Puerto Rico’s health care challenge: proving results
The “Big Beautiful Bill” represents just one piece of a sweeping federal health care transformation. Massive cuts to the Department of Health and Human Services, combined with a new presidential budget, funding clawbacks, myriad executive orders, and Centers for Medicare and Medicaid Services regulations, aim to fundamentally reshape health care policy.
The administration’s “Make America Healthy Again” philosophy assumes prevention-focused systems and initiatives to eliminate “fraud, waste and abuse” can justify reduced funding.
For Puerto Rico, this shift creates both unprecedented risk and unexpected opportunity — but only if we can prove our health care investments make our population healthier.
The biggest threat to Puerto Rico’s health care isn’t only federal cuts — it’s also our track record with federal investment. As we approach crucial 2027 funding negotiations, this outcome gap matters more than any current policy debate. It threatens our health care future.
The numbers tell an uncomfortable story. In 2010, 12% of Puerto Rico’s population had diabetes. Today, that figure is 19%. Despite massive increases in federal health care investment, our health outcomes have deteriorated. When federal policymakers see these results, they don’t see a territory deserving more funding — they see a poor return on investment.
The recent federal policy moves reflect a broader shift in Washington’s approach to health care spending. Policymakers increasingly demand measurable results for taxpayer investment. Puerto Rico’s exclusion from a new $50 billion rural hospital fund wasn’t coincidental — it signals federal decision-makers’ view of our track record.
This perception problem transcends partisan politics. Whether Democrats or Republicans control Congress during upcoming negotiations over Medicaid funding, the fundamental question remains: Why should federal taxpayers continue investing in a health care system that shows declining results despite increased funding?
The answer isn’t just more passionate advocacy. It’s also demonstrating that we can deliver measurable health improvements when properly supported.
Some Puerto Rico health care initiatives already prove this is possible. Hospital General de Castañer’s Optimizing Virtual Care program, funded by a $2 million federal investment, achieved measurable results: a 5% improvement in diabetes control, similar gains in hypertension management and a 72% reduction in unnecessary hospitalizations among the sickest patients.
This success came through integrated care that combined telemedicine technology with community health workers addressing social determinants of health. Instead of simply treating diabetes complications, the program prevented them — improving lives while reducing costs.
These results matter because they demonstrate something federal policymakers desperately need: proof that health care investment can improve population health while reducing long-term costs.
Puerto Rico has already shown this capacity through significant improvements and recognition in clinical care quality at its Federally Qualified Health Centers and Medicare Advantage plans that have earned prestigious five-star ratings from CMS. We possess the expertise to deliver excellent health care outcomes — our challenge is scaling these pockets of excellence across the entire system to create population-level health improvements.
As Puerto Rico prepares for the crucial 2027 Medicaid negotiations, we must shift from simply requesting funding continuation to proposing measurable health improvement targets tied to federal investment. This requires fundamental changes in how we approach health care delivery.
We need systematic implementation of proven prevention models across the island. We must prioritize integrated care that addresses why people get sick, not just treating them after they do. Most importantly, we need robust data collection proving that federal investment translates into healthier communities.
The health care workforce crisis — with 50% of specialist physicians considering leaving Puerto Rico and burnout rates exceeding 80% among doctors and 90% among nurses — demands immediate attention. But addressing workforce issues without simultaneously improving health outcomes won’t satisfy federal scrutiny.
The path forward requires acknowledging an uncomfortable truth: We haven’t been able to maximize previous federal investments. But this recognition creates opportunity. Puerto Rico can position itself as a health care innovation laboratory demonstrating how targeted federal investment creates measurable population health improvements.
Federal policymakers need solutions to America’s health care cost crisis. We can provide those solutions by proving that prevention-focused, community-based care models work. Success requires moving beyond defensive advocacy to proactive demonstration of results.
The “Big Beautiful Bill” represents just one element of changing federal health care policy. Puerto Rico’s response must address the broader accountability challenge we face. We have little time before 2027 to prove that investing in Puerto Rico’s health care system delivers results worth continued federal support.
The choice is clear: Continue requesting funding based on need or start earning it through demonstrated success.
María Fernanda Levis is CEO of Impactivo and a consultant for health centers, hospitals, pharmaceutical companies, insurance companies, nonprofits and governments in New York, Washington, D.C., and Puerto Rico on issues related to health systems transformation, patient-centered approaches, health policy and financing.
She holds master’s degrees in public administration and public health from Harvard University. She is also a National Committee for Quality Assurance Patient-Centered Medical Home Certified Content Expert and a Robert Wood Johnson Foundation fellow.
