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Saturday, August 4, 2012

Pierluisi Discusses the Positive Impact of the Affordable Care Act in Puerto Rico with Democratic Leader Nancy Pelosi

Resident Commissioner also cites health care challenges and disparities that the Island continues to confront

San Juan, Puerto Rico- Resident Commissioner Pedro Pierluisi today received in Puerto Rico for the second time the Democratic Leader of the U.S. House of Representatives, Nancy Pelosi, who played a critical role in securing passage of the 2010 Affordable Care Act and in ensuring that Puerto Rico was treated equitably in that landmark legislation. Leader Pelosi and her Democratic colleagues are now combating efforts by Republicans in Washington to repeal the health care law.

“I want to welcome Leader Pelosi back to Puerto Rico. We are so privileged to have her here with us today,” said Pierluisi.

Resident Commissioner hosted an event this afternoon in order to brief Leader Pelosi on the positive impact that the Affordable Care Act is having in Puerto Rico, as well as on the health care challenges and disparities that the Island still faces. The presentation featured the Secretary of the Puerto Rico Department of Health, Dr. Lorenzo González; the Chief of Staff to Governor Luis Fortuño, Miguel Romero; the President of the Puerto Rico Hospital Association, Pedro González; and various other representatives from the health care industry and beneficiaries of the reform legislation.

“Everyone in this room should understand that we would not be here discussing the many positive steps that Puerto Rico is taking to improve health care on the Island were it not for our guest of honor. If Leader Pelosi had not fought so hard in 2009 and 2010, if she had followed the advice of the many naysayers who were urging her to scale back her aspirations when challenges to comprehensive health care reform emerged, if she had pursued the politically safe course of action rather than seeking the best policy outcome for the American people—the Affordable Care Act would never have become law. But in large part because of her efforts, and her refusal to give up or to give in, history was made. And Puerto Rico is part of that history,” said the Resident Commissioner.

Pierluisi explained that the Affordable Care Act dramatically increases federal funding for Puerto Rico’s Medicaid program, known as Mi Salud. Under the legislation, federal funding for Mi Salud will essentially triple over the next decade. Instead of receiving about $300 million a year, the Island now receives over $1 billion annually.

“The federal government pays a significant share of Medicaid’s cost in the states—and up to 80 percent in the poorest states. By contrast, federal law imposes a cap on funding to Puerto Rico. Historically, Puerto Rico’s cap was so low that the federal government paid under 20 percent of the program’s costs on the Island each year. This has made it difficult for Puerto Rico to provide quality health care to our most vulnerable residents. It has also required the Puerto Rico government to spend a tremendous amount of its own funds to compensate for the shortfall in federal dollars, which has caused damage to the Island’s fiscal health,” noted Pierluisi.

The Resident Commissioner reminded the audience that the first significant increase in federal funding for Puerto Rico’s Medicaid program was not provided by the Affordable Care Act, but rather by the February 2009 Recovery Act, known as ARRA.

"Early versions of ARRA proposed an increase in Puerto Rico’s Medicaid funding of 15 percent or less. Because of efforts, however, and with Leader Pelosi’s strong support, the final bill provided a 30 percent increase. This translated into over $230 million dollars in additional federal funding for Puerto Rico between 2009 and 2011. At the time, this was the largest increase in funding for health care in the Island’s history,” Pierluisi said.

The temporary funding infusion achieved in ARRA was later surpassed by the long-term gains realized in the Affordable Care Act.

In addition, the health care law has already saved Medicare beneficiaries in Puerto Rico $97.2 million in the cost of prescription drugs, with the average senior saving $642 a year.

At the same time, the Resident Commissioner recognized that, although much had been accomplished on the health care front, much work still remained to be done.

“First and foremost, we must continue to be vigilant in our efforts to preserve and protect the gains we achieved in the Affordable Care Act. In May, the Republican-controlled House voted to approve a budget reconciliation bill that would repeal every single penny of the new Medicaid funding that Puerto Rico and the other territories received under the Act, singling us out for unfair treatment. Let me absolutely clear: just as we fought to obtain this long-overdue and much-needed funding, we will fight to protect it from those who, in their zeal to cut spending, have abandoned any and all sense of perspective or justice,” he said.

In addition, the Affordable Care Act, for all of its positive features, did not mitigate a number of disparities that Puerto Rico faces under Medicare. “As Leader Pelosi knows, in Congress, as in life more generally, you win some battles and you lose some battles. But you live to fight another day. And you never stop fighting,” he said.

Currently pending before Congress are various bills introduced by Pierluisi to eliminate disparities that Puerto Rico faces under Medicare.

“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. About 53,000 Part B beneficiaries in Puerto Rico have opted in to Part B after the seven-month enrollment period and are therefore paying a lifetime penalty. All told, these beneficiaries—most of whom are senior citizens of limited means—are paying over $7 million dollars per year in late enrollment fees to the federal government. In addition, there are over 130,000 eligible Puerto Rico beneficiaries who are not enrolled in Part B at all. If and when they enroll in the future, they too will have to pay a late penalty,” the Resident Commissioner.

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. In addition, his bill would 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.

“Another Medicare-related fight I am waging involves the 2009 HITECH Act, which provides bonus payments under both Medicare and Medicaid to hospitals and doctors that become meaningful users of electronic health records, which improve patient care and reduce medical errors. Illogically, the bill excluded Puerto Rico hospitals from the Medicare bonus payments, but included the Island in all other components. With the strong support of the Puerto Rico Hospital Association, I introduced legislation in 2010, and again in 2011, to rectify this oversight,” Pierluisi said.

“Finally, I recently reintroduced legislation to improve the way that Puerto Rico hospitals are reimbursed under Medicare. Puerto Rico hospitals receive a lower base rate than hospitals in the 50 states. 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. I firmly believe that Puerto Rico hospitals—and the patients they serve—deserve nothing less than full equality,” the Resident Commissioner said.