Wednesday, May 22, 2019

[Editorial] Heroes for More Than One Day

By on October 25, 2018

Editor’s note: The following originally appeared in the Oct. 25-31, 2018, issue of Caribbean Business.

The newspaper that you are holding in your hands is a Special Edition of Caribbean Business dedicating more than the usual amount of space to the embattled healthcare sector because it faces pressing concerns—particularly in the aftermath of a natural disaster and the many punishing lessons endured.

It will be a very long time before we forget the violence wrought by Hurricane Maria and the consequences suffered when some hospitals lost electricity—most people were largely left to their own devices without critical access to quality healthcare.

Thankfully, more than a year later, the stalwarts of the healthcare industry—physicians, nurses and hospitals—have proven their resilience. I know firsthand of medicine students from some of our finest universities—the University of Puerto Rico and Ponce Health Sciences University among them—who went out into the field to help mend the broken, either in shelters or Mash units.

Today, many of Puerto Rico’s hospitals have become storm-hardened; physicians and med students have proven their mettle in the face of adversity. The healthcare sector rallied under very adverse conditions.

Truth be told, Puerto Rico’s healthcare sector has a long trajectory of rallying for the disadvantaged—in the 1990s, the island’s doctors came to grips with the strict tenets of universal healthcare for Puerto Rico’s medically indigent population. In those salad days of healthcare reform, Puerto Rico suffered the same growing pains that have traditionally been tied to managed care as Puerto Rico’s Reforma de Salud under then-Gov. Pedro Rosselló received a paltry 15 percent in Medicaid funding—the remaining 85 percent of costs were covered by the state.

In managed care, rationing of services is inevitable; doctors who are forced to behave as accountants have a tough time dealing with sometimes onerous capitation levels—Puerto Rico has not been the exception.

When the Affordable Care Act (ACA) was passed in March 2010, under the administration of then-President Barack Obama, Puerto Rico’s healthcare sector had opted to receive a $5.4 billion block grant at a clip of $700 million annually—seven years later, the Puerto Rico’s government had blown through the lot, leaving the Puerto Rico Health Insurance Administration at the border of a fiscal cliff.

Had it not been for lobbying by Puerto Rico’s entire healthcare industry—the Hospital Association, Medicaid & Medicare Advantage Products Association, Manufacturers Association and Chamber of Commerce, together with Gov. Ricardo Rosselló and the island’s Resident Commissioner in Washington Jenniffer González—the local government health system would have run out of money. To her credit, González conveyed the extreme disparities Puerto Rico faces in Medicaid and Medicare funding (the island receives 43 percent of the national average).

Puerto Rico secured $4.8 billion earmarked for Medicaid—$1.2 billion of which is contingent upon the adopting of best practices in data reporting through a Medicaid Management Information System (MMIS) and the establishment of a fraud-detection unit by year’s end. There is work to be done.

The big prize, however, is the Puerto Rico Integrity in Medicare Advantage Act (Prima), also now as House Resolution 6809. That measure would grant Puerto Rico close to $3 billion in Medicare Advantage funds over three years commencing in 2019.

Importantly, the measure includes a provision that would guarantee 50 percent of those Medicare Advantage funds would go to healthcare providers—physicians, hospitals and pharmacies. If that helps stem the tide of doctors leaving Puerto Rico at a rate of one physician per day, it will be huge help. Time will tell. At this writing H.R. 6809 has six co-sponsors, but its future will not be decided until after the Nov. 4 midterm elections.

Two observers with vast experience dealing with Puerto Rico healthcare issues on Capitol Hill believe the bipartisan support for the bill could give the measure a fighting chance to be included in a larger economic package beyond the midterm elections.

That is important because so many of the island’s seniors—as much as 72 percent—who are eligible for Medicare, have chosen Medicare Advantage to cover cost gaps in Puerto Rico’s insufficiently funded Medicare.

One of this newspaper’s sources on Capitol Hill insists Puerto Rico should be pounding down the door at the Centers for Medicare & Medicaid Services (CMS) to help obtain the parity in funding for a program that every single U.S. citizen on the island has fully paid into through Social Security taxes.

Perhaps Prima is a right for so many wrongs past—but the time has come to stop asking for handouts for something that is rightfully ours.

Rosselló Administration All In On P.R. Integrity in Medicare Advantage Act

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