Prima Bill Gains Important Support
Grover G. Norquist, president of Americans for Tax Reform, joined the request by the Government of Puerto Rico and Financial Oversight & Management Board (FOMB) requesting Congress to approve H.R. 6809, the P.R. Integrity in Medicare Advantage Act (Prima), which was presented by the island’s Resident Commissioner Jenniffer González Colón.
Americans for Tax Reform is a nationally known anti-tax advocate organization that Norquist founded. His support is important because this group is a strong ally of several Republican members of Congress and President Donald Trump.
In the letter to members of Congress, Norquist said the legislation “has bipartisan support in the House of Representatives,” and legislators “should ensure the Prima Act is passed into law before the end of the year, either as a standalone bill or in a broader vehicle.”
Prima was introduced by Resident Commissioner González Colón and seeks to establish a 0.70 average geographic adjustment (AGA) baseline for each county in the United States. The AGA changes reimbursement based on estimated operating expenses in different regions across the country.
“The Prima Act provides a temporary, modest, deficit-neutral correction to Puerto Rico’s Medicare Advantage [MA] base payments level that will help the island recover from the catastrophic negative impacts of the hurricanes,” Norquist said in his letter.
“Compared to traditional Medicare coverage, [MA] plans leverage competition to promote consumer choice, increase options and put downward pressure on costs. The Trump administration is rightly expanding on this model to promote further private-sector negotiation and efficiency,” Norquist added. “Utilization of [MA] plans in Puerto Rico are high compared to many U.S. states. Today, there are roughly 580,000 seniors in Puerto Rico covered through [MA] plans, or nearly 90 percent of those eligible for Medicare,” Norquist pointed out.
In Puerto Rico, Medicare Advantage payment rates were 24 percent lower than the U.S. average in 2011 and have fallen for the past seven years. In 2019, the average base payment will be 43 percent lower than the U.S. average.
The intention of the legislation is to address this discrepancy “by increasing Puerto Rico’s average geographic adjustment, which is set by the Centers for Medicare & Medicaid Services to 0.70 for 2019, 2020 and 2021.”
“Over 97 percent of the counties currently have AGA factors of between 0.70 and 1.3, so this is a modest change that will bring Puerto Rico more in line with the mainland United States,” the activist said.
On similar terms, Natalie Jaresko, executive director of the FOMB, last week wrote to the U.S. congressional leadership requesting they address the disparity between the island and other stateside jurisdictions regarding healthcare funding.
Her letter stressed that the situation “affects the viability of doctors and service providers for Medicare beneficiaries to continue working in Puerto Rico, further exacerbating the exodus of physicians.”
“This increase would have a significant impact on Puerto Rico’s private health sector. The bill establishes a three-year sunset [automatic termination unless it is reauthorized] on this increase, sufficient to counterbalance the long-term effects of the devastation caused by the  hurricanes,” Jaresko, wrote.
The letter was addressed to Senate Majority Leader Mitchell McConnell Jr., House Speaker Paul Ryan Jr., Senate Minority Leader Charles Schumer and House Minority Leader Nancy Pelosi.