The “Commonwealth” party government’s alternative to the major new program created by the 2010 Federal healthcare reform known as ‘Obamacare’ has so far fallen far short of the government’s expectations.
Six weeks ago, Commissioner of Insurance Angela Weyne said that the insular program’s goal was to enroll 140,000 of the 282,000 Puerto Ricans who lacked healthcare insurance. As of the end of the initial six-month enrollment period March 31st, only had 14,978 signed up.
The next opportunity to join the Commonwealth alternative will begin with October and last through December.
The Federal program lists private healthcare insurance plans that include required coverage and subsidizes purchases by middle-income individuals. The new Federal healthcare insurance exchange program is helping residents of States with incomes from 100% to 400% of the Federal poverty level pay insurance plan premiums with subsidies that can be most of the cost.
In 2014, the income eligibility level ranges from $11,670 to $46,680 in the case of an individual, with $4,060 to $16,240 more for each additional family member. So, for example, families of four with incomes between $23,850 and $95,400 can receive subsidies.
The program offered to fund State healthcare insurance exchanges and operates a Federal exchange in States that did not accept.
Obamacare also offered to fund expansions of State Medicaid programs for individuals who make too little to qualify for the private insurance subsidies, at 100% of the cost at first and, then 90%.
The law makes available whatever funds are needed to pay all of these costs and others in the States.
But in the case of Puerto Rico, Obamacare created the newest instances of discrimination against the Commonwealth in major Federal programs.
The Obamacare law included just $925 million for middle-income insurance premium subsidies in the Commonwealth from this year through 2019. Federal officials have estimated that equal subsidies in the territory would cost $1.5 billion a year, $7.5 billion over the six years.
Because Obamacare law decision-makers recognized that the $925 million would not be sufficient to pay for substantial subsidies in Puerto Rico, the law permitted the government of the territory to use the money for its Medicaid program.
Since the Commonwealth Medicaid program does not even provide healthcare for all individuals and families earning less than the amount needed to qualify for the subsidies in the States because of a lack of funding, the Government of Puerto Rico is using the $925 million for its Medicaid program. Even though Obamacare tripled the annual Federal contribution to the cost of Puerto Rico’s Medicaid program, the Federal government gives it as much as $2.9 billion a year less than it would provide the Medicaid program of a State of Puerto Rico.
Additionally, instead of paying 100% of the cost of an expanded Medicaid program as in the States, the Federal law pays only 55% of the cost in the Commonwealth.
Although he has publicly supported Obamacare, Governor Alejandro Garcia Padilla has written that “the limited application” of the law “to Puerto Rico significantly curtails the ability to expand health coverage of Puerto Rico’s uninsured.”
The “Commonwealth” party government’s first strategy regarding Obamacare was to quietly seek an exemption from the Federal law’s coverage requirements for insurance plans. The U.S. Department of Health and Human Services rejected the petition to have the law’s consumer protections not apply to Puerto Ricans.
The Commonwealth’s far less than equal funding is made possible by the Commonwealth’s unincorporated territory status.