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Puerto Rico medical organization sues US Health Dept. to obtain funding parity

By on February 8, 2018

SAN JUAN – Consejo de Salud de Puerto Rico, a community based nonprofit corporation, recently sued U.S. Health and Human Services Secretary Alex M. Azar, contending that Puerto Rico’s disparate treatment by Congress in the allocation of health care federal funding violates the Constitution’s Equal Protection Clause and the constitutional right to interstate travel.

“We start from a basic proposition: Equality and human rights must be guaranteed to every United States citizen. However, United States citizens residing in Puerto Rico are burdened with a second-rate healthcare system on the verge of collapse. This second rate healthcare system is perpetuated by Puerto Rico’s disparate treatment in federal funding in Medicaid, Medicare and the State Children’s Health Insurance Program (SCHIP),” the suit reads.

Consejo de Salud was formerly named Consejo de Salud de la Comunidad de la Playa de Ponce, the same entity that more than 15 years ago sued Puerto Rico’s Health secretary for discrimination in healthcare funding. That case hit headlines after federal Judge Gustavo Gelpí ruled Puerto Rico had ceased to be an unincorporated territory to become an incorporated territory of the United States, rejecting the so-called Insular Cases, in which the Supreme Court ruled that state constitutional rights do not necessarily apply to territories.

Although the case has been closed since 2011, Consejo de Salud asked this week for the two cases to be consolidated, arguing there are unresolved issues in the previous one. The Justice Department has objected the request, asserting that federal rules prevent a live case from being consolidated to a closed one.

The lawsuit, which will be handled by Judge Gelpí, comes about after Washington Resident Commissioner Jenniffer González announced Wednesday that Puerto Rico’s public health-care costs will be covered for two years as part of a proposed two-year budget deal announced in the Senate.

The proposal would inject $4.9 billion into Puerto Rico’s healthcare system if approved, covering 100 percent of Medicaid costs during the two-year period.

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“That eliminates the concern of a Medicaid cliff,” she said on social media, referring to the looming collapse of the local healthcare system this year.

However, that does not mean the island will not face health funding shortages in the future. The lawsuit contends that unlike U.S. states, which get funding based on per capita income, Puerto Rico’s funding is set by statute at 55 percent. Puerto Rico, which has the lowest per capita income compared to any state, is limited by statute to almost the lowest funding available, the lawsuit says.

“Puerto Rico’s disparate treatment is subject to a second cap. In Puerto Rico Medicaid funding is not open-ended,” the suit reads. The island’s Medicaid program historically has been between 15 percent and 20 percent a year. Puerto Rico was spending upward of $1.4 billion in commonwealth funds to provide health services to more than 1.2 million low income beneficiaries, and receiving less than $400 million from the federal government for healthcare.

“If Puerto Rico were instead treated equally as any other State, the United States Government Accountability Office estimates that federal Medicaid spending would be up to $2.1 billion per year,” the lawsuit adds.

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