The Puerto Rican healthcare crisis: 10 things to know

The healthcare system in Puerto Rico is "headed for an all-out crisis," though the roots of the issue date back several decades, according to The New York Times.

Here are 10 things to know about Puerto Rico's healthcare issues and where they stem from, according to The New York Times.

1. More than 60 percent of Puerto Ricans are on Medicare or Medicaid. About 1.6 million people, or 45 percent of the population, are enrolled in Medicaid, making Puerto Rico the top territory or state with the greatest share of its population enrolled in Medicaid.

2. The island also faces considerable issues in the delivery of healthcare and the health of its population. It has some of the highest rates of diabetes and asthma in the country. Meanwhile, it faces a severe shortage of nurses and specialists, and more than 3,000 physicians have left Puerto Rico in the last five years, seeking jobs in the mainland U.S.

3. Citizens of the territory pay Medicare and Social Security taxes, according to the report, but economists say there is a huge difference in federal funding to Puerto Rico for healthcare compared to mainland states, which has buried the island in debt. More than one-third of the island's debt — $25 billion — is due in part to the lack of federal funds for Medicaid, according to the report.

4. Congress capped federal Medicaid reimbursement to U.S. territories in 1968. Compared to U.S. states like Oklahoma and Mississippi, which received $3 billion and $3.6 billion respectively, Puerto Rico receives about $373 million annually from the federal government for Medicaid. The island pays the remaining $2.5 billion.

5. The island's Medicaid program could run out of grant funds by 2016, according to the report, which would cause the state to drop 900,000 residents off the program.

6. Additionally, Puerto Rico is facing major cuts to Medicare Advantage payments, which account for 75 percent of islanders with Medicare. Starting next year, Medicare Advantage plan payments will be cut 11 percent to make them more comparable to Medicare fee-for-service rates. This echoes cuts on the mainland U.S., though the cuts there are not as dramatic, according to the report.

7. Physicians on the island receive 60 percent of the average mainland rate for Medicare Advantage reimbursement and 40 percent of average mainland rates for Medicare, according to data from the Puerto Rico Health Care Coalition in the report.

8. Managed care companies are terminating several hundred physician contracts to narrow networks on the island and help manage revenue reductions.

9. Puerto Ricans do not, however, pay federal income taxes, so they are not eligible for health insurance subsidies. For this reason, the island has not launched its own health insurance exchange. It also cannot participate in the federal exchange.

10. Puerto Rican healthcare professionals told The New York Times that continued strain on the island's healthcare system could cause many residents to move to the mainland to seek care.


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