Amidst a long lasting recession, Medicare program benefits in Puerto Rico re suffering the largest funding cuts in the United States, estimated at $700 million since the Affordable Care Act began to be implemented in 2011, healthcare leaders from the Puerto Rico Medicare Coalition for Fairness said Monday.
With more cuts already mandated for 2015 and beyond, the coalition representing at least 13 major healthcare organizations in Puerto Rico, recently addressed a proposal to President Barack Obama, calling for action to avoid further harm to the island’s healthcare system and the more than 700,000 U.S. citizen beneficiaries in Puerto Rico.
Jim O’Drobinak, president of the Medicaid and Medicare Advantage Products Association of Puerto, said a significant part of the Medicare funding reductions are due to an unintended result of the ACA and its detrimental impact on Puerto Rico.
“The ACA changed the formula for the calculation of Medicare Advantage funding for each beneficiary to one solely based on estimated costs of Traditional Medicare in each county of the nation,” he said.
“We do not believe that the intention of the leaders of the ACA was to generate the highest cuts to the poorest counties, but that has been the result for Puerto Rico since its implementation in 2011. The Medicare Advantage program serves more than 700,000 beneficiaries in Puerto Rico and was already operating at the lowest MA base rate in the nation by more than 20 percent before the ACA was enacted,” O’Drobinak further explained.
He said the letter sent to President Obama contains specific short term potential solutions the Coalition supports, which can be executed without the need of Congressional action, by the Centers for Medicare and Medicaid Services and which tackle issues the Obama administration has previously supported.
“The Coalition is asking the President to act upon his previously stated beliefs and commitments; in particular by addressing key contents of the April 2013 HHS Report to the President’s Task Force on Puerto Rico Status, as well as the Task Force Report of March 2011,” O’Drobinak said.
“The Medicare program in Puerto Rico is the platform for short term economic solutions for the entire healthcare system with direct impact on benefits, beneficiaries and providers’ disposable income, as well as local government finances,” he said.
The solutions proposed in the Coalition’s letter to the President are not bail-out type measures; they are practical proposals for long-standing Medicare funding inequities that make the Medicare program fairer for the eligible US citizens that reside in Puerto Rico, O’Drobinak added.
“We respectfully request action at the Executive level, from the President’s Task Force and the leaders of HHS and CMS, to avoid more harm to the Medicare program in Puerto Rico and to over 700,000 beneficiaries residing in the island,” he said.In October 2009, President Barack Obama signed an executive order that instructed the Task Force on Puerto Rico to expand the responsibilities of the group that addresses issues related to job creation, education, health, renewable energy and economic development. (Credit: Wikipedia)
Cuts already hurt
The reductions are already being felt in the pockets of beneficiaries. For example, the poorest Medicare beneficiaries in Puerto Rico are paying almost $300 a year more for their benefits compared to the benefits available in 2010. Multiplied by more than 230,000 citizens participating in the Medicare Platinum program, the total impact to beneficiary pockets is close to $78 million in 2014, alone, according to the conclusions of an analysis performed by the members of the Coalition.
The Coalition also explained that the impact to beneficiaries is also being seen by decreased availability of physicians, including specialists, the consolidation of services and less available care options for beneficiaries on the island.
At present, Medicare Advantage base rates in Puerto Rico are the lowest in the U.S. and are now almost 30 percent below the next lowest state. In addition, Puerto Rico has also been excluded from the Part D Low Income Subsidy since 2006. It is estimated that Puerto Rico is losing more than $250 million in prescription drugs benefits per year because of the exclusion for residents in the territories.
“Many people do not know about these cuts, but you see it in the day to day lives of beneficiaries when they notice they have to pay more premiums and co-pays. Provider compensation is also impacted directly for Traditional Medicare, and there are increased economic pressures under the Medicare Advantage program cuts,” said Rolance Chavier, family physician, past president of the Puerto Rico Medical Association and currently delegate of the American Medical Association in the island.
“Beneficiaries in Puerto Rico pay the same Medicare Tax and the same Part B premium as any beneficiary residing in the mainland. We need action from the Federal government to mitigate these inequities and stop the widening disparity in benefits just because the person lives in Puerto Rico,” Chavier said.
The Puerto Rico Medicare Coalition for Fairness was founded in October 2013 to support specific policy changes proposed to Congress due to the increasing cuts to the Part D and Medicare Advantage programs. Its members include: Community Pharmacies Association of Puerto Rico; Medicaid and Medicare Advantage Association of Puerto Rico; the Puerto Rico Hospital Association; AARP of Puerto Rico; Public Health Association of Puerto Rico; Primary Health Association of Puerto Rico; Health Administrators Association of Puerto Rico; Clinical Laboratories Association; Pharmaceutical Industry Association of Puerto Rico; Ponce School of Medicine; IPA Association of Puerto Rico; and Medical Association of Puerto Rico, among others.