Industry representatives say it will result in a stronger, more competitive healthcare industry
If Puerto Rico receives parity in Medicaid funding, the federal government could allocate nearly $5.2 billion annually to increase eligibility to the government health plan, improve access and quality of services, and also increase compensation to physicians and health care providers.
This was stated by government and medical industry representatives consulted by EL VOCERO, who agree that these benefits could increase the island's competitiveness in the medical sector. Recently, U.S. President Joe Biden asked in Congress for "equal treatment" for Puerto Rico in Medicaid and other federal programs.
According to Jorge Galva, executive director of the Health Insurance Administration (ASES), "the parity would represent 13 times more money than we would have under the cap. Unlike the states, the island operates Medicaid with a cap of $392 million in federal funds, which is equivalent to 55% of expenditures. The remaining 45% is matched by the Puerto Rico government.
"This would be an extremely significant inflow of money that would be in addition to other federal money flows. What is being discussed is that this change in parity be permanent with the elimination of the cap and that parity or something close to that be established," Galva explained.
The official stressed that during fiscal years 2020 and 2021, the allocation to Medicaid increased through supplemental contributions to $2.6 billion and $2.7 billion, respectively, bringing the ASES budget to $3.4 billion and $3.5 billion for these years.
"The parity would represent double what we received in these two years. It is approximately $5.2 billion that could be coming in. It is a dramatic difference between what we have and what is proposed. That's $2.5 billion more over those special allocations and $4.8 billion more than the cap," Galva said.
In this regard, the resident commissioner in Washington, Jenniffer González, explained that the island's health system has a cost of $3.128 billion, which is why she believes it is necessary to eliminate the $392 million cap.
"The federal government gives us 55 cents on the dollar, but if we were a state they would give us 86 cents on the dollar. $392 million is not enough," he said.
Increase in eligibility
Among the many benefits that parity of funds would have on the island, the ASES executive director pointed out that it would allow the government to raise eligibility levels to 133% of the federal poverty level. "What this means is that people who are earning close to $2,000 a month, up to $11 an hour, would be eligible for the government plan and would not have to give up their jobs," he added.
Galva made it clear that since Puerto Rico is a low-wage jurisdiction, with the increase in eligibility virtually the entire population of the island would be insured.
"We are talking that we could add an additional 125,000 to 150,000 people to those we previously added when they raised the poverty level to 85%. This would make the Island the only jurisdiction in the United States where 100% of the population would have the option of insurance, either through Medicaid, Medicare or a commercial plan," the official added.
More services
Health Department Secretary Carlos Mellado said that the additional federal funds would allow adding services to the Vital Plan coverage that are not available due to lack of money. Long-term care and support at home could be added to the government reform coverage, as well as covering the expenses of the Medicare Part B coverage to add 60,000 people to the program.
"Among what we are looking for is prolonged home care, as well as the cost of glucometers for diabetics, diapers for bedridden people, positioning beds, among other things... Medicare patients have access to this under Cover B, but we have 60,000 people who do not have Cover B and who also do not have access to services under the (Vital) reform," said Mellado.
Galva added that expenses related to non-emergency medical transportation, durable medical equipment, adult immunizations, increased drug coverage and diabetes and nurse midwife services, among others, would also be covered.
System stability
Víctor Ramos, president of the College of Medical Surgeons, said that parity in Medicaid funding would provide stability and reliability to the island's health system, which would help retain medical talent.
"You could increase compensation to physicians to the same as what is paid in the United States, where they go for better opportunities," he said.
The president of the College of Health Services Administrators (CASS), Efraín Piñero, also agreed.
"With more funds, we would be in a position to stem the drain of medical professionals. With more revenue we can pay better salaries to medical, nursing and technical staff," he said.
Piñero emphasized that the increase in Medicaid funds will also allow ASES to pay better rates to hospitals, which would help them improve their infrastructure and the quality of services.
"With all this we would have a stronger and more competitive medical industry," he maintained.