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Monday, April 25, 2012

Pierluisi Writes to Republican Leader of House Committee on Energy and Commerce Regarding His Proposal to Cut New Medicaid Funding for the U.S. Territories Provided Under the Affordable Care Act

San Juan, Puerto Rico- Resident Commissioner Pedro Pierluisi has written a letter to the Republican Chairman of the House Energy and Commerce Committee, Fred Upton, expressing strong opposition to a bill that Chairman Upton filed that would repeal the provision in the Affordable Care Act that mitigated the unequal treatment that residents of the territories have historically been subject to under Medicaid.

Although it is widely understood that this bill will not become law, the Resident Commissioner—joined by the delegates from the four other territories—urged Chairman Upton to reconsider his proposal, given the severe harm it would do to territory residents if implemented.

“As the representatives of the 4.1 million Americans residing in the five U.S. territories, we write to express our disappointment that you filed legislation that would repeal the provision in the Affordable Care Act that mitigated, but by no means ended, the unequal treatment that our constituents have long received under Medicaid,” read the letter written by Pierluisi and Donna Christensen (U.S. Virgin Islands), Madeleine Bordallo (Guam), Eni Faleomavaega (American Samoa), Gregorio “Kilili” Camacho Sablan (Commonwealth of the Northern Mariana Islands).

The proposal put forward by Chairman Upton comes in response to a directive in the Fiscal Year 2013 budget approved by the House last month that requires the Energy and Commerce Committee to submit legislation to reduce the deficit by $96.76 billion over the next decade. Pierluisi advised Chairman Upton that his proposal to cut the $6.3 billion in Medicaid funding authorized for use by the territories would “undo all of the progress that Congress recently made in providing more equitable treatment for the territories under Medicaid, and would send “a terrible message of exclusion to our constituents.”

The federal government pays at least 50 percent of the Medicaid program’s cost in each of the states and upwards of 80 percent in the poorest states. By contrast, federal law imposes an annual cap on funding in the territories. Historically, the territories’ caps were shockingly low. In Puerto Rico’s case, for example, the federal government typically paid less than 20 percent of total Medicaid program costs in any given year.

“As a result of chronic underfunding by the federal government, too many patients in the territories receive inadequate care, too many providers in the territories are not adequately compensated for their services, and too much of the financial burden associated with health care delivery must be borne by the territorial governments themselves,” said Pierluisi and the other delegates in their letter to Chairman Upton.

This disparity was mitigated in the Affordable Care Act as a result of the countless efforts undertaken by the Resident Commissioner, including a direct and personal appeal to President Obama at the White House several days before the final legislation was approved. Thanks to these efforts, the Affordable Care Act provided the territories with $6.3 billion in badly-needed Medicaid funding (including $5.4 billion for Puerto Rico) and $1 billion to establish a health care exchange (including $925 million for Puerto Rico).

“While we understand that you support repealing the ACA in its entirety, we also understand that you are in favor of replacing that landmark bill with another piece of legislation designed to improve health care services in this country. We would hope that you would have included in any such legislation a provision narrowing the gap between the treatment of the territories and the treatment of the states under Medicaid. Instead, with this bill, you have proposed to cut every single dollar of our new funding,” said the delegates in their letter to Upton.

The Resident Commissioner reiterated his pledge to continue his battle in Congress for equitable treatment for Puerto Rico under federal programs, and made clear that he would offer amendments in an effort to defeat Chairman Upton’s proposal.