On The Brink Of A Health Care Crisis, Puerto Rico Asks Trump To Waive Medicaid Costs

WASHINGTON/SAN FRANCISCO (Reuters) – Puerto Rico, nonetheless reeling from Hurricane Maria, is looking the Trump management and U.S. lawmakers for assist in staving off a Medicaid disaster that has put 1 / 4 of the island’s citizens susceptible to dropping hospital therapy.

The territory, which has grappled for years with shortfalls in investment of its Medicaid healthcare program, is not off course to expire of cash to pay docs and hospitals through early subsequent yr, leaving as many as 900,000 low-income Puerto Ricans with out care.

Puerto Rico Governor Ricardo Rossello has requested Washington to waive the territory’s percentage of Medicaid prices ― a step that might price masses of tens of millions. Last week, Rossello returned with some other request: an infusion of $1.6 billion in step with yr for no less than 5 years.

A dozen Democratic senators have raised the problem with the Trump management. Republican Senator Marco Rubio has additionally expressed strengthen, pronouncing the Medicaid woes may hasten an exodus from the island, despite the fact that he has now not but taken a place on explicit proposals.

“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 stated in an interview.

Seema Verma, head of the Centers for Medicare and Medicaid Services, advised Reuters that the management was once operating on a Medicaid proposal for the island however she gave no main points.

“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,” stated Verma, who visited Puerto Rico remaining week.

The timing and legislative automobile for any investment don’t seem to be but transparent. The White House is operating on some other emergency aid bundle for Puerto Rico, anticipated in mid-November.

The Republican-controlled House of Representatives has proposed together with $1 billion in stop-gap investment for Puerto Rico Medicaid as a part of a invoice to resume investment for the Children’s Health Insurance Program.

The program price virtually $2.five billion in 2016, and was once projected to be no less than $875 million quick in budget in 2018. (For a graphic at the Medicaid investment “cliff”: http://tmsnrt.rs/2yT1qWG)


As Puerto Rico is a territory and now not a state, its citizens don’t pay federal revenue taxes. Washington, which stocks the price of Medicaid with states, has lengthy capped spending to territories.

The end result: low-income states corresponding to Mississippi get 75 p.c in their Medicaid invoice coated through Washington, whilst handiest about 12 p.c of Puerto Rico’s prices are coated below the cap.

Six weeks after Maria tore via Puerto Rico, the island is suffering to pick out up the items, and about two-thirds of its citizens stay with out energy.

The territory declared chapter previous this yr and the hurricane has plunged its economic system into deeper uncertainty, exacerbating the Medicaid disaster.

“I am worried about my patients. I am worried about myself. I have a family and obligations,” stated Ivan Gonzalez-Cancel, a middle surgeon at Centro Cardiovascular de Puerto Rico, who stated he expects the territory to expire of Medicaid cash in February.

“I have been talking to many people for years saying, ‘We need a Plan B,’” Gonzalez stated. “They are counting on that money.”

The storm is certainly one of a number of huge screw ups to hit the United States over the last 3 months. Congress has authorized greater than $51 billion in emergency assist since September and can believe some other assist request this month.

Carlos Mercader, a spokesman for the governor, stated he was hoping federal consideration to Puerto Rico’s storm woes would result in a longer-lasting repair for its Medicaid issues.

But Joe Antos, a healthcare economist on the American Enterprise Institute, stated that could be a tricky promote in Washington, given the island’s lengthy listing of wishes.

“They have had no traction on this issue, whatsoever, for decades,” Antos stated. “This is just a very bitter frosting on a really tough cake.”

(Reporting through Roberta Rampton in Washington; further reporting through Robin Respaut in San Francisco and Richard Cowan in Washington; graphic through Han Huang; Editing through Marguerita Choy and Andrew Hay)

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