Full op-ed published in El Nuevo Dia on July 19, 2022.

Despite the chaos that Hurricane Maria caused in Puerto Rico five years ago, our health infrastructure still lacks adequate resources to face another natural disaster. The lack responds largely to the lack of adequate funding for the two federal programs that serve the health of the majority of the population.

This iniquity dates back several decades and its scope and impact is wide. Medicare Advantage rates on the island are 41% below the national average and 23% below the neighboring Virgin Islands. Meanwhile, in 2020, per capita Medicaid spending was 68% below the US average.

Chronic underfunding has forced health professionals to seek opportunities in various US states, creating a shortage of providers, an acute problem especially in the face of a disaster.

Given this reality , we have to promote close collaboration between public and private entities and non-governmental organizations to protect the most vulnerable during the hurricane season . These alliances, which emerged in response to Hurricane Maria, were of great value. Now they must be strengthened to protect our population, especially those who suffer from conditions that can be exacerbated during a natural disaster.

Consider the 6,500 kidney patients who depend on frequent access to hemodialysis therapy to survive. When winds and rains destroy dialysis facilities or leave them without access to power or water, it is a matter of life and death to find access to treatment.

In the aftermath of Hurricane Maria, member companies of the Medicaid and Medicare Advantage Products Association (MMAPA) coordinated with local and federal entities to achieve continuity of care. We assisted in providing critical resources to thousands of patients who required treatments and therapies such as dialysis and to avoid losing medications that required refrigeration. MMAPA members worked to bring needed supplies to isolated communities and made it easier for vendors to keep their offices open by providing generators and other needed supplies.

Collectively, there is no such thing as being over-prepared when we think about the devastation that Maria caused. MMAPA recognizes the availability of allied organizations, individuals, and government to be ready for the next disaster. And MMAPA will continue to work tirelessly to ensure that Puerto Rico receives the health funding it deserves.

As we continue our collaborative efforts to achieve equity in funding, we must build on the lessons from Maria to be more agile and better prepared for the next disaster. For example, local governments should consider establishing shelters and/or clinics for patients who require generators to run ventilators or pumps that power bedridden patients. And MMAPA is ready to lend support.

The clinical teams of the health plans must be part of the planning before the next hurricane hits us, since they are the ones who know where the vulnerable patients are and what they need. Direct involvement of these teams will benefit emergency management efforts. Access to that kind of information can make the difference between life and death. Both government and federal entities can provide transparency in data access to ensure that plans and their provider networks are meshed in both planning and response, to avoid the serious logistics issues that occurred in the response to Maria .

Public-private partnerships and the support of many entities have helped Puerto Rico face multiple crises and will be vital in responding to disasters in the future. Together, the health plans that are part of MMAPA, local and federal agencies will work together to ensure that Puerto Ricans are in the best possible position to receive the necessary care, especially life and death, in the face of an imminent crisis.

This column was written by the Committee of Chief Medical Officers of the Medicaid and Medicare Advantage Products Association (MMAPA): Dr. Ángel Rivera Martínez (First Medical), Dr. Ivonne Vega (Humana); Dr. Inés Hernández Roses (MCS), Dr. Diego Rosso-Flores (MMM), Dr. Gregorio Cortés-Soto (Mennonite Health Plan) and Dr. José Novoa (Triple-S).

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