Puerto Rico’s healthcare system is in complete disarray. What was already a long-standing issue for many years, has been exacerbated by the effects of Hurricane Maria. A number of the island’s residents suffer from chronic health conditions and there is a growing elderly population. At the same time, mental and physical health needs caused by Hurricane Maria mean that medical professionals and social workers are needed more than ever. Yet, in spite of this, the island’s government is planning to cut more than $840 million in savings from Medicaid by 2023, as required by an agreement with the U.S. government in order to reduce Puerto Rico’s substantial and crushing debt.
Unsurprisingly, these cuts will impact the poorest people on the island. They also leave little money for health services and personnel in a territory where health care has been suffering. Due to Puerto Rico’s decades-long recession and out-of-control government spending, the island’s government defaulted on more than $70 billion of debt. As the government works with Congress to restructure that debt, it has tried to cut back on Medicaid spending while simultaneously trying to improve access to health care and insurance. This is no easy task and, in many ways, these two things contradict each other. After all, improving healthcare access for Puerto Ricans requires funding the system, or at the very least, a major overhaul of it. Sadly, Puerto Rico’s government has failed miserably at both.
At the same time, the federal government only contributes a small percentage to Puerto Rico’s Medicaid budget—around 19 percent, which is way smaller than it contributes to actual states and that money is paid out as a fixed annual payment. With the high numbers of people who are sick and elderly, the island is struggling to cover the cost of its Medicaid bills. In fact, almost half of the island’s residents qualify for public health insurance costing billions of dollars in Medicaid annually. Back in February, Congress agreed to pay an additional $4.8 billion to cover Puerto Rico’s Medicaid bills. But that money will likely run out next year. So the island’s government continues to flounder as it looks for options. The government continues to maintain that cuts mean Medicaid patients will have more options for insurers and greater access to specialists. But the picture is grim and no one believes them. In fact, one insurance company executive, Dr. Richard Shinto, says just the opposite: “The oversight board is fixated on cuts, but we're never going to improve health care unless more money is put into the system."
When the Medicaid funding runs out, close to one million island residents will lose healthcare coverage. As NPR notes, cuts to Medicaid won’t alleviate the crisis that Puerto Rico’s healthcare system is facing. The island needs more money for health services, not less. “The economic overhaul doesn't rectify Puerto Rico's fundamental problem—it can't sustain its Medicaid program so long as Congress treats the territory differently than it treats states.”
Once again, the US government is failing the people of Puerto Rico and leaving them to languish. Funding 19 percent of the island’s Medicaid budget is woefully inadequate and not nearly on par with how it funds states—especially given the population’s needs. Inaction and willful neglect in Washington is killing Puerto Ricans on our watch. And as we approach the one year anniversary of Hurricane Maria, things become more urgent and dire in Puerto Rico by the day. This situation is worsening with no end in sight.