Puerto Rico’s exclusion from Congress’s first attempt to replace Obamacare, as well as the lack of liquidity besieging the state Government, shine a light on the urgency to restructure the Mi Salud program, so as to ensure it will be able to cover the services its beneficiaries need.

Ricardo Rosselló’s administration, the healthcare industry, and our allies in the healthcare sector and in Washington DC still have time to step up their efforts to persuade the White House and Congress of how detrimental it would be to exclude the Island from the new healthcare model they are proposing to replace the Affordable Care Act. 

Under this federal act, Puerto Rico received an allocation of $1.2 billion, which will run out by the end of this year. Furthermore, the Oversight Board has already instructed the Government not to include any additional federal funds in the income projections for its fiscal plans, which would help balance the budget and lead the restructuring of the debt.

In any case, there is no doubt that the assistance-based Mi Salud program should be adjusted to our fiscal possibilities. This way, it will be impervious to partisan whims and the changing fiscal priorities in the US capital, which is precisely what is happening with Obamacare. In 2010, the health reform was geared to cover 50 million citizens without healthcare insurance in the US. Now that Donald Trump is President, it will be repealed and gradually replaced.

The first two bills are sending very clear and troubling messages to Puerto Rico. One bill would reform the method of Medicaid fund allocations, which Mi Salud depends on. The second would eliminate the citizen subsidies that allow them to acquire health insurance. Neither of these bills addresses the crisis closing in on our public healthcare system. 

In light of this harsh reality, the Government must have no doubt that the way forward needs to include measures for organizational efficiency and budgetary savings in the funding for service delivery. The Government should also make sure that those who receive coverage actually need it, by refining the eligibility criteria. These and other initiatives could prevent our Island from facing a humanitarian crisis. 

If the Government fails to do this, thousands of people could be left uninsured. This group includes those who are unemployed, pensioners, students, and the medically indigent, as well as workers whose salaries are not enough to pay for commercial coverage but don’t qualify for the healthcare reform. 

Data from the Census Bureau reveals that approximately 297,000 people in the Island lacked healthcare insurance in 2010. Four years later, the Health Insurance Administration—in charge of Mi Salud’s operations—identified 214,000 people without insurance. Experts on the subject say this amount could actually be closer to 300,000, including those who would have to be added due to unemployment, and unauthorized immigrants, who seldom submit their information to the Government. 

By 2015, after Obamacare was implemented, there were 63,000 individual healthcare plans that complied with the law’s provisions and 98,000 transitional plans, which guarantee certain healthcare coverage until the end of 2017, according to reports by the Office of the Commissioner of Insurance.

The current situation calls for the diversification of strategies to make our public healthcare system fiscally sustainable. While we must depend on the resources we can afford, pressure must be exerted on Washington to include Puerto Rico in the reconciliation bills currently being considered in Congress. In the name of prudence, responsibility, and humanity, this must be done.