[Congressional Record (Bound Edition), Volume 161 (2015), Part 3]
[House]
[Page 3780]
[From the U.S. Government Publishing Office, www.gpo.gov]




 PUERTO RICO HOSPITAL MEDICARE REIMBURSEMENT EQUITY ACT AND THE PUERTO 
                    RICO MEDICARE PART B EQUITY ACT

  The SPEAKER pro tempore. The Chair recognizes the gentleman from 
Puerto Rico (Mr. Pierluisi) for 5 minutes.
  Mr. PIERLUISI. Mr. Speaker, today I am refiling two bills to 
eliminate disparities that Puerto Rico faces under the Federal Medicare 
program.
  At the outset, I want to make clear that the only reason that I have 
to introduce these bills is because Puerto Rico is a U.S. territory. I 
look forward to the day when Puerto Rico becomes a U.S. State, when it 
is automatically treated fairly under Federal programs, and when the 
island's elected officials no longer need to implore Congress to treat 
our constituents the same as their fellow American citizens. That is 
why, 6 weeks ago, I introduced legislation that would provide for 
Puerto Rico's admission as a State once a majority of island voters 
affirm their desire for statehood in a federally sponsored vote. The 
bill already has 80 cosponsors and strong bipartisan support.
  The first bill I am filing today involves Medicare part A, which 
covers inpatient hospital services. The Federal Government reimburses 
hospitals who admit Medicare patients under a system known as the 
inpatient prospective payment system. The payment made to the hospital 
is intended to cover the operating and capital costs that a hospital 
incurs in furnishing care. Each hospital is paid a base rate, which can 
then be adjusted upwards based on a variety of factors.

                              {time}  1030

  Every hospital in the States, whether in New York City or rural 
Alaska, is paid the same base rate, about $5,870. In Puerto Rico, 
however, hospitals are paid a base rate that is just over $5,000, about 
14 percent lower than the base rate for stateside hospitals.
  This adversely affects patient care in Puerto Rico and the financial 
stability of island hospitals. The American Hospital Association has 
endorsed my legislation to eliminate this unprincipled disparity, and I 
urge my colleagues in Congress to enact it into law.
  The second bill I am filing today involves Medicare part B, which 
covers doctors' services and outpatient hospital services. Puerto Rico 
is the only U.S. jurisdiction where individuals who become eligible for 
part A are not automatically enrolled in part B, but rather must opt in 
to receive part B coverage.
  Individuals who do not enroll in part B during the 7-month initial 
enrollment period, which begins several months before they turn 65 and 
ends several months after they turn 65, are required to pay a late 
enrollment penalty. The penalty is significant and lasts for as long as 
that individual receives Medicare.
  This system has operated to Puerto Rico's detriment. There are tens 
of thousands of seniors on the island who enrolled late in part B, and 
each year, they pay millions of dollars in late penalties to the 
Federal Government.
  There are also over 100,000 seniors in Puerto Rico who are enrolled 
in part A but not in part B. When those individuals seek to enroll in 
part B in the future, they, too, will be required to pay lifetime 
penalties.
  I am working to address this issue on both the administrative and the 
legislative front. I persuaded the Federal Government to improve the 
written materials they make available to island seniors so that they 
are better informed about the part B enrollment period and the 
financial consequences of late enrollment.
  In addition, I am refiling legislation today that would convert 
Puerto Rico from the Nation's only opt-in jurisdiction to an opt-out 
jurisdiction, just like every other U.S. State and territory.
  My bill would also reduce the late penalties now being paid by Puerto 
Rico seniors who enrolled late and authorize a special enrollment 
period during which island seniors who do not have part B could enroll 
on favorable terms.
  I urge my colleagues to support the bills I am filing today. Until 
the day that Puerto Rico becomes a State and is treated equally as a 
matter of course, I will continue to fight for fair treatment for my 
constituents under all Federal health programs.
  The 3.5 million American citizens of Puerto Rico deserve no less.

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