, Molina Healthcare, and Triple-S) and CEO of MMM, a Medicare Advantage organization in Puerto Rico.

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