When it comes to federal healthcare spending, the debate has lately focused on whether to expand coverage by increasing spending or save money by reducing coverage. Puerto Rico can change that equation for policymakers on Capitol Hill. The Island is actually requesting the federal government to save taxpayers close to $30 billion between now and 2025. Keeping the same amount of current federal Medicaid spending in Puerto Rico would not only save states and the federal government money, but would also prevent close to 500,000 Puerto Ricans from losing health insurance. The reason is simple, healthcare costs are three to four times more expensive in the states than in Puerto Rico. Since the island’s residents are U.S. citizens, they are just a plane-ride away from receiving full healthcare benefits that they do not enjoy in the Island.

How did we come to this point? Puerto Rico already faces an arbitrary cap on Medicaid funding which is much lower than what states receive. Making matters worse, the island now faces a daunting situation called the Medicaid cliff. The Affordable Care Act (ACA) set this ticking fiscal time-bomb where at the end of 2017, Puerto Rico would lose $1.2 billion a year in Medicaid funding. After that reduction takes place, Puerto Rico’s already fragile budget will have to absorb those costs or leave half a million of its fellow citizens without health coverage.


The problem is that Puerto Rico is in its worst fiscal crisis in modern history, and it is actually reducing health spending in order to balance its budget and meet is obligation to its creditors. If Congress does not act before the Island’s budget is approved on June 30, the Centers for Medicare and Medicaid Services (CMS) will not have time to approve the new contracts with health providers in Puerto Rico, and the budget deficit will take a sharp increase. 

The solution is for Congress to include bridge funding in the upcoming omnibus spending bill to ensure Puerto Rico receives at least the same amount of Medicaid dollars it receives today. Policymakers should also work with the Island on a more sustainable solution in the medium to long-run. By spending a modest amount now, Congress will be saving states and the federal government tens of billions of dollars should our island go over the Medicaid cliff.

If nothing happens soon, everybody loses. Not only will the Puerto Rican economy lose, but the mass migration that has already seen the flight of 384,594 Puerto Ricans in the last four years alone, will continue. Migrant Puerto Ricans on Medicaid are projected to cost Florida $6.3 billion, Texas $1.6 billion, and $26.3 billion total for all states by 2025 if this problem isn’t solved now. Therefore, the fiscally responsible path forward is for the federal government to provide funding for Puerto Rico now, before it is forced to spend up to four times more in the states.

When it comes to Puerto Rico issues, members of Congress have told Puerto Ricans time and again to come to an agreement amongst ourselves before we come to Capitol Hill. I am happy to report that equitable treatment under federal healthcare programs is a bipartisan effort in the Island and in the mainland. In fact, I am proud to say that my colleagues in the Puerto Rico Senate passed a resolution on a bipartisan basis asking Congress for justice in federal healthcare programs for Puerto Rico. In Congress, we have Democratic and Republican allies, in both the House and Senate, who understand the need to act now to avoid a fiscal and humanitarian calamity later.

The choice is clear. Congress needs to prevent the Puerto Rico Medicaid cliff now. In so doing, the federal government will save taxpayers billions of dollars, while also protecting the health coverage of 500,000 U.S. citizens. That is the morally correct and fiscally sound course of action to take. There is no excuse for inaction.

Ríos is the Puerto Rico Senate Majority Leader, representing the New Progressive Party of Puerto Rico (NPP), and is also the Vice President of the National Hispanic Caucus of State Legislators (NHCSL).

The views expressed by this author are their own and are not the views of The Hill.

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Congress can save taxpayer money by avoiding Medicaid cliff in Puerto Rico