The U.S. government has long underfunded Medicare and Medicaid for the American citizens of Puerto Rico. In fact, federal funding levels for Medicare and Medicaid on the island are lower than those for any state in the nation. Congress also funds Puerto Rican health care programs on a short-term basis, regularly subjecting that funding to federal politics and jeopardizing these Americans' access to care.
This underfunding, combined with the devastation wreaked by Hurricanes Irma and Maria in 2017, has debilitated Puerto Rico’s health care infrastructure. As former MMAPA President Dr. Rick Shinto has written, the storms inflicted enormous physical and mental harm on the population and devastated a health care system that was already under immense strain. As a result, thousands of Puerto Ricans, including many health care professionals, have fled the island in search of stability on the mainland.
The lack of access to care has immediate and long-term consequences. The American citizens of Puerto Rico have the highest rates of chronic disease in the country—making access to care particularly critical. Investment in preventive and chronic care today will improve patient outcomes and lower costs in the long run, but under current conditions, that is simply impossible. Congress can address this crisis by establishing higher, long-term, and consistent levels of federal investment in Puerto Rico's Medicare and Medicaid programs.