Congress Returns with Puerto Rico Issues on the Agenda, Medicaid Funding Uncertain

Some Puerto Rico issues are high on the agenda of the Democratic majority that took control of the U.S. House of Representatives yesterday.

Most of the discussion concerns the Federal response to the devastating Hurricane Maria: investigation of the perceived slow delivery of assistance and needs that have not been addressed, including the President’s reluctance to provide more aid because some of it could ultimately benefit bond creditors and because of alleged misuse.

The Trump reluctance particularly concerns the Democratic priority for additional contributions to the territory’s Medicaid program, which is a major part of its “My Health” program. (Other components of the funding are territorial revenue, Federal Children’s Health Insurance Program grants, and a relatively small Medicare allowance for medicine for low-income elderly and disabled Puerto Ricans.)

The PROMESA Financial Board’s Fiscal Plan for the territory anticipates no new Federal funding for the $2.4 billion-a-year program other than the less than $400 million a year provided for by ongoing law, although Congress has acted three times to grant an additional $11.4 billion over the past eight years.

Even with this, the program does not provide all of the services or cover all of the people covered by a State Medicaid program. Federal funding is a third to a half what would be provided in a State. (There is a range because State programs can provide services as long as certain minimums are covered.)

Kaiser Health News reported yesterday that among the services provided in all of the States not provided in Puerto Rico is medicine that cures Hepatitis C. Nor does the territory’s Medicaid program cover liver transplants — needed if the organ fails due to Hepatitis C. Hepatitis C an infection carried in the blood increases the risk of cirrhosis, liver cancer, and death.

The number of people in Puerto Rico with the infection is unknown but about one percent of the population of the U.S. is infected and a 2010 estimate put the rate in Puerto Rico among people 21 to 64 years old at 2.3%. Additionally, more than 11,000 cases were reported in the islands from 2010 to September 2016. Further, from 1987 t0 2014, new liver cancer cases in the territory increased an average of 2.1% annually for men and .7% for women.