[Congressional Record (Bound Edition), Volume 157 (2011), Part 8]
[House]
[Pages 11005-11006]
[From the U.S. Government Publishing Office, www.gpo.gov]




HEALTH CARE IN PUERTO RICO: HISTORIC PROGRESS AND CONTINUING CHALLENGES

  The SPEAKER pro tempore. The Chair recognizes the gentleman from 
Puerto Rico (Mr. Pierluisi) for 5 minutes.
  Mr. PIERLUISI. Madam Speaker, I rise this morning to discuss the 
issue of Federal support for health care in Puerto Rico and the other 
U.S. territories. This is a story of unprecedented progress, but it is 
also a chronicle of continuing challenges.
  While the treatment of the territories under Federal health care 
programs has substantially improved in recent years, serious 
disparities still remain. The consequence of these inequalities is not 
difficult to discern.
  Last month, a study found that patients at hospitals in the 
territories

[[Page 11006]]

fared significantly worse than patients at hospitals in the States. The 
study cited funding disparities under Medicaid and Medicare along with 
the territories' lack of voting representation in the Federal 
Government as likely causes for these discrepancies. The study 
concluded that ``eliminating the substantial quality gap in the U.S. 
territories should be a national priority.''
  Consider Medicaid, which helps our most vulnerable citizens. Medicaid 
has always operated differently in the territories. The Federal 
Government pays at least 50 percent of the program's cost in the 
wealthiest States and upwards of 80 percent in the poorest States. By 
contrast, Federal law imposes an annual cap on funding in the 
territories. Historically, Puerto Rico's cut was so low that the 
Federal Government paid less than 20 percent of Medicaid costs on the 
island in any given year. Inadequate Federal funding has made it 
difficult for Puerto Rico to provide quality health care to its low-
income population.
  If the purpose of this policy was to save the Federal Government 
money, it was shortsighted. Between 2005 and 2009, over 300,000 Puerto 
Rican residents moved to the States. Many were men and women of limited 
means who, upon migrating, immediately became eligible for full 
benefits under Medicaid and other Federal programs.
  Last Congress, my fellow Delegates and I fought hard to ensure that 
our constituents were treated in an equitable manner in the Affordable 
Health Care Act. Under the law, funding for Puerto Rico's Medicaid 
program will triple over the next decade. Though it is far less than 
Puerto Rico would receive if treated like a State, this increased 
funding does represent a significant step towards parity.
  But the Affordable Care Act did not eliminate serious disparities 
facing my constituents. For example, Puerto Rico is still subject to 
unequal treatment under Medicare. Although island residents pay the 
same payroll taxes as their fellow citizens in the States, ill-
conceived Federal formulas provide lower Medicaid reimbursements to 
Puerto Rico hospitals.
  Despite the pressing need to correct all these disparities, I know 
that to legislate effectively you must choose your battles wisely, 
especially in a fiscal climate as challenging as the one our country 
faces today. Therefore, I have introduced three health bills that would 
correct unprincipled inequalities and do so in a fiscally responsible 
way.
  The first bill amends the HITECH Act, which provides payments to 
doctors and hospitals that become users of electronic health records. 
The act inadvertently excluded Puerto Rico hospitals from the Medicare 
payments, and my budget-neutral bill would include them. My second 
bill, which has bipartisan support, would modify a unique Federal law 
that makes it more difficult for Puerto Rico seniors to enroll in 
Medicare part B and would reduce the penalties for late enrollment. And 
my third bill would make it possible for territory Medicaid programs to 
cover breast and cervical cancer treatments by placing Federal 
contributions for those services outside the annual cap.
  So I have filed these three cost-conscious bills to address some of 
these disparities we are facing, and I hope to have the support of my 
colleagues when the time comes to consider them.
  Now a word about the current state of affairs in Puerto Rico; after 
all, I represent Puerto Rico in this Congress. And if we're going to be 
talking about a crisis in Puerto Rico, I'll tell you about a crisis in 
Puerto Rico. It is the high incidence of violent crime that is tied to 
the drug trafficking that is happening in the Caribbean. And I, for 
one, am doing something productive. I am seeking additional resources 
because it is in the interest of both the United States as a country, 
as a whole, and Puerto Rico to increase the presence of Federal law 
enforcement officers in Puerto Rico.
  While I want civil rights to be protected all over America, what I am 
doing is supporting the ongoing investigation of the Department of 
Justice. But I am not denigrating the integrity of those who put their 
lives at risk to defend the safety of our citizenry.

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