The close to $300 million in a congressional allocation for Medicaid in Puerto Rico represents some relief for the Mi Salud program, but it’s insufficient to overcome the insolvency to which the Island’s underprivileged-intended health system is dangerously drawing closer.

This austere item coincides with the recent feat in Congress by president Donald Trump to eliminate the Obamacare program, and with remarks by the president that put in doubt the administrative reputation of Mi Salud.

This delicate juncture must diligently press the Puerto Rican Government to tackle a structural medical-hospital reform centered on the efficiency of its managerial and services rendering components.

It has to be admitted that the administrative criticism about the local health system posed by Trump and the Republican leadership in Congress is charting in meritorious waters, as opposed to the previous presidential cybernetics, regarding health funds for the Island.

For example, federal sting operations to put a stop to the improper use of funds have publicly shamed Puerto Rico. It happened, for instance, in 2016 when federal charges were brought on show business stars, models, attorneys, and others who earned over $100,000 a year while unduly benefiting from Mi Salud. About 6,000 people availed themselves of this scheme at a cost of close to $10 million, according to authorities.

While these corruption scheme charges constitute a minority, they illustrate the problem of contamination in the lists of eligible patients. The Mi Salud program, while slow and deficient in rendering certain services, is practically free of charge for many in its rolls. Correcting this issue is part of the local agenda as shown by the hiring of a company specialized in verifying eligibility.

Shared financial responsibility with the patient will also have to be proposed, based on the health care services received and the beneficiary’s income. The idea is for the structural transformation to direct public resources to the truly needy. The Government is rightly headed in that direction, as it reports.

It is vital for both the public and private components of the health system to participate in curing its managerial and service delivery ailments. An efficient collections system in the State’s health entities will help close the deficit gap. Redefining the mission of the Medical Center in Río Piedras, with respect to the role of private hospitals, will relieve the burden of overcrowding.

Among the numerous changes required by Mi Salud, focusing the program’s vision toward prevention is essential to achieving savings in state and federal health budgets, and the expansion of coverage leading to universal health. That is the path to attaining a healthier population.

It is important to show the federal Government that there are local controls in place to polish the processes to be eligible for benefits and improve on other operational areas. It is likewise essential to guaranty Congress and the White House that the funds requested are used only to increase the allocated budget.

It is unfair for Puerto Rico to be trapped in the squabbles between Democrats and Republicans in the United States, or Trump’s aversion to Obamacare. But we have to admit that the operation of Mi Salud burdens fiscal and operational responsibilities with large inefficiencies, and that the abuse of the programs overloads the government’s system.

The administrative surgical procedure on Mi Salud must be accompanied by the tireless demand for federal funds required by the thousands of people who depend on the Government tending to their health. The $295.5 million in federal funds for Medicaid must be deemed as an advanced payment, while the Island steps up its fight to convince US public powers that the $900 million in funding requested to keep Mi Salud afloat has a valid purpose.

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