Congress' proposed fix for Puerto Rico's $72 billion debt crisis does not include any provisions to bolster the island's Medicare and Medicaid funding.
The Senate ceased debate on the Puerto Rico Oversight, Management and Economic Stability Act— or PROMESA—on Wednesday, gearing up for a final vote this week on the measure that would create a fiscal control board with debt restructuring powers to assume the commonwealth's economic decisionmaking.
In addition to its overall debt crisis, Puerto Rico faces significant cuts to Medicare and Medicaid funding, despite receiving approximately 70% lower Medicaid reimbursement rates than the rest of the U.S. The programs serve more than 75% of the island's 3.5 million residents.
But PROMESA won't alleviate the strains on Puerto Rico's healthcare sector, said Rep. Pedro Pierluisi, the commonwealth's resident commissioner and congressional representative.
Rather than adjust Medicare and Medicaid funding, PROMESA would require a task force to analyze how federal law and programs impede economic growth in Puerto Rico, including the island's access to Medicare and Medicaid.
“Any objective analysis of the situation will conclude that Puerto Rico's profound mistreatment under Medicare and especially under Medicaid harms quality of life in the territory and stunts economic growth,” he said.
As Puerto Rico's reliance on Medicare and Medicaid increases, its resources are stretched thin since the programs' funding is also capped and the island isn't eligible to receive Medicare disproportionate care hospital payments, according to the American Action Forum.
Pierluisi has introduced another bill in the House to address the funding disparities that Puerto Rico and other territories face. Two provisions from those bills—one to give Puerto Rico hospitals the same Medicare base payments as the states for treating patients and another to make them eligible for additional funding if they use electronic health records—were enacted in the December 2015 omnibus bill, he said.
But the island still faces an upcoming “Medicaid cliff” as funding will expire in late 2017 or early 2018 without congressional intervention because of a drafting error in the Affordable Care Act, Pierluisi said.
“Providing Puerto Rico with state-like treatment within certain parameters, as I and the Obama administration have proposed, is one option,” Pierluisi said. “But there are numerous other options that cost less and will still help Puerto Rico. Congress needs to choose one of these options, or we are going to have an extremely serious problem on our hands.”
