John Rawls in his influential book A Theory of Justice states that in a just society, among other things, social and economic inequalities should be arranged so they work for the greatest benefit of the least advantaged. Ironically, the way the Medicaid program operates in Puerto Rico appears to have been expressly designed to violate this principle.In general, Medicaid is financed partly by each state and partly by the Federal government and the relative shares are determined by a statutory formula that gives significant weight to poverty rates — the poorer the state the larger the Federal share.ADVERTISEMENTIn Puerto Rico the Federal share is set at 50% of the cost of the program, which is the Federal rate set for the wealthiest states and, in addition, the law sets a very low cap on the total amount of the Federal contribution to Puerto Rico.The perverse result is that one …
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Medicaid fairness for Puerto Rico