Puerto Rico struggles with low levels of fed provider reimbursement

The federal government vastly underpays Puerto Rico's providers to provide care to its populace, creating a fiscal crisis.

Although Puerto Rico is not a state, as a United States possession its residents are eligible to receive care from the Medicare and Medicaid programs. Approximately 60 percent of the island's residents are enrolled in Medicare or Medicaid, according to the Puerto Rico Healthcare Crisis Coalition.

However, the federal government pays providers in Puerto Rico a fraction of what their counterparts in the states receive--about 70 percent lower for Medicaid providers, the coalition said in a statement. It also noted that the Centers for Medicare & Medicaid Services plans to cut Medicare Advantage premiums by 11 percent in 2016, which will likely exacerbate the revenue crunch. The island is expected to have a nearly $2 billion funding shortfall by 2018 as a result.

"Healthcare represents 20 percent of Puerto Rico's economy, which means its collapse will have catastrophic effects for the Island's already fragile economy," Dennis Rivera, chairman of the coalition said in the statement. "The federal government's shortchanging of healthcare funding is blatant discrimination against Puerto Ricans. We are not asking for special treatment--we pay the same Social Security and Medicare taxes but get less than Americans who live on the mainland."

The situation is so dire that Mi Salud, the private insurer that managed Puerto Rico's Medicaid program, is currently not providing medications to its enrollees, La Prensa reported. It owes $39 million to providers for drugs alone.

"The government doesn't pay its providers on time," Joseph Aponte, a Puerto Rico lawmaker, told La Prensa. The lack of pharmaceuticals for the Medicaid population is endangering as many as 5,000 residents who have dangerous health conditions, he said. 

Although the situation is apparently not as dire as the one in Puerto Rico, the decision by 20 states that decided not to expand Medicaid eligibility under the Affordable Care Act also impacts patients and providers.

To learn more:
- read the La Prensa article 
- here's the Puerto Rico Healthcare Crisis Coalition statement