Unless Congress and the White House can agree on a funding fix for Medicaid in the U.S. territory, many worry that Puerto Rico’s health care system could collapse when stopgap funding ends next year.
San Jorge Children’s Hospital is Puerto Rico’s largest pediatric hospital, drawing patients from throughout the Caribbean. It’s a bustling facility in San Juan, with specialties in surgery, rheumatology and oncology. It also has brightly colored live parrots at every entrance.
“It just sends a message to the patient that they’re in a friendly place,” explains San Jorge’s vice president of operations, Domingo Cruz Vivaldi. “That they’re here to be treated, but they’re also going to have a good time.”
Still, as Cruz would be the first to say, right now is not a good time to be in the hospital business in Puerto Rico.
A nearly decade-long recession has taken a severe toll on the island’s economy. Half of San Jorge’s patients are on Medicaid now, up from a fifth just a few years ago. And, for decades, the U.S. government has capped Medicaid reimbursements in Puerto Rico at a level far below what states receive. Cruz says that cap has forced his hospital and many others to cut services — he’s had to close two wings and 40 rooms.
He only managed to avoid staff layoffs, he says, by freezing 100 open positions — doctors, nurses, technicians and support personnel. And last year, when Puerto Rico ran out of money and couldn’t make a $250 million payment to hospitals, San Jorge was forced to reduce hours and cut pay for all employees.
Since long before the advent of Obamacare, Puerto Rico has had a health care plan that covers nearly everyone on the island. Sergio Marxuach, public policy director for Puerto Rico’s Center for a New Economy, says it’s a generous plan, but has never been adequately funded.
“It has become, in a way, the third rail of Puerto Rican politics,” Marxuach says. “Nobody wants to touch benefits. Obviously it’s very politically sensitive. Low-income residents love it. So, it’s going to be very hard to modify unless we get additional Medicaid funding, or somehow get some sort of fix that we can do locally.”
The head of Puerto Rico’s Health Insurance Administration, Ricardo Rivera-Cardona, describes it in another way.