Unless Republicans in Congress step up, the people of Puerto Rico are about to be dealt a terrible blow: Medicaid funding could evaporate by the end of the year. Low income and poor Puerto Ricans could be denied the ability to see a doctor, putting lives and families at risk. This would be a disaster on an epic scale, and something that I never thought I would see happen to my fellow Americans. What is most concerning is that Puerto Rico may already be at its breaking point.
As you are probably aware, Puerto Rico is already facing a terrible debt crisis that is threatening to destabilize the entire island. The facts are frightening. The Commonwealth owes creditors around $70 billion dollars. About half of the population there is living in poverty and the unemployment rate is over 12%. In many places, crime is escalating at disturbing levels and the government is struggling to fund even basic services that mainland Americans take for granted. Shockingly, its economy is expected to shrink by 16.2% in the next fiscal year.
We can argue who is to blame for the debt crisis, but what cannot be disputed is that most Puerto Ricans are simply victims of poor governance and greedy creditors all too eager to make a quick buck off of the Commonwealth’s financial problems. My bet is that neither the former government officials nor the creditors are faced with losing their healthcare by the end of the year. But that is exactly what might happen to one million poor people in Puerto Rico.
Medicaid in Puerto Rico is becoming a crisis, because for many years the Commonwealth has received much lower Medicaid reimbursement rates – than the mainland states — from the federal government. Over the years, the Congress has appropriated supplemental funding to make up for that shortfall. This supplemental funding is critical, because itensures that healthcare providers are paid for treating Medicaid patients. However, that supplemental funding is set to expire and the Republican leadership in Congress has not taken steps or scheduled a vote to remedy this situation.
Because of the seriousness of this pending crisis, the Senate Finance Committee recently analyzed the situation. The Committee released a bipartisan report, which found fully funding Puerto Rico’s Medicaid program was a “serious and urgent issue.”
In response to this impending crisis, seventy-four Democratic Members of Congress recently penned a letter to Speaker Paul Ryan urging him to get serious about this issue. In the letter to the Republican leader or the House of Representatives, the Democrats wrote: “Not addressing the cliff will also result in additional outmigration to the mainland, where the cost of providing Medicaid is much greater than on the island. We have already seen unprecedented numbers of Puerto Rican residents, including health care providers, leave the island.”
By failing to address the Medicaid shortfall, the Congress would also be ignoring a bipartisan compromise reached by the Puerto Rican Task Force – established by the Puerto Rico Oversight, Management, and Economic Stability Act (PROMESA) – to address the impending Medicaid disaster. If Speaker Ryan and the Republican Congress fail to take up this legislation – or a similar bill to shore up Medicaid funding – it would also be another setback for PROMESA’s hopes to solve the Puerto Rican debt crisis in a responsible and bipartisan way.
Ultimately, Republicans in Congress need to look in the mirror and ask themselves if they are willing to simply let one million of their fellow Americans risk going without healthcare. As a nation, we spend billions of dollars a year on foreign aid and other programs to help people in similar situations in other countries. How can the Congress in good conscience let Puerto Ricans – citizens of the United States – face a situation that could literally cost them their lives?
Solomon Ortiz, a Texas Democrat, served in Congress from 1983 – 2011.