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Friday, March 9, 2012

Pierluisi Expresses Commitment to Address Medicare Inequalities in Puerto Rico

In a taped message delivered at the 2012 Puerto Rico Medicare and Medicaid Symposium, Resident Commissioner Pedro Pierluisi detailed the steps that have been taken in the last several years to improve Puerto Rico’s treatment under Medicaid and reaffirmed his commitment to seek more equitable treatment for Island residents under Medicare.

With respect to Medicaid, the Resident Commissioner noted that, under the 2009 American Recovery and Reinvestment Act and the 2010 Affordable Care Act, federal funding for Puerto Rico’s Mi Salud program will essentially triple this decade.

“Most of you have probably heard me describe the efforts that Governor Luis Fortuño and I—working side-by-side with so many of you—took to ensure that Puerto Rico was treated in an equitable manner under the Affordable Care Act. As I always underscore, while the final result was historic for Puerto Rico, it was not inevitable. To the contrary: we had to struggle for every dollar we got,” said Pierluisi in his taped message.

In his remarks, the Resident Commissioner noted that “although much has been accomplished on the health care front, much work—as always—remains to be done.” In particular, he described the various disparities that Puerto Rico confronts under Medicare and what he is doing to address those inequalities.

First, Puerto Rico is the only U.S. jurisdiction where individuals who become eligible for Medicare Part A must take affirmative steps to opt in to Part B. As a result, about 53,000 individuals have opted in to Part B after the seven-month enrollment period and are therefore paying a lifetime penalty. In total, these seniors—most of whom are individuals of limited means—are paying over $7 million dollars per year in late enrollment fees to the federal government. In addition, there are over 100,000 eligible Puerto Rico seniors who are not enrolled in Part B at all. If they enroll in the future, they too will have to pay a late penalty.

The Resident Commissioner noted that he has sought to address this issue on both the administrative and the legislative front. Working with Senator Charles Schumer of New York, he has successfully persuaded the federal government to improve the written materials they make available to Island seniors, so that they are better informed about the enrollment period and the financial consequences of late enrollment. In addition, Pierluisi has introduced legislation that would convert Puerto Rico from the nation’s only opt-in jurisdiction to an opt-out jurisdiction just like everywhere else. This bill would also reduce the late penalties now being paid by Puerto Rico seniors who enrolled late and would authorize a special enrollment period during which Island seniors who do not have Part B could enroll on favorable terms.

A second Medicare-related fight that the Resident Commissioner is waging involves the HITECH Act, which provides bonus payments under both Medicare and Medicaid to hospitals and doctors that become meaningful users of electronic health records. The bill excluded Puerto Rico hospitals from the Medicare payments, but included the Island in all other components. The Resident Commissioner has introduced legislation to rectify this oversight, and Senator Bob Menendez of New Jersey has introduced companion legislation.

Most recently, Pierluisi reintroduced legislation to improve the way that Puerto Rico hospitals are reimbursed under Medicare. Under current law, Puerto Rico hospitals receive a lower base rate than hospitals in the 50 states. The base rate is intended to cover a hospital’s operating and capital costs. Every hospital in the states receives the same base rate, regardless of where the hospital is located. But Puerto Rico hospitals receive a blended rate that is 13 percent lower than the base rate in the states.

“Puerto Rico hospitals—and the patients they serve—deserve nothing less than full equality,” said Pierluisi.

Finally, Pierluisi outlined the efforts he has made to ensure that Medicare Advantage plans in Puerto Rico are fairly reimbursed by the federal government so that they can continue to provide high-quality care to Island seniors. Puerto Rico’s MA penetration rate is the highest in the nation by a substantial margin, with nearly 480,000 of the Island’s 690,000 Medicare beneficiaries enrolled in an MA plan.