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  • Writer's pictureRoberto Pando

Moral and economic duty with health




Roberto Pando 

President of the Medicaid and Medicare Advantage Products Association


Puerto Rico has been facing challenges for years to subsidize the health system that serves more than 3.2 million American citizens who reside on the island. It is urgent to take action in a situation that is worsening when we see that around 300,000 of the 650,000 people over 65 years of age enrolled in Medicare Advantage are dual eligible and also depend on Medicaid to receive health services.


Some 21 professional and health organizations understand the seriousness that, since the conception of Medicare in 1965, Puerto Rico has been given different and unequal treatment, despite the fact that American citizens reside here and contribute to the program. of Medicare since we entered the workforce through the compensation tax (FICA).


We have joined together in one voice to demand action from Congress and the federal Department of Health, to urgently request three concrete actions that can begin to correct the inequity in Medicare Advantage coverage for American citizens living in Puerto Rico.


An immediate solution is to equate the payment of premiums for the Medicare Advantage program on the island to the same level that is granted to the American Virgin Islands. Puerto Rico currently receives 21% less funds than that territory, and 39% less than what is assigned on average to the states.


The Centers for Medicaid and Medicare Services (CMS), which regulates these programs, is currently working on drafting the rules that will apply to both programs and that will go into effect in 2025. The new rules should raise the allocation premium payments that Puerto Rico currently receives from $672 to at least the same $847 that is granted to the Medicare Advantage program in the Virgin Islands. This level would keep Puerto Rico at a lower level than all states, but would guarantee a minimum of resources to support payment for medications, infrastructure and professional compensation at levels that are closer to the United States health market.


Puerto Rico reflects a trend of rapid aging of our population, above many states and countries. According to Federal Census data, in 2010, 11% of Puerto Rico's population was 65 years old or older and in 2020 this proportion has doubled to 22%.


Our elderly population also has high incidences of chronic diseases, such as cardiovascular conditions, cancer, Alzheimer's, diabetes, among other diseases that may be preventable. This means that we need more and better health services and support for the quality of life for the most vulnerable population in the country. The more than 650,000 Medicare Advantage beneficiaries depend on this program daily to keep their health in optimal conditions.


Our healthcare system relies heavily on federal funds to operate efficiently. For years we have managed to do more with less. For example, we pay for medicines at United States prices, but we have to do it with 40% less budget. As it is, the economic gap is too much and not correcting the economic structure of Medicare Advantage worsens the problem every year.


The Biden administration has stated its focus and priority on taking action to equity health programs across the United States. The federal government has a moral and fiduciary responsibility to its citizens on the island to urgently address this economic inequity in health funds. We urge President Biden's administration to put action behind these principles by providing Medicare Advantage beneficiaries in Puerto Rico with the necessary resources to guarantee the future of the program and its benefits in order to offer health services with the efficiency and quality that all citizens deserve, no matter where they reside.


“We have united in one voice to demand action from Congress and the federal Department of Health, to urgently request three concrete actions that can begin to correct the inequity in Medicare Advantage coverage”


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