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Seeking equality for U.S. citizens in Puerto Rico


April 28, 2005
Copyright © 2005 CARIBBEAN BUSINESS. All Rights Reserved.

It isn’t news that under the system of commonwealth government, U.S. citizens who reside in Puerto Rico don’t receive the same treatment as citizens who reside in the 50 states. U.S. citizens in Puerto Rico aren’t eligible for many programs, funding, or federal government assistance such as SSI benefits, which help the poor and disabled. In a special report entitled "What If" and published from August to October 2004, CARIBBEAN BUSINESS reported that if Puerto Rico was treated on an equal basis as the States, the island would receive over $35 billion a year, instead of the $14 billion received in fiscal 2003-2004.

One of the biggest myths in Puerto Rico’s politics is we don’t pay federal taxes on the island, and therefore we aren’t eligible for certain benefits or funds. While it’s true that with the exception of federal employees and a few others, we don’t pay federal income taxes in Puerto Rico; employees, employers, and the self-employed pay nearly $2.4 billion in Social Security taxes a year, under the full contribution formula based on income as do stateside citizens. Although we pay billions in Social Security taxes, equal to stateside citizens, Puerto Rico isn’t treated equally.

There are 600,000 Medicare and Medicaid recipients in Puerto Rico, U.S. citizens who aren’t receiving the same treatment nor have the same rights as the citizens under the U.S. Social Security program who reside in the 50 states. In U.S. territories, such as Puerto Rico, Medicare doesn’t cover all healthcare services, nor does it pay the entire cost of those services that are covered. The same occurs with Medicaid. Puerto Rico spends $1 billion a year on Medicaid recipients, but receives only $219 million from the U.S. Congress.

While island residents contribute to Social Security and Medicare in the same proportion as stateside residents, Puerto Rico hospitals only receive 75% reimbursement on Medicare services, while hospitals in the States receive 100%. As a result of the unequal treatment, island hospitals receive about $100 million less than they would if they were reimbursed at a 100% rate. These additional funds would help hospitals obtain state-of-the art equipment and improve their facilities. Getting 100% reimbursement would also contribute to better salaries for hospital and nursing staffs.

Resident Commissioner Luis Fortuño and the Director of the Puerto Rico Federal Affairs Administration Eduardo Bhatia have been lobbying Congress to obtain equality for the U.S. citizens residing in Puerto Rico. They are meeting with key members of Congress, senators, congressional staffers, and the secretary of the Department of Health & Human Services to advocate for equal treatment for the U.S. citizens residing in Puerto Rico. It’s important for the sake of Puerto Rico that Fortuño and Bhatia work together on this effort to obtain equality in Medicare and Medicaid and not let the political battles that have paralyzed the Commonwealth government on the island to influence them.

Our representatives in the U.S. Congress and Washington also need Puerto Rico’s support. The commonwealth government, Puerto Rico Hospital Association, and the private sector must lobby Congress aggressively, while island residents must learn everything possible on the subject and form coalitions with groups that can lend a helping and knowledgeable hand.

The Commonwealth government and the Puerto Rico Legislature must also lend their support to the Puerto Rico Hospital Association, as well as work with the American Hospital Association by establishing coalitions and joint strategies to spread the message of equal treatment under Medicare and Medicaid.

This won’t be an easy battle. The federal government’s budget deficits, projected deficits in Social Security and Medicare, and the war in Iraq are concerns that have the White House and Congress looking to cut spending and not to increase. The fact is Puerto Rico isn’t asking for more than its share of Medicare and Medicaid funds. We are simply asking to be treated the same as any other citizen of the U.S. If we achieve this, it can also be the first step toward getting equal treatment in other areas for Puerto Rico’s nearly 4 million U.S. citizens.

This Caribbean Business article appears courtesy of Casiano Communications.
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