[Congressional Record (Bound Edition), Volume 161 (2015), Part 5]
[House]
[Pages 6585-6586]
[From the U.S. Government Publishing Office, www.gpo.gov]




             THE APPROACHING MEDICAID CLIFF IN PUERTO RICO

  The SPEAKER pro tempore. The Chair recognizes the gentleman from

[[Page 6586]]

Puerto Rico (Mr. Pierluisi) for 5 minutes.
  Mr. PIERLUISI. Mr. Speaker, earlier this week, I sent a letter to 
President Obama regarding an approaching problem that is unique to 
Puerto Rico and the other U.S. territories and that can be called the 
Medicaid funding cliff. This morning, I rise to advise my colleagues 
about this cliff, which each territory will reach by 2019 and which 
Puerto Rico could reach by 2018 or even 2017.
  My goal is to ensure that Federal officials have advance notice of 
the problem so we can begin working together now on a fair, thoughtful, 
and bipartisan plan to address this problem before it arrives. Timely 
action is critical. Inaction would be unacceptable from a moral and 
public policy perspective.
  Let me outline the problem. The territories are treated unequally 
under Medicaid, which is funded in part by the Federal Government and 
in part by each State or territory government. In the States and D.C., 
Medicaid is an individual entitlement, meaning there is no limit on the 
amount of funding the Federal Government will provide so long as the 
State in question provides its share of matching funds. The Federal 
contribution, known as FMAP, can range from 50 percent in the case of 
the wealthiest States to 83 percent in the poorest States.
  By contrast, Mr. Speaker, there is an annual ceiling on Federal 
funding for the Medicaid program in each territory. When I took office 
in 2009, Puerto Rico--home to 3.5 million American citizens--was 
subject to a ceiling of $280 million a year and had the minimum 
statutory FMAP of 50 percent. Indeed, because of the annual ceiling, 
our true FMAP was less than 20 percent a year. Puerto Rico was spending 
more than $1.4 billion in territory funds each year to provide 
healthcare services to about 1.2 million low-income beneficiaries and 
receiving only $280 million from the Federal Government.
  To place this in context, consider Mississippi, which has a 73 
percent FMAP. In 2014, Mississippi--home to fewer people than Puerto 
Rico--paid $1.3 billion in State funds and received $3.6 billion in 
Federal funds. Or take Oregon with a 63 percent FMAP which paid $1.8 
billion in State funds and received $5 billion in Federal funds. Again, 
Puerto Rico was receiving just $280 million a year.
  The Affordable Care Act provided a total of $7.3 billion in 
additional Medicaid funding for the five territories, with Puerto Rico 
receiving $6.3 billion of that amount. Each territory's FMAP was also 
increased from 50 percent to 55 percent. The result is that, instead of 
receiving about $300 million a year from the Federal Government, Puerto 
Rico now draws down about $1.1 billion to $1.3 billion annually.
  That is a major increase, and I can not adequately express how hard 
we had to fight for it. But let me be clear. Our funding is nowhere 
close to State-like treatment and remains deeply inequitable.
  Moreover, Mr. Speaker, this additional Medicaid funding for the 
territories expires at the end of fiscal year 2019--the only coverage 
provision in the law that sunsets in this manner. The Puerto Rico 
Government has less than $3.6 billion of its $6.3 billion in funding 
remaining. This is the cliff. It is coming, one way or another; it is 
just a question of whether it will arrive in 2017, 2018, or 2019. If 
this pool of funding is not replenished, Puerto Rico will go back to 
receiving less than $400 million a year.
  In the coming months, I will continue to brief Federal officials on 
this subject. I will explain how inaction will deepen the current 
health, migration, and fiscal crisis in Puerto Rico, and why action is 
not only in Puerto Rico's interest, but also in the national interest. 
In short, I will fight as hard to continue this essential funding as I 
fought to obtain it in the first place.

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