Congress has the unique opportunity to save billions of dollars by preventing Puerto Rico from falling off the Medicaid fiscal cliff. If current federal Medicaid spending there is preserved it would also prevent approximately 500,000 Puerto Ricans from losing health insurance.
A massive wave of Puerto Ricans has already moved to the states in the last decade, seeking full health care coverage not available in the Island. However, the situation will get worse if nothing is done to prevent the loss of $1.2 billion a year in Medicaid funding that expires at the end of 2017. The reality is that it costs three to four times more to treat a patient in the states than in the Island. By acting now to prevent this cliff, the federal government could save taxpayers close to $30 billion, which is the cost of providing health care for the tens of thousands of Puerto Ricans who would move to the states to receive better health care services by 2025.
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How did we come to this point? The Affordable Care Act (ACA) set this ticking, fiscal time-bomb by modifying an already arbitrary cap on Medicaid funding for Puerto Rico, which was supposed to last until 2019. When compared to the states, the program was underfunded ab initio. Now, the money will be depleted by the end of 2017, forcing Puerto Rico’s already fragile budget to absorb $1.2 billion a year or leave half a million of its residents without health coverage.
The problem is that Puerto Rico is currently suffering its worst fiscal crisis in modern history, and has already reduced health spending in order to balance its budget and meet its obligation to creditors. If Congress does not act before the Island’s budget is approved on June 30, the Centers for Medicare and Medicaid Services (CMS) will not have time to approve the new contracts with health providers in Puerto Rico, and the budget deficit will take a sharp increase. That is why postponing action on the Medicaid cliff until fall, when Congress is expected to reauthorize the Children’s Health Insurance Program (CHIP), would be too late.
The solution is for Congress to include bridge funding in the upcoming omnibus spending bill to ensure Puerto Rico receives at least the same amount of Medicaid dollars it receives today. If nothing happens soon, everybody loses. Migrant Puerto Ricans on Medicaid are projected to cost $6.3 billion in Florida ($2.53 billion in state funds and $3.75 billion in federal money), and $1.6 billion in Texas ($687 million and $951 million in federal funds) by 2025, and $26.3 billion total for all states by 2025 if this problem isn’t solved now. Therefore, the fiscally responsible path is for the federal government to provide funding for Puerto Rico now, and work on a more sustainable solution in the medium to long-run.
In the past, when it comes to Puerto Rico issues, members of Congress have told Puerto Ricans time and again to come to an agreement amongst ourselves before we come to Capitol Hill. Unequivocally, this time, the whole Island agrees. In fact, the Puerto Rico Senate passed a resolution on a bipartisan basis asking Congress for justice in federal health care programs for Puerto Rico. We also have Democratic and Republican allies in both chambers of Congress, in both House and Senate, who understand the need to act now to avoid a fiscal and humanitarian calamity later.
The choice is clear. It behooves Congress to act now, and, in so doing, save taxpayers billions of dollars, while also protecting the health coverage of 500,000 U.S. citizens in Puerto Rico. That is the morally correct and fiscally conservative course of action to take.
Ríos is the Puerto Rico Senate Majority Leader, representing the New Progressive Party of Puerto Rico (NPP), and is also the Vice President of the National Hispanic Caucus of State Legislators (NHCSL).
The views expressed by this author are their own and are not the views of The Hill.
