Fortuño reiterates push for parity in federal healthcare spending

The governor characterized the disparity between federal healthcare spending in Puerto Rico and other states as a “historic injustice.” Most states with similar demographics are responsible for only 20% of healthcare costs, with the federal government assuming the rest, while the island picks up 80% of its healthcare costs.

“The government of Puerto Rico has had to take substantial sums to provide quality health services for our citizens,” Fortuño said.

The governor, speaking at the monthly Rotary Club luncheon, highlighted that five different committees in both the U.S. House of Representatives and the U.S. Senate have submitted national health reform proposals.

While much of the focus in the debate on Puerto Rico’s treatment in federal healthcare has focused on the disparity in Medicaid funding, Fortuño said Medicare funding inequities were equally troubling.

Last year, island seniors were penalized $32 million for failing to sign up on time for the Medicare Part B supplemental program. Puerto Rico is the only place in the U.S. where seniors are not automatically enrolled in the program, and they are penalized for the rest of their life for enrolling late, the governor said. Island hospitals and other medical facilities also receive funding through a formula that is less than what is paid stateside.

Calling equal treatment in Medicare funding a “right,” Fortuño said Congress “must recognize one of the basic fundamentals of democracy: equality for all American citizens.”

Fortuño, a national Republican Party member, expressed support for President Barack Obama’s health reform initiative, saying it was necessary to both improve quality of medical care and extend its coverage while controlling costs. He said one of the best aspects of the plan was increased use of technology, which could have real cost savings. However, he cautioned about too much government control of the issue.

“You have to do something because American spends more than most other countries on healthcare and the quality is not necessarily there and too many people are left without coverage,” Fortuño said.

Despite some recent setbacks, Fortuño expressed optimism that Puerto Rico could progress on its goal towards achieving healthcare funding parity.

This week, the Senate Finance Committee is drawing up legislation based on a proposal by its chairman, Sen. Max Baucus, D-Mont, which leaves Medicaid funding to Puerto Rico at its current level of $354 million. That’s in stark contrast to a U.S. House plan that would increase Medicaid funding to $1 billion next year, and continue increasing it to $1.7 billion in 2019. The huge boost would bring Puerto Rico and other territories, which have been subject to a cap on federal healthcare spending for decades, to parity with the states. The island’s funding level has been capped at $272 million annually, but was increased under the American Recovery & Reinvestment Act this year to $354 million through 2010.

Sen. Charles Schumer, D-N.Y., is pushing for an amendment to specifically include Puerto Rico and the other territories in a national health insurance exchange program being created as part of the national health reform being hashed out in Congress. Inclusion in the program is vital for Puerto Rico to be able to provide coverage to an estimated 500,000 low-income workers and their families who currently lack coverage.

Meanwhile, Sen. Robert Menéndez, D-N.J., wants to ensure that hospitals and other medical facilities in Puerto Rico and the territories get paid through the Medicare program using formulas similar to those used throughout the rest of the U.S. The proposal would also automatically enroll Medicare recipients in the island in the Part B program.

Pierluisi told CARIBBEAN BUSINESS that it was decided for “strategic reasons” not to present an amendment calling for an increase along the lines of a House proposal. Instead, Puerto Rico and the territories would try to work with another provision of the Baucus proposal that provides additional funding not subject to the cap to cover new beneficiaries in federal healthcare programs.

Pierluisi said the Baucus plan’s language has “room enough” to work on the Medicare funding issues during this week’s mark up. The final version of the Senate and House bills will also need to go to conference committee for a final agreement.