United for the health of our people

United for the health of our people

Hernán Padilla

Prior to defining a new public health policy, it is necessary to consider that the health programs in Puerto Rico depend greatly on the public policy, laws, regulations and federal funding.  We are part of the medical-scientific culture and the health system in the United States.

The “Patient Protection and Affordable Care Act” (ACA) of 2010 granted Puerto Rico an increase in the Medicaid formula.  However, if we compare the federal contribution to the medical needs of beneficiaries in the island, we actually received 18% of the amount needed to provide adequate services to people of low means (whereas the amount should have been 83%).

This happens because the ceiling set by Congress for territories like Puerto Rico restricts federal funding to a level below that which would apply if Puerto Rico were a state.

Despite this limitation, an increase in the maximum limit of federal Medicaid funds was granted in 2010. Still, we only received less than 40% of what we would be entitled to if we were a state of the Union, which is further evidence that the ELA’s inferior territorial status sacrifices the most neediest.

President Obama’s Affordable Health Care Act (ACA) increases Medicaid funding for Puerto Rico by more than $5.5 billion over nine years to offer health services to more than a million citizens under the program “Mi Salud.”

The previous administration, under Governor Luis Fortuño, took action to incorporate the protections of federal reform via Law 161of 2010 which amends the Patient Bill of Rights of PR. Article 3 provides that the rights will be governed in accordance with the requirements and procedures set forth by the ACA as well as federal and state regulations.

Because many of the provisions of Act 161 are so important, I want to highlight some of those that incorporate patient protections under the federal law. These include «the prohibition of discrimination on grounds of pre-existing medical conditions and the prohibition of imposing lifetime or annual limits on benefits provided, as defined under federal law”.

Similarly, «a patient is guaranteed medical coverage for preventive care, as well as coverage with direct access without need for a referral or authorization, to gynecology and obstetrics services, in cases where the plan covers these services”.

We must recognize that the federal reform and amendments to Law 161 gave way to «an additional step to ensure that all Puerto Ricans have adequate access to high quality health services and medical facilities, according to their needs and irrespective of socioeconomic status, pre-existing health conditions, medical history or ability to pay.»

Act 161 provides that «every patient, user, or consumer in Puerto Rico is entitled to a choice of health care plans and health care providers that is appropriate and sufficient to ensure access to care and high quality healthcare services.

Similarly, «patients under 19 years old may select the health care plan and those providers who meet their needs without being discriminated against for any pre-existing medical condition or medical history, and starting in 2014, the right not to be discriminated against by their pre-existing medical condition or medical history will apply to all patients, regardless of age.»

Undoubtedly, the federal programs to improve health services for our people bring us closer to our American nation.

We are very satisfied with the decision by the Center for Medicare and Medicaid Services (CMS) to increase the benefits for seniors in Puerto Rico covered by Medicare Advantage. This is a great accomplishment, but not enough to close the gap between current benefits in Puerto Rico and those received by beneficiaries in the 50 states.

American citizens who reside in Puerto Rico do NOT have the same Constitutional rights and opportunities that all other US Citizens have in any of the 50 states of the Union.