[Congressional Record (Bound Edition), Volume 149 (2003), Part 10]
[House]
[Pages 13906-13907]
[From the U.S. Government Publishing Office, www.gpo.gov]




                            MEDICARE REFORM

  The SPEAKER pro tempore (Mr. Porter). Under a previous order of the 
House, the gentleman from Puerto Rico (Mr. Acevedo-Vila) is recognized 
for 5 minutes.
  Mr. ACEVEDO-VILA. Mr. Speaker, the Commonwealth of Puerto Rico like 
the majority of States is confronting a number of challenges as it 
strives to provide quality health care to its 4 million citizens. Our 
local government is committed to strengthening the health care system. 
In fact, the Commonwealth finances approximately 85 percent of the 
costs of Medicaid in Puerto Rico, a burden no other jurisdiction has 
and one that is becoming unbearable. For us to move forward, it is 
essential that the Federal Government be an active and strong partner 
in this endeavor. As Congress considers creating a prescription drug 
benefit as

[[Page 13907]]

well as enacting fundamental Medicare reform, I urge my colleagues to 
ensure that any Medicare legislation approved by Congress addresses the 
needs of the U.S. citizens living in Puerto Rico.
  Since its inception, Medicare has provided health care for seniors 
living in Puerto Rico. Mr. Speaker, we must not exclude now our 525,000 
seniors from any new basic health care coverage. Therefore, it is 
essential that beneficiaries living in the island have access to the 
same level of prescription drug coverage under the same terms and 
conditions as is offered to all others throughout the country. In 
addition, any Medicare prescription drug program must provide 
appropriate subsidies for low-income beneficiaries in Puerto Rico as in 
other all jurisdictions.
  Puerto Rico's workers and employers pay their full share of Social 
Security and Medicare payroll taxes to the Federal Government. 
Beneficiaries who live in the island are as much a part of Medicare as 
those living in Florida, California, or Nebraska. Limitations on the 
benefits of subsidies that have no foundation in health care policy but 
based on geographic location would undermine the social insurance 
nature of this vital programs and would fail the fundamental goal of 
providing uniform Medicare benefits to all.
  The second issue that I expect Congress to address in the Medicare 
reform bill is the payment to hospitals in Puerto Rico. While all U.S. 
hospitals receive 100 percent Federal reimbursement, hospitals in 
Puerto Rico only receive 50 percent through a special formula. No other 
jurisdiction receives this type of treatment under the Medicare system. 
As a result of this disparity, our hospitals operate under extreme 
financial constraints and some have even decided to withdraw from the 
program.
  Again, U.S. citizens in Puerto Rico pay the same Federal payroll 
taxes as any other jurisdiction. They deserve equity. Therefore, 
Medicare reimbursement to Puerto Rico hospitals should be equitable 
with all other U.S. jurisdictions' hospitals.
  Finally, I urge Congress to enact legislation to correct the great 
disparity that currently assists in Medicare payments to physicians in 
Puerto Rico. This is the same disparity that rural physicians across 
the country experience today. In fact, our physicians currently have 
the lowest geographic cost-of-practice index value in the entire United 
States despite the fact that the city of San Juan has the eighth 
highest cost of living in the United States. As a result, not only are 
our rural areas suffering; physicians in metropolitan areas such as San 
Juan are carrying a great burden when they treat Medicare patients.
  Mr. Speaker, doctors in Puerto Rico provide the same time and skill 
to patients, and they must be paid appropriately for their great, noble 
work.
  I would like to finish by thanking my colleagues in the House and 
Senate who have continuously supported us on resolving these critical 
issues to ensure that Medicare beneficiaries in Puerto Rico are 
afforded quality health care. They all realize that fairness is 
essential to quality health care, and that is as true in Puerto Rico as 
it is elsewhere in the United States.

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