DONALD TRUMP (horizontal-x3)
Last week, president Trump rejected the allocation of funds for the Island. (EFE)

WASHINGTON - Drafting a new position within the government of Donald Trump, the White house Office of Management and Budget (OMB) yesterday told Congress it was displeased with the decision to allocate almost “$300 million for Medicaid in Puerto Rico without any reforms to the (Puerto Rican) health system.”

Although the funds already are part of the agreement reached over the omnibus budget bill which should be passed by Congress today, the OMB maintained that the funds are going to a system that, as with others in the US, “has been seriously damaged” by the Obamacare federal health reform.

Since 2016, several republicans in Congress have demanded the Puerto Rican government to focus more on efforts against fraud in the Medicaid program.

“Any sustainable solution for the terrible fiscal situation of Puerto Rico must include the passing of public policies in favor of the Island’s economic growth,” said, also, the statement on public policy by the White House on the omnibus budget bill. However, no measure by the Trump government is known in favor of economic growth in Puerto Rico.

The resident commissioner in Washington, Jenniffer González, said she hoped the statements by the OMB were a reference to the effort that the Puerto Rico government will undertake to reform the Mi Salud plan and the measures recommended by the Congressional Task Group on Economic Development in the Island.

Trump’s position

Last week, president Trump himself rejected the allocation of funds for the Island, while failing to mention the need for reforms or a public policy on growth, describing it only as a “financial bailout” for Puerto Rico pushed by the democrats.

His secretary of Health, Tom Price, had said that the health system of Puerto Rico required $900 million in Medicaid funds by 2018, when the Island’s fiscal year ends.

Democrats in Congress, headed by minority leaders, congresswoman Nancy Pelosi (California), and senator Charles Schumer (New York), put the allocation of new Medicaid funds for the Island as one of their conditions to support an agreement over the bill that will complete funding for federal government spending.

The measure seeks to mitigate the depletion late this year of the close to $1.2 billion per year in Medicaid funds granted by Obamacare to Puerto Rico, which in turn, fund, the government’s Mi Salud plan.

To prevent a deficit in the Island’s health system, the Health Insurance Administration (ASES, by its Spanish acronym) maintains that at least $532 million in additional Medicaid funds are required for next fiscal year, $236 million more than is currently proposed. Commissioner González trusts that to obtain at least that amount with the reauthorization of the State Children’s Health Insurance Program SCHIP, perhaps in September.

Seeking to defendpresident Trump, the OMB director, former republican congressman Mick Mulvaney, rejected the analysis by the Congressional Budget Office (CBO) on the omnibus budget legislation.

The CBO determined that the allocation of $295.9 million in Medicaid funds for the Island increased the fiscal deficit of the federal government by $249 million. From the conservatives’ point of view, the least (one) wants to say is that a project increases the fiscal deficit that president Trump has vowed to reduce.

Mulvaney meant that the funds come out of the $925 million Obamacare line item that was originally intended for Puerto Rico, anticipating its decision on whether to open the Health Insurance Markets as allowed by the law.

But, at the time, it had been said that, if Puerto Rico decided not to open the health insurance markets, the $925 million would be added to the $5.4 billion directly allocated to Medicaid. 

To the Congressional Budget Office, if the money was allocated via Medicaid, it meant cancelling the item for the health insurance market as provided in Obamacare.

But, since the end of president Barack Obama’s administration, funds have been drawn from that item, even to fund programs against the Zika virus.

“You had democrats yelling they had $295 million for Puerto Rico. Not a cent of that money is new, all that money was there already (allocated). Actually, it was part of Obamacare under a previous agreement. That was unspent money and all we agreed to was to move it from one place to another. The taxpayer paid nothing. They wanted new money, they wanted a bailout. We didn’t give them one. We gave them money already allocated,” said Mulvaney during a White House briefing.

Commissioner Gonzalez agrees with Mulvaney’s opinion: “the $295.9 million are the remnant of the money remaining in (the health insurance market places). Had there been more, we would have received that too.”

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