Medicaid block grants are hurting Puerto Rico’s children
Lexie Pèrez-Grüber (Former Staff)Health
A coalition of patients, advocates, and politicians are marching on the cobblestone streets of San Juan today to protest the unequal federal healthcare funding that has left the public healthcare system in ruins. For decades, Puerto Rico has received lower federal reimbursements for Medicaid and Medicare than any of the 50 states despite the fact Puerto Ricans pay the same Medicare rates as citizens in the states. Misssisppi, one of the poorest mainland states, is reimbursed for 80 percent of their costs. But Puerto Rico, despite being immersed in a financial disaster, is only reimbursed for 15 percent of their Medicaid costs.
As a result, Puerto Rico has incurred nearly $20 billion dollars of debt to fund the public healthcare system. The major reason for this is due to the fact that Caribbean island has to rely on a block grant to support its Medicaid program. But with funds expected to run out in 2017, it seems that the healthcare impasse is only going to get worse.
Puerto Rico’s healthcare crisis illustrates how harmful Medicaid block grants are. Medicaid block grants are often suggested as ways to cut federal spending while leaving states, or in this case Puerto Rico, holding the bag. Simply put, a block grant is a capped amount of federal dollars. In sharp contrast, Medicaid’s financing structure changes to align with a state’s changing needs during a time of economic recession or natural disaster. But with block grants, the funding remains stagnant irrespective of the changing needs.
The effects on children are devastating. Doctors are fleeing to the mainland or refusing to accept patients on Medicaid, leaving children without pediatricians. Without access to preventive care, children are more likely to have preventable hospitalizations and use overwhelmed hospital emergency departments for illnesses that should be treated by a primary care physician. The lack of access to specialists, like dentists, leaves children at risk of developing preventable chronic diseases like tooth decay. In extreme cases, these diseases can take a child’s life.
Medicaid is essential to protecting the health of our most vulnerable and poorest children. As evidenced by the crisis in Puerto Rico, block grants can undermine that progress and threaten the well-being of our nation’s most vulnerable citizens, including children. Congress should recognize the role it has played in both Puerto Rico’s health and fiscal crises and eliminate the Medicaid block grant limit that has been unfairly imposed on Puerto Rico.
In addition, the American people and our nation’s governors should learn this lesson and reject policy proposals, including those by presidential candidates or by Congress, to block grant the Medicaid program. Just as it has been a disaster for Puerto Rico, it would be for the rest of our nation as well.
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