The territory, which has grappled for years with shortfalls in
funding of its Medicaid healthcare program, is on track to run out
of money to pay doctors and hospitals by early next year, leaving as
many as 900,000 low-income Puerto Ricans without care.
Puerto Rico Governor Ricardo Rossello has asked Washington to waive
the territory's share of Medicaid costs - a step that could cost
hundreds of millions. Last week, Rossello returned with another
request: an infusion of $1.6 billion per year for at least five
A dozen Democratic senators have raised the issue with the Trump
administration. Republican Senator Marco Rubio has also expressed
support, saying the Medicaid woes could hasten an exodus from the
island, though he has not yet taken a position on specific
"If you take the storm and you add already all the inconveniences,
obstructions that it's created - and combine that with a Medicaid
collapse - then you're really going to accelerate the number of
people coming to the mainland," Rubio said in an interview.
Seema Verma, head of the Centers for Medicare and Medicaid Services,
told Reuters that the administration was working on a Medicaid
proposal for the island but she gave no details.
"We’re looking at everything at this point. We want to make sure
that we’re supportive of them to deal with this crisis – but also
dealing with some of their baseline issues that they had with the
healthcare system,” said Verma, who visited Puerto Rico last week.
The timing and legislative vehicle for any funding are not yet
clear. The White House is working on another emergency relief
package for Puerto Rico, expected in mid-November.
The Republican-controlled House of Representatives has proposed
including $1 billion in stop-gap funding for Puerto Rico Medicaid as
part of a bill to renew funding for the Children's Health Insurance
The program cost almost $2.5 billion in 2016, and was projected to
be at least $875 million short in funds in 2018. (For a graphic on
the Medicaid funding "cliff": http://tmsnrt.rs/2yT1qWG)
'WE NEED A PLAN B'
As Puerto Rico is a territory and not a state, its residents do not
pay federal income taxes. Washington, which shares the cost of
Medicaid with states, has long capped spending to territories.
[to top of second column]
The result: low-income states such as Mississippi get 75 percent of
their Medicaid bill covered by Washington, while only about 12
percent of Puerto Rico's costs are covered under the cap.
Six weeks after Maria tore through Puerto Rico, the island is
struggling to pick up the pieces, and about two-thirds of its
residents remain without power.
The territory declared bankruptcy earlier this year and the storm
has plunged its economy into deeper uncertainty, exacerbating the
"I am worried about my patients. I am worried about myself. I have a
family and obligations," said Ivan Gonzalez-Cancel, a heart surgeon
at Centro Cardiovascular de Puerto Rico, who said he expects the
territory to run out of Medicaid money in February.
"I have been talking to many people for years saying, 'We need a
Plan B,'" Gonzalez said. "They are counting on that money."
The hurricane is one of several massive disasters to hit the United
States over the past three months. Congress has approved more than
$51 billion in emergency aid since September and will consider
another aid request this month.
Carlos Mercader, a spokesman for the governor, said he hoped federal
attention to Puerto Rico’s hurricane woes would lead to a
longer-lasting fix for its Medicaid problems.
But Joe Antos, a healthcare economist at the American Enterprise
Institute, said that might be a tough sell in Washington, given the
island’s long list of needs.
"They have had no traction on this issue, whatsoever, for decades,"
Antos said. "This is just a very bitter frosting on a really tough
(Reporting by Roberta Rampton in Washington; additional reporting by
Robin Respaut in San Francisco and Richard Cowan in Washington;
graphic by Han Huang; Editing by Marguerita Choy and Andrew Hay)
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