[Congressional Record (Bound Edition), Volume 155 (2009), Part 10]
[Extensions of Remarks]
[Pages 13883-13884]
[From the U.S. Government Publishing Office, www.gpo.gov]




   INTRODUCTION OF H.R. 2680, THE ``TERRITORIAL HEALTH PARITY ACT OF 
                                 2009''

                                 ______
                                 

                       HON. MADELEINE Z. BORDALLO

                                of guam

                    in the house of representatives

                        Wednesday, June 3, 2009

  Ms. BORDALLO. Madam Speaker, today I have introduced a bill, H.R. 
2680, to amend the Social Security Act to provide for parity in the 
Medicaid program for Puerto Rico, the U.S. Virgin Islands, Guam, the 
Commonwealth of the Northern Mariana Islands (CNMI), and American 
Samoa. This bill, entitled the ``Territorial Health Parity Act of 
2009,'' would amend the Social Security Act to eliminate the federal 
funding caps now in place and to strike the statutorily set Federal 
Medicaid Assistance Percentage (FMAP) of 50% that currently applies to 
all the territories. This bill would ensure that each of the 
territories, like each of the 50 states, receives an FMAP that 
accurately reflects its economic conditions and demographics. In 
addition, because certain data

[[Page 13884]]

 needed to determine the true FMAP rates for the territories is 
presently lacking from the Bureau of Economic Analysis (BEA), this bill 
would direct the Secretary of the Department of Health and Human 
Services to take steps to ensure that the FMAP rates for the 
territories are calculated in a fair and appropriate manner.
  It is clear from all the evidence that the federal funding caps and 
the FMAP set in statute at 50% (which applies solely to the 
territories) have created significant health disparities between 
residents of the territories and their fellow citizens residing in the 
50 states. Additionally, this policy has resulted in the territorial 
governments shouldering a disproportionately high financial liability 
when it comes to providing health care services to their indigent 
populations. Treating the territories in such fashion is as unjust in 
principle as it is harmful in effect.
  The bill I have introduced today, along with my colleagues from the 
territories, is needed as Congress continues the debate over 
comprehensive health care reform. Based on a report released last year 
by the Office of Insular Affairs, within the Department of the 
Interior, the territories' health jurisdictions are ``at the crossroads 
of a total breakdown.'' Combined with the financial state of the 
territorial governments, operating under decreasing revenues due to an 
economic downturn, the territories must bear a majority of the payment 
for indigent care under the current arrangements. Accordingly, 
eliminating the funding caps and adjusting the FMAPs for the 
territories are both critically important to public health in these 
U.S. jurisdictions.
  Additionally there is a provision in this bill that extends the 
Medicaid program to the citizens of the Freely Associated States (FAS), 
which is comprised of the Federated States of Micronesia (FSM), the 
Republic of the Marshall Islands (RMI) and the Republic of Palau (RoP). 
The FAS governments have special relationships with the United States, 
as they entered into Compacts of Free Association that have been 
approved by the Congress of the United States. One component of these 
international, federally-negotiated agreements, allows for the 
unrestricted entry of citizens of the FAS to the United States, 
including the territories, without visas. Many FAS citizens have 
settled in the Pacific territories of Guam and the Commonwealth of the 
Northern Mariana Islands. They also constitute a significant and 
growing presence in the states of Hawaii and Arkansas. This section of 
the bill is important as it extends federal Medicaid coverage to them 
and would set an FMAP for otherwise qualified services rendered by the 
states and territories to them at 100%. This change in law would ensure 
that the territorial and state governments do not shoulder the sole 
costs of providing care for these citizens. I believe that this 
provision is consistent with the intent of the Medicaid program and 
provides for health equity to a disenfranchised population.
  This bill represents policy for which I and my colleagues from the 
territories--Mr. Pierluisi of Puerto Rico, Mrs. Christensen of the 
Virgin Islands, Mr. Sablan of the Northern Mariana Islands, and Mr. 
Faleomavaega of American Samoa--have collaborated. We are grateful for 
the support that we have received from Mr. Serrano, who joins us as an 
original co-sponsor. Each of us and our predecessors has worked on 
improving the federal Medicaid program for the territories. This bill 
is to serve as starting point for advancing parity in treatment for the 
territories, with respect to the national health care reform debate. 
There are other areas of federal law that need to be amended in order 
to improve public health in the territories and to bring full parity. 
These include, for example, amendments to law governing Medicare Part D 
and the Supplemental Security Income Program (SSI). We look forward to 
working with the leaders in the House of Representatives and the 
Senate, and the Chairmen and Ranking Members of the committees of 
jurisdiction in both chambers in advancing legislation addressing these 
issues, including the bill we have introduced today.

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