Washington - The Puerto Rican government will warn today the House Committee on Natural Resources that if Congress does not act on time, by next spring Puerto Rico's health care system will fall into a fiscal cliff that will cause the collapse of services and nearly 600,000 people will be left without medical care.
Ángela Ávila, executive director of the Health Insurance Administration (ASES, Spanish acronym) - according to the presentation she sent to the committee - said that Congress must act before September 30, 2019, to prevent catastrophic damage to the island's health system, and to the health and well-being of the people of Puerto Rico.
Although Medicaid is under the jurisdiction of the Energy and Commerce Committee, the chairman of the Natural Resources Committee, Democrat Raúl Grijalva (Arizona), stressed that today's hearing will open the debate regarding a recurring crisis in other islands.
In the presentation, ASES director projects that Medicaid funds would run out by the end of 2019.
However, Ávila had advanced that Medicaid funds - mainly due to the $526 million pending under the Affordable Care Act (ACA), also known as Obamacare - allocated to the island will actually run out in early April, that is five months before the end of the federal fiscal year 2020, which begins in October and two months before the Puerto Rican fiscal year.
Consequently, Puerto Rico's health care system will reach a fiscal cliff of about $1.2 billion.
Governor Ricardo Rosselló Nevares' 2019-2020 budget bill counts on $1.643 billion in Medicaid funds to pay for the cost of the Government Health Plan (Vital), which reaches $2.965 billion.
Due to a $4.8 billion emergency allocation in Medicaid funds following Hurricane María, the federal government has financed 100 percent of the services of that program since early 2018.
However, as of October, Puerto Rico will have only $380 million available annually in Medicaid and will be subject to a law that only allows the federal government to fund 55 percent of the cost of the services provided under that program.
Ávila said that such level of federal support for Puerto Rico's Medicaid program is not sustainable since the funding is projected to “cover only 19 percent” of the federal funding needed during fiscal year 2020 for Medicaid spending.
Rosselló Nevares asked Congress to allocate $15.1 billion to Puerto Rico for the next five years - some $3 billion annually- and to raise the federal funding responsibility for Medicaid services to 83 percent.
For Ávila, this funding would give the island short-term certainty, while Congress works with the government to determine a sustainable long-term funding mechanism that eliminates inequity in funding and allows them to meet the health needs of the most vulnerable residents.
ASES director told El Nuevo Día last week that nearly half of the 1.25 million participants of the Vital plan will be left without medical services if at least federal appropriations are not matched with the funding the island had under Obamacare.
"(Puerto Rico) can't take another cut," Avila warned back then, stressing that in addition to 600,000 participants that may lose coverage, the government would have to "rethink" whether it can offer dental care and pharmacy services. "A system that doesn't have those pillars is definitely going to collapse," not only because of a lack of resources, "but also because of health conditions," she added in last week's interview.
In her presentation, Ávila added that without an annual allocation of at least $1.6 billion in Medicaid funds, the island's fiscal crisis will worsen, there will be more delays in improvements to hospitals, clinics, and other necessary infrastructure, Puerto Rico will continue to "lose more of our medical providers," and there will be a "mental health crisis."
In a written presentation to the committee, the Executive President of the Puerto Rico Hospital Association Jaime Plá also warned of the damage to the health system that continued uncertainty over access to Medicaid funds causes.
He referred to the loss of doctors and other health professionals, and about the limitations, they will face in accessing loans and promoting improvements to medical facilities.
Plá said that the uncertainty and financial pressure imposed on Puerto Rico's hospitals and other providers have made it very difficult to offer attractive and competitive compensation packages to retain the island’s experienced and bilingual medical staff and professionals.
Meanwhile, the Board´s executive director Natalie Jaresko sent her statement to the Committee indicating that “the Commonwealth’s recovery and fulfillment of PROMESA’ s objectives will be significantly aided by the Congress legislating a long-term Medicaid program solution to mitigate the drastic reduction in federal funding for healthcare in Puerto Rico that will happen later this year absent congressional action.”
Jaresko urged Congress to grant a funding for Medicaid that is “more closely tied to the size and needs of its low-income population.”
Virgin Islands Assistant Commissioner Michal Rhymer-Browne; Samoan Medicaid Director Sandra King Young; Guam Chief Human Services Administrator Maria Theresa Arcangel; Northern Mariana Islands Medicaid Agency Director Helen Sablan; and the Northern Mariana Islands Commonwealth Healthcare Corporation Chief Executive Officer Esther Muna will also testify in today´s hearing.
Yesterday afternoon, Washington Resident Commissioner Jenniffer González hosted a congressional briefing on the needs of Puerto Rico's health care system, covering both the potential fiscal collapse in the health care system and the lower rates received by the island's Medicare Advantage plans.
Ávila, the executive director of the Puerto Rico Fiscal Agency and Financial Advisory Authority (FAFAA) Christian Sobrino Vega, former Governor Luis Fortuño and a representative of the Kaiser Foundation were part of the panel.