The lower house has only six days to be in session this month, due to arecess from tomorrow to September 25. (AP) (horizontal-x3)
The lower house has only six days to be in session this month, due to arecess from tomorrow to September 25. (AP)

WASHINGTON - Efforts to integrate an allocation that provides stability to Puerto Rico's health system to the Children's Health Insurance Program (CHIP) will remain in the hands of the congressional leadership and may extend beyond the end of the month, when the program technically expires.

At a time when they were pushing for CHIP to be the legislative vehicle to keep the level of annual Medicaid allocations to the Island at $ 1.6 billion, that was the main message that several representatives of the health industry received from congressional officials.

Officially, the law authorizing CHIP funds expires on September 30. But all states and territories have remaining funds until December, so there are several sources of Congress that see a tendency not to reauthorize the law or refinance the program until the end of the year.

"Productive partisan talks continue regarding the extension for CHIP funding," stated yesterday Jennifer Sherman,  spokeswoman for the Health Subcommittee of the House Energy and Commerce Commission.

After meetings that included Speaker Paul Ryan's Public Policy Advisor, Matthew Hoffman, President of the Medicaid and Medicare Advantage Products Association of Puerto Rico (MMAPA) and the main Triple S executive officer in Puerto Rico, Roberto García Rodríguez, she stressed that there is uncertainty whether the reauthorization will occur at the end of the month.

"An official told us that, if we had had conversations a month ago, he would be affirming that it will be reauthorized, but due to recent events, hurricanes, priorities have changed," indicated García Rodríguez.

During the meetings they had with lobbyist Jerry Weller, an adviser to the Puerto Rico Hospitals Association, representatives of MMAPA focused on the issue of Medicaid yesterday.

The meetings that health industry representatives are having include –yesterday and today- advisors to Senate Republican majority leader Mitch McConnell (Kentucky), Senate Democratic minority leader Charles Schumer (New York) , and Democratic spokesman on the Senate Finance Committee, Ron Wyden (Oregon), among about two dozen appointments.

Representatives from the Front for Puerto Rico -which last week had about 40 meetings regarding claims for better access to Medicaid- devote their second round of visits to congressional offices to the federal tax reform, according to the Puerto Rico Federal Affairs Administration (PRFAA).

The plans of the leadership of the Republican majority in Congress and President Donald Trump are to push this fall in favor of a federal tax reform that may impact the Island. Puerto Rico's authorities and the private sector seek to insert themselves into any legislation that proposes changes to the federal tax system, in order to promote investment on the Island and protect the benefits they already have, including those of the Controlled Foreign Corporations (CFC).

But, in the short term, the attention of government and the Island's health industry will be focused this month on whether CHIP is reauthorized or refinanced. Governor Ricardo Rosselló, for example, has meetings tomorrow, Thursday, in Congress that would include the Medicaid issue and the House minority leader, Nancy Pelosi.

"In terms of integrating Medicaid funds into CHIP, we are expecting the Republican leadership," said a congressional source who predicts the issue will come –whether later this month or later this year- by speaker Paul Ryan and Pelosi.

Resident Commissioner, Jenniffer Gonzalez, who also met with health industry representatives yesterday, has indicated that speaker Ryan pointed out that CHIP is the ideal vehicle to try to resolve the depletion of Obamacare funds.

The lower house has only six days to be in session this month, due to arecess from tomorrow to September 25.

Like the Puerto Rican government did, the message from health industry representatives has emphasized that at least the same level of allocations -some $ 1.6 billion- that the Island has received in Medicaid funds should be extended.

But the Obamacare allocations, which total about $ 1.2 billion a year, run out in April, leaving a gap of $ 369 million in the traditional Mi Salud (My Health) budget, which is 60 percent financed by Medicaid.

"The United States must determine whether it is willing to provide Puerto Rico with additional tax relief without getting anything in return," said Richard Reeves and Katherine Guyot, investigators of the influential Brookings Institution study group, in an opinion piece in which they stressed the serious fiscal crisis of the Island.

For Weller, Hospital Association lobbyist and former Illinois Republican congressman, the Island's health system "moves from crisis to crisis." "The lack of certainty (about Medicaid funding) limits services," he added.

Regarding the fact that CHIP funds are not exhausted until the end of the year, Weller noted that Congress often chooses to get to work when faced with "deadlines."

Senate Finance Committee’s chairman, Orrin Hatch (Utah), said last week that the first thing they have to decide on is whether they will reauthorize the program –which entails to review its functioning- or simply refinance it.

The Tax issue

On the other hand, representatives of the Front for Puerto Rico -which included former governor Aníbal Acevedo Vilá- yesterday focused their meetings on the issue of the tax reform.

Acevedo Vilá, lobbyist Weller, this time representing the Manufacturers Association; John Motly of the Puerto Rico Chamber of Marketing, Industry, and Distribution of Food (MIDA, Spanish acronym); Jorge Socca, of the Retailers' United Center (CUD, Spanish acronym); José Salvatella, of the Puerto Rico Restaurant Association; and Ramón Ponte, of the Association of Certified Public Accountants of Puerto Rico participated in the meetings -coordinated by the PRFAA-.

Most meetings of the PRFAA and private industry officials were attended by Republican members of the House Ways and Means Committee, which will address the tax reform issue.

Acevedo Vilá joined PRFAA's deputy director, George Laws García -who took office this month- to meet with Democratic Congresswoman Michelle Luján Grisham (New Mexico), president of the Congressional Hispanic Caucus. They also discussed Medicaid with iLujan Grisham.

But Acevedo Vila had scheduled his own meetings with the tax advisors to Senate minority leader Charles Schumer (New York) and Republicans Roger Wicker (Mississippi) and Richard Burr (North Carolina).

Acevedo Vilá pointed out that Republicans have not yet shared the details of their tax reform plan, but in Schumer's office they indicated him they are aware that if the changes include the tax system for companies abroad, the situation of Puerto Rico should be taken into account.

The former governor's perception of the meetings is that although  Republicans are going to present their tax reform bill in a few weeks, the lack of consensus within their own party will extend the debate until 2018.

Meanwhile, Resident Commissioner Gonzalez said that last Friday she brought to the chairman of the Ways and Means Committee, Republican Kevin Brady (Texas), the initiatives she wants to turn into bills to amend the programs in the areas of economic development, business and community renewal.

Her proposals include granting loans to companies in economically depressed jurisdictions for investment in commercial real estate, property depreciation, building rehabilitation, capital gains and research and development activities.

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