Resident commissioner Jenniffer González. (horizontal-x3)
Resident commissioner Jenniffer González. (Xavier J. Araújo Berríos)

WASHINGTON -  Resident commissioner Jenniffer González and representatives from Puerto Rico’s health industry were said to be guardedly optimistic that, by next week at the latest, a federal budget resolution will include a funding bridge to fill at least part of the gap left by the depletion of the $1.2 billion in annual funds for Medicaid provided by Obamacare.

The intention of the plan now gaining traction is for the resolution funding the remaining US government spending for this federal fiscal year, which ends in September, to include an allocation for Medicaid of about $600 million, according to industry representatives.

The most recent analysis from the Puerto Rico Health Insurance Administration (ASES, by its Spanish acronym) indicates that the Obamacare Medicaid funds –which totaled $6.4 billion–, will run out in December and that the Mi Salud plan will require $562 million from January through June 2018 to avoid a fiscal abyss in the healthcare system.

Until very little, official data was forecasting that the money would run out by October leaving a hole of $886 million for next fiscal year. “ASES has been very diligent in providing us with weekly numbers,” said the resident commissioner.

González foresees that Congress will pass this week a resolution that will extend discretionary spending of the federal government for just a few days, to prevent a partial shutdown starting on Friday, and then seek to ratify next week a measure to fund the remainder of the 2016-2017 federal budget.

It is in that second resolution that including a Medicaid fund allocation for Puerto Rico is seen with real possibilities. A longer term solution would then be left for the reauthorization of the S-CHIP program, which could happen by next September at the latest.

The commissioner warned that the amount of money to be legislated for the Puerto Rican 2017-2018 fiscal years, which starts in July, is not written on stone. And a democratic source said to fear the government may just reluctantly accept the $562 million and not attempt to solve it all now.

In a letter, US Health secretary, Tom Price, told republican senator Marco Rubio (Florida) yesterday, that funding the entire Medicaid program for Puerto Rico until June 30, 2018 will cost approximately $900 million.”

Price confirmed that the Centers for Medicare & Medicaid Services (CMS) extended until May 5, the deadline for the government of Puerto Rico to submit the Mi Salud contracts -which must be in effect by July,- to provide more time to learn about the future of the Medicaid funds.

The Industry 

Following a meeting with Florida senators, Rubio and democrat Bill Nelson, several representatives of the Puerto Rico health industry expressed an optimism similar to that of the commissioner. “We are nearer to achieving the funds,” said the executive president of the Hospitals’Association, Jaime Plá.

Together with Plá, present at the meetings were the president of the San Jorge Children’s Hospital, Domingo Cruz; the president of Triple Triple S, Roberto García; David Dizney, CEO of United Medical Corporation; owners of the San Jorge, and doctor Scott Covington, Chief Medical Officer of Healogics.  “It is a critical moment,” said García.

Both Dizney and Covington do business in Puerto Rico, but have their main offices in the areas of Orlando and Jacksonville, Florida, respectively.  Dizney took advantage of this to offer his state’s legislators his take on the impact that the Islands health crisis has on Florida.

“I have witnessed the exodus to Florida,” said Dizney, while indicating that the recent emigration could cost both the federal and state governments about $2 billion in Medicaid funds.

The impact that Puerto Rican migration is having on the US was also mentioned by democratic senators Nelson and Robert Menéndez (Nueva Jersey) in a letter sent to the republican majority leader in the Senate, Mitch McConnell (Kentucky).

“If Congress fails to address this funding gap, there will be a significant increase in the migration from Puerto Rico to the continental United States, which will bear substantial pressure on state programs and increase costs for US taxpayers,” said Menéndez and Nelson, who, just like Rubio, were part of the Puerto Rico Congressional Task Group on Economic Development. 


Meanwhile, governor Ricardo Rosselló advocated for the Medicaid funds with US Health secretary, Tom Price, the administrator of the Centers for Medicare & Medicaid Services (CMS), Seema Verma, and six senators, including republicans Thad Cochran and Roger Wicker. 

Senators Cochran and Wicker were two of the eight republicans who helped block in the federal Department of Justice the original law for a plebiscite that the government of Puerto Rico wants to hold on June 11.

Also in attendance during his meetings with Price and Verman were Puerto Rico Health secretary, Rafael Rodríguez, the head of ASES, Ángela Avila, and the director of the Puerto Rico Federal Affairs Administration (PRFAA), Carlos Mercader. Mercader also accompanied him to Congress and commissioner González attended the meeting with Wicker, according to La Fortaleza.

Moreover, according to La Fortaleza, Verma also undertook to amend the Medicaid state plan to adjust it to the changes in the health system as proposed by governor Rosselló.

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