New Ad Focuses on a Puerto Rican Health Care Crisis No One Knows About

In the spirit of sharing yet another story out of Puerto Rico few mainland Americans would even care to follow, a new ad from a group called the Puerto Rico Healthcare Crisis Coalition is now running in the Washington, D.C., media market:

The coalition, which according to its website is “a group of concerned patient advocates, doctors, hospitals, insurers, activists, labor unions and business leaders that have joined forces to call on the Federal Government to end the appalling injustice in funding of healthcare in Puerto Rico,” has also published an online petition, addressed to President Obama:


To President Barack Obama:

We need you to intervene to prevent the collapse of Puerto Rico’s healthcare system, which will jeopardize care for 3.5 million U.S. Citizens and lead to the shutdown of Puerto Rico’s already fragile economy.

Puerto Ricans are U.S. citizens and pay the same Medicare taxes, but the Island’s healthcare system gets half the federal funding as the other 50 states. This chronic underfunding will reach the breaking point on June 1st when even more funding cuts are due to be enacted.

We need you to direct HHS Secretary Burwell and CMS to reject these cuts before it’s too late.

The site also includes a letter from members of Congress (including Florida senator Marco Rubio) urging HHS to reconsider its decision:

Joint Letter to HHS and CMS Leadership
Dear Secretary Burwell, Acting Administrator Slavitt and Deputy Administrator Cavanaugh:

On March 17th a number of us wrote you to express “our deep concern regarding the future of the Medicare Advantage program in Puerto Rico in 2016 and beyond” and “our sincere hope that the Centers for Medicare & Medicaid Services will take concrete action in the April 6, 2015 Final Rate Announcement and Call Letter to preserve the stability of the MA program in Puerto Rico.”

Now that the 2016 Final Rate Announcement and Call Letter have been published, we write to express our acute disappointment that CMS declined to take any action to address this issue. As a result, MA plans in Puerto Rico stand to.receive an 11 percent funding cut in 2016, versus 2015, whereas MA plans in the rest of the United States will receive an approximately 3 percent funding increase. This cut will jeopardize the future of the MA program in Puerto Rico, which serves 540,000 beneficiaries. In addition, this cut is likely to have broader ripple effects, placing severe financial pressure on Puerto Rico’s Medicaid program and other components of its health care system.

In light of our concerns regarding the repercussions of this funding cut for beneficiaries in Puerto Rico, we were heartened to learn that CMS has committed to immediately undertake a thorough empirical analysis related to the dual-eligible population in Puerto Rico that CMS was evidently unable to complete by the April 6th deadline. We hope CMS will act with a sense of urgency and finalize its analysis before June.

In the event this analysis confirms that an upward adjustment to the payment rates for MA plans in Puerto Rico is justified, it is clear that CMS has the administrative authority to make this actuarial adjustment. Moreover, in light of all the circumstances, we believe that any adjustment deemed appropriate should be reflected in the 2016 payment rates, not delayed until 2017.

Thank you for your continued attention to this critically-important issue.


The Honorable Charles E. Schumer
The Honorable Pedro Pierluisi
The Honorable Marco Rubio
The Honorable José E. Serrano
The Honorable Kirsten E. Gillibrand
The Honorable Charles B. Rangel
The Honorable Bill Nelson
The Honorable Luis V. Gutierrez
The Honorable Cory A. Booker
The Honorable Nydia M. Velázquez

An opinion piece published in April contains more information:

CMS ignored the high rate of poverty and poor health in Puerto Rico. They ignored the fact that the island has the highest dual-eligible penetration in the country. They ignored the 18,000 letters from a coalition of Puerto Ricans seeking relief from looming cuts to the program. And they refused to recognize that Medicare Advantage rates in Puerto Rico are already 32 percent lower than the national average.

To be fair, Puerto Rico was not entirely forgotten in the 2016 CMS Call Letter was released. In fact, it was mentioned 27 times. Unfortunately, each time Puerto Rico was mentioned, CMS proffered only more excuses for ignoring the 560,000 MA beneficiaries on the island, stating that they did not have the necessary authority, time or desire to address the urgent needs of these beneficiaries.

Not everyone had such bad luck. Some health plans and beneficiaries applauded the fact that CMS adjusted the 2016 final rates to provide health plans across the country an average 3.5 percent rate increase. Media outlets trumpeted the positive news. But these same media outlets and CMS documents failed to note that Puerto Rico’s beneficiaries will face an 11 percent cut in 2016. Remarkably, the fact that Puerto Rico would lose over $300 million in Medicare Advantage funding in 2016 wasn’t mentioned.