Puerto Rico is fast approaching another Medicaid cliff — this time amid the worst global pandemic in modern history. Without congressional action before the end of September, Puerto Rico’s Medicaid funding will plummet by 86 percent. The hundreds of thousands on the island who rely on this program are some of the most vulnerable citizens in the United States. Failure to act to avert the cliff would have devastating repercussions for these American citizens and the Puerto Rico health system at large.
The Medicaid cliff is not a surprise. It’s become a cruelly predictable feature of Puerto Rico policymaking in Washington: This is the fifth Medicaid cliff Puerto Rico has faced in the past decade. By funding Medicaid in Puerto Rico on a short-term basis and underfunding Medicare, Congress continually jeopardizes access to essential care on the island. Simultaneously, it undermines the local government’s ability to make long-term plans and improvements in the island’s health care system, which is in serious need of stability.
Another short-term fix is not enough.
The need for federal health care funding is arguably greater in Puerto Rico than anywhere else in the country. In 2018, more than 4 in 10 Americans in Puerto Rico, and nearly 6 in 10 children, lived in poverty, compared to only 1 in 10 Americans and 2 in 10 children on the mainland. In addition, Puerto Rico also has some of the highest rates of Alzheimer’s and dementia, asthma, chronic kidney disease, diabetes, cardiovascular disease and lung disease in the country.
Nevertheless, as the Biden-Harris campaign noted during the 2020 election, Puerto Rico’s Medicaid program is capped “at one-third of the eligible income level in the states, provides only 10 of 17 essential services, pays providers less, and spends less per enrollee.”
The problem is not limited to Medicaid. Puerto Rico’s Medicare Advantage benchmarks are inconsistent with funding in other parts of the country as well. MA payments in Puerto Rico are 40 percent lower than the national average, even though Americans in Puerto Rico pay the same Medicare payroll tax as mainland citizens.
Low MA rates have played a major role in provider migration from the island, among other issues related to access and quality. President Joe Biden has pledged to “address historically low Medicare Advantage payment rates and their consequences to Puerto Rico’s health system,” but ultimately Congress can correct these structural disparities with the long-term legislative changes that are needed.
Health plans play a key role in the Puerto Rico health system, and we are committed to doing our part. Insuring nearly 2 million people under Medicaid and MA, we have a responsibility to make sure the people of Puerto Rico have access to the care they need when they need it. We also have a responsibility to step up in times of need. During the pandemic, health plans have invested in campaigns to prevent spread and are playing a key role in vaccination efforts. However, we are only one piece of the puzzle.
Congress and the administration should seize the opportunity presented by the Medicaid cliff to eliminate funding disparities and ensure state-like treatment for Puerto Rico once and for all. March’s House Energy and Commerce Subcommittee on Health hearing was an important step toward action, but we must keep up the momentum.
The time has come for a long-term solution for the chronic underfunding of Puerto Rico’s health care programs. The time has come for parity. The disparate treatment of more than 3 million U.S. citizens in Puerto Rico’s health care system and the inconsistencies in federal law must end.
We can achieve parity simply by treating Americans in Puerto Rico equitably. This approach would address funding problems while also providing the certainty and stability the island’s health care system needs to deliver essential health care.
Roberto García is the president of MMAPA, the Medicaid and Medicare Advantage Products Association of Puerto Rico.
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