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Medicaid Fix Reflects Disadvantages of Being a U.S. Territory

Congress is on track to enact a $1.4 trillion spending deal this week, preventing  the kind of government shut down that took place last year. Included in the bill is $5.7 billion in Medicaid funding for Puerto Rico over the next two years.

Initially, the bipartisan agreement hammered out by the House Energy and Commerce Committee and the Senate Finance Committee specified $12 billion over four years.

However, the entire spending bill initially exceeded the allowed limit of $1.7 trillion. Threatened by another government shutdown, Congress had to cut spending.

The bill was complex, including numerous controversial issues. According to El Nuevo Dia, President Trump asked Senator Grassley to cut his healthcare program requests in half. Puerto Rico Medicaid spending was among the targeted areas.  Funding for research on gun control was also cut in half, from $50 million to $25 million.

“The reduction impacted all federal and state spheres that benefited from the negotiation,” said Jose Fuentes Agostini, former Attorney General of Puerto Rico. “Of course, since we don’t have two senators and congressional representation who would be provided to defend us if we were a state, anything could happen.”

Senate Minority Leader Schumer called the funding decrease a “personal vendetta” by President Trump.

Resident Commissioner Jenniffer Gonzalez Colon pointed out the significance of Puerto Rico’s status as a U.S. territory in the debate, observing, “I have to point out that, if Puerto Rico were a state, we would not have to be negotiating anything year after year because these funds would receive them automatically.”

Future of Medicaid in Puerto Rico

Some observers are concerned that the two year allocation of funds will not be enough to allow Puerto Rico to improve healthcare in the territory. The uncertainty of funding up till now, according to experts, has prevented the Island from being able to negotiate better terms with healthcare providers or to commit to needed long-term improvements.

The new funding bill delays the Medicaid cliff which was threatening Puerto Rico and the other territories, and provides for the next two years. It does not prevent Congress from providing further funding for 2022 and beyond. Jennifer Storipan, executive director of the Puerto Rico Federal Affairs Administration, said that the territory would “continue to work hand-in-hand with the federal government to achieve a longer-term funding mechanism that provides stable healthcare to the people of Puerto Rico.”


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