Published in The Hill on April 5, 2022
By Rafael Bernal
Puerto Rico’s health care industry is raising the alarm over disparities in how the territory’s Medicare plans are funded, hurting the quality of services for around 630,000 senior citizens.
In a joint letter to Health and Human Services (HHS) Secretary Xavier Becerra and Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure, a coalition of Puerto Rican medical, pharmaceutical, hospital, business and insurance associations called on the Biden administration to close a “funding gap” that’s undercutting the island’s medical services.
In their letter, the groups referenced an explicit campaign promise made by President Biden to address the territory’s growing Medicare funding gap.
“Biden will address historically low Medicare Advantage payment rates and their consequences to Puerto Rico’s health system by directing the HHS Secretary to develop and recommend payment reforms and enhancements to the program,” reads the Biden-Harris Plan for Recovery, Renewal & Respect for Puerto Rico.
“President Biden promised to address historically low Medicare Advantage payment rates and their consequences to Puerto Rico’s healthcare system,” said Roberto Pando, president of the Medicaid & Medicare Advantage Products Association of Puerto Rico.
“We hope HHS Secretary Xavier Becerra takes positive actions and implements policies that provide a path to fair treatment and equity on healthcare funding for Medicare beneficiaries in the Island,” added Pando.
The Hill has reached out to Becerra’s office for comment.
Puerto Rico’s Medicare system is heavily reliant on Medicare Advantage, a program that allows private insurers to provide Medicare services.
More than 90 percent of Puerto Ricans who use Medicare rely on Medicare Advantage programs, but the federal government funds Puerto Rico’s Medicare Advantage at 42 percent below the average national rate.
That gap has nearly doubled over the past decade — in 2011, Puerto Rico’s Medicare Advantage funding lagged 24 percent behind the national rate — and Puerto Rico not only lags behind states, but behind other territories.
In their letter to Becerra and Brooks-LaSure, Puerto Rico’s health care providers noted that Puerto Rico’s funding rate is 37 percent below that of Hawaii, the lowest-funded state in the program, and 23 percent “below the next-lowest jurisdiction (U.S. Virgin Islands).”
While Medicare Advantage is enormously popular in Puerto Rico, it is not as widely used on the mainland.
Still, Medicare Advantage usage has been growing throughout the United States, and it is estimated that about half of all Medicare users will be on an Advantage plan by 2030, according to the Kaiser Family Foundation.
The discrepancy in funding rates for Puerto Rico has contributed to underservicing of seniors and other Medicare beneficiaries on the island, but also to emigration from the island both of patients seeking better care and of medical professionals seeking better working conditions.
According to the letter, there are 280,000 dually-eligible seniors in Puerto Rico, who are immediately eligible to receive medical services on the island or in one of the states.
“Now is the time to end funding disparities for Medicare beneficiaries in Puerto Rico and U.S. territories,” said Elliot Pacheco, president of Entrepreneurs for Puerto Rico, a local business association.
Puerto Rico’s health care industry has long warned that continued shortchanging of the island’s medical system could prompt more out-migration with costs to the states.
A reduction in the funding gap, they argue, would instead prompt seniors and medical professionals to stay on the island, where costs of living are lower and every Medicare dollar can be stretched further.
“Such action would also reduce the rate of provider migration to the states, strengthen the island’s healthcare infrastructure while fulfilling the administration’s overall commitment to equity for underserved areas,” they wrote.
Last month, a bipartisan group of 11 House members penned a similar letter to Becerra, warning that “failing to close the [Medicare Advantage] funding gap between Puerto Rico and the states effectively relegates the Puerto Rico health care system to second-tier status.”
That letter, led by Puerto Rico Resident Commissioner Jenniffer González-Colón (R), included among its signatories the late Rep. Don Young (R-Alaska), a longtime proponent of equal treatment for territories and of statehood for Puerto Rico.
The letter, signed on March 18, the day of Young’s death, called on Becerra to “fix these long-standing inequities once and for all.”