Mario Marazzi Santiago

Tribuna Invitada

Por Mario Marazzi Santiago
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Dear Mr. President

Saludos de la gente de Puerto Rico.  Today, I want to talk to you about the health care crisis in Puerto Rico, because it’s something that everyone in Washington, DC needs to be taking seriously.

Right now, as you know, Puerto Rico’s health care system is under enormous financial strain, and on the verge of breaking down with considerable humanitarian consequences for thousands, if not millions, of people.

As Puerto Rico’s other crisis, its debt crisis, quickly unravels over the coming months, other parts of Puerto Rico’s society may also fail, exacerbating the crisis in Puerto Rico’s health care system.  For instance, selective power outages may leave key health facilities and patients without electricity. 

That’s why we need to gather every penny, nickel, and dime we can find to help fund Puerto Rico’s health care system, and there are many ways to do this.

Just last year, the Puerto Rico Institute of Statistics found that your Centers for Medicaid and Medicare Services (CMS) tipped the scales against doctors, patients, and health care providers in Puerto Rico to the tune of $120 million annually, using a method that introduced a statistical bias in the Geographic Practice Cost Index (GPCI) during your first term in Office.

This summer, we were very excited to hear that CMS is proposing to exercise its administrative authority to change its methodology in a way that will fix the public housing bias identified by the Puerto Rico Institute of Statistics.  However, on closer examination, we noticed that CMS is proposing to phase-in the fix through a 2-year period.  In addition, thus far, CMS has not spoken if and when these adjustments will be allowed to show through to the Medicare Advantage Benchmark, which contributes the most to the $120 million annually. 

When you boil it down, this means that out of the $120 million owed to Puerto Rico annually, Puerto Rico can expect to receive an additional $20 million next year when CMS begins the phase-in period of the Puerto Rico GPCI fix.

But, it can’t just be up to Puerto Rico’s health care system to foot the bill for the rest of the federal short change.  If we are going to protect Puerto Rico’s next generation, we need everybody to take action.

The good news is that there are steps that you can take right now to help stop the crisis: 1) immediately fix the statistical bias that takes away money from physicians in Puerto Rico for offering services under Medicare Part B, 2) communicate openly and honestly with the Puerto Rico health care system regarding whether the fix of the GPCI statistical bias will be allowed to show through to the Medicare Advantage Benchmark, so that all types of health care providers can adequately plan, negotiate, and adjust for the recovery of the system.

For a copy of the report of the Puerto Rico Institute of Statistics, visit:

Make no mistake.  The threat of the crisis in Puerto Rico’s health care system is real.

That is why we are taking this so seriously in Puerto Rico.  That is why you have to take it seriously too.

On a more personal note, the statistical bias mentioned here is just the tip of the iceberg of the historically very unequal application of federal health care policy in Puerto Rico.  Mr. President, you really should take a look at trying to end the Health Apartheid of Puerto Rico. 

Muchas gracias.

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