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Congressman sees possible changes in Medicaid for Puerto Rico

By on October 10, 2017

SAN JUAN – U.S. Rep. Michael C. Burgess, the chairman of the Energy and Commerce Subcommittee on Health heard firsthand Monday the importance of Puerto Rico having Congress modify the applicable laws and regulations on the island, which result in unequal treatment of physicians and hospitals when it comes to Medicaid reimbursements.

The legislator, who was accompanied by Resident Commissioner Jenniffer González, visited the Río Piedras Medical Center, the island’s largest public hospital; the Pediatric Hospital in the same San Juan district; and Auxilio Mutuo Hospital in Hato Rey, and spoke with physicians and executives of those facilities about the problems regarding the disparity in benefits.

From left, Health Secretary Rafael Rodríguez, Resident Commissioner Jenniffer González; and Congressman Michael C. Burgess. (Juan J. Rodríguez / CB)

“We are required to have the same standard of quality of service as in the United States, but the reimbursement we receive is lower,” Dr. Teilioio Rucabado, director of cardiology at Auxilio Mutuo said while speaking on a small balcony on the hospital’s ninth floor. Pieces of ceiling on the floor and water are evidence of the damage to the building caused by Hurricane Maria.

Meanwhile, Hospital Association President Jaime Plá said the lack of reimbursement parity with the states, coupled with the inability of many doctors to continue their private practice due to the lack of electric power service after the hurricane will result in physicians leaving the island, seriously limiting the availability of service to patients.

“In Puerto Rico, contrary to the United States, most doctors depend on their private practice; if reimbursements don’t flow and they cannot run their private offices, we will see an even greater exodus of doctors,” Plá said.

Puerto Rico governor turns to diaspora to lobby Congress

According to the administrator of Auxilio Mutuo, Jorge Mata, recent weeks have seen the departure of emergency room physicians, pediatricians, internists and surgeons.

It is estimated that in Puerto Rico, doctors and hospitals receive a 26% lower rate than in the U.S. Virgin Islands and 38% less than the stateside average.

Faced with this reality, Puerto Rico’s government administrations and representatives have long sought from Washington parity with the states in benefits or at least having the gap that separates the island from other jurisdictions reduced.

Asked if the emergency crisis could pave the way for Congress to finally pass more fair legislation with regard to Medicaid in Puerto Rico, Burgess replied: “It’s quite possible.”

Last week, the U.S. House Energy and Commerce Subcommittee on Health approved a new allocation of $1 billion in Medicaid funds for Puerto Rico, which can be used until Dec. 31, 2019.

The allocation will be included as part of the bill that would reauthorize the Children’s Health Insurance Program (CHIP) for five years and extend the life of the local government’s health plan until 2019. The measure must now pass go the full House for consideration and be approved by the Senate before being sent for to the president for his signature.

“I think Congress will be going through with Children’s Health Insurance [CHIP] that addresses many of the three major issues you have. That could be next week, but it will depend on what the political parties decide to do. Disaster assistance, which includes not only Puerto Rico, but also Florida and Texas, that second round of aid will hopefully happen next week or the following one. And then there will be other reconstruction aid, which could be approved by December 8, when the budget must be approved,” Burgess told Caribbean Business.

For recovery aid, Puerto Rico must submit the necessary documentation for the island to be considered.

Importance of visit stressed

The resident commissioner stressed that for Congress to understand the importance of legislating in favor of the changes that Puerto Rico is requesting, it is imperative that members of Congress see the island’s situation with their own eyes.

“This is not only the committee that allocates the resources, but also will allow us legislation to make some of the health provisions for Puerto Rico more flexible,” González said.

The resident commissioner highlighted House Speaker Paul Ryan expected visit Friday and stressed that he has been instrumental in making both White House officials and U.S. lawmakers aware of the island’s needs.

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