[Congressional Record (Bound Edition), Volume 161 (2015), Part 6]
[House]
[Page 8504]
[From the U.S. Government Publishing Office, www.gpo.gov]




 IMPROVING TREATMENT OF U.S. TERRITORIES UNDER FEDERAL HEALTH PROGRAMS 
                                  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 introducing a comprehensive 
bill to improve the treatment of Puerto Rico and the other territories 
under Medicaid, traditional Medicare, and Medicare Advantage.
  This is the first time that a Member of Congress has filed 
legislation to address the range of challenges that patients, 
physicians, hospitals, and insurance providers in the territories face 
as a result of the unequal treatment the territories receive under 
Federal health programs.
  The bill serves as a blueprint for policymakers in identifying the 
various problems that exist under current Federal law and in proposing 
fair, realistic, and technically precise solutions to each problem.
  Based on my conversations with congressional leaders and officials in 
the Obama administration, I believe there is bipartisan recognition 
that Federal health laws do not do justice to American citizens living 
in the territories.
  I recognize that Republicans and Democrats have different opinions 
regarding the virtues of the Affordable Care Act, but it is my hope 
that policymakers can agree that it is in the national interest to take 
concrete steps to eliminate or reduce the numerous disparities that the 
territories confront under Medicaid and Medicare. These inequalities 
were enshrined in law long before 2010 and remain in place today.
  Stated simply, if the will exists among officials in the legislative 
and executive branches to improve the treatment of the territories 
under Federal health programs, as I believe it does, then my bill 
provides a way forward. After today, no Federal policymaker can say: I 
want to help, but I don't know how.
  Rather than summarizing the bill's 16 sections, I will highlight the 
provisions relating to Medicaid, the program for low-income 
individuals, which is jointly funded by the Federal Government and each 
State or territory government.
  In the States, there is no limit on Federal funding for Medicaid as 
long as the State provides its share of matching funds. The Federal 
contribution, known as an FMAP, can range from 50 percent for the 
wealthiest States to over 80 percent for the poorest States.
  By contrast, the funding that the Federal Government provides for 
Medicaid in each territory is capped. When I took office in 2009, 
Puerto Rico's cap was only $260 million a year, and the Federal 
Government was covering less than 20 percent of the cost of the 
territory's Medicaid Program.
  During my tenure, the Federal Government has increased Medicaid 
funding for the territories, but that funding remains capped. 
Especially in the case of Puerto Rico, it is still profoundly 
inequitable. Most problematic, this funding expires in 2019, and in 
Puerto Rico, it will be depleted well before then.
  This funding cliff is unique to the territories. The bill I am filing 
today would avert this cliff and provide a more stable and equitable 
level of Medicaid funding for the territories. Starting in fiscal year 
2017, the bill would provide the territories with State-like treatment 
within well-defined parameters.

                              {time}  1100

  Specifically, each territory's Medicaid program could cover 
individuals whose family income is at or below the Federal poverty 
level. As long as a territory covers individuals within these income 
limits, the Federal Government would fund the territory's Medicaid 
program as if it were a State Medicaid program. The annual funding caps 
would be eliminated, and each territory would receive an FMAP based on 
its per capita income. However, the limiting principle is that if a 
territory wants to cover individuals earning above the Federal poverty 
level, it will generally be required to use territory dollars, not 
Federal dollars.
  The rationale behind this new proposal is simple. Residents of the 
territories are American citizens. At the very least, the Federal 
Government should provide each territory with the funding necessary to 
provide health coverage to their residents who live at or below the 
Federal poverty level. Anything less is unacceptable from a moral and 
public policy standpoint.
  I invite my colleagues to support this comprehensive bill and to work 
with me to enact its provisions into law.

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