On July 8, 2015 the speaker of the New York City Council, Melissa Mark Viverito, sent a letter to President Obama about healthcare funding in Puerto Rico:

July 8, 2015

Dear President Obama:

As you know, the Centers for Medicare and Medicaid Services (CMS) gave notice last month of its intention to proceed with a devastating 11% federal funding cut for Puerto Rico’s Medicare Advantage (MA) plans. We are shocked and outraged by this decision, especially given the bipartisan groundswell of opposition from Members of Congress, elected officials from Puerto Rico and many others who reached out to you, Secretary Burwell and CMS.

This decision is a blow to the entire Puerto Rican community. By moving forward with these cuts, the federal government has turned its back on 8.4 million Puerto Ricans — all of whom are U.S. Citizens: the 4.9 million Puerto Rican residents in the states and the 3.5 million Puerto Ricans on the Island.

What makes this announcement particularly appalling is that federal healthcare funding rates for Puerto Rico are lower than of the mainland states, even though Puerto Ricans who live on the Island pay the same Social Security and Medicare taxes as other Americans. Rather than experiencing a 3% increase in funding for Medicare Advantage like the mainland, Puerto Rico’s MA rates will now decrease about 11% compared with 2015 funding levels. Why is the healthcare of Puerto Rican’s worth less than that of other Americans?

Similarly, Puerto Rico’s Medicaid program low reimbursement rate is being temporarily supplemented by a federal grant that will soon expire. This program is already experiencing cash flow problems and, without intervention, the government of Puerto Rico will have to come up with $1.8 billion starting in 2018 or dramatically reduce the program.

Finally, Puerto Rico insurance companies are expected to pay for the Health Insurance Tax (HIT). This is a tax to pay for Affordable Care Act (ACA) programs including subsidies and exchanges, many of which do not exist in Puerto Rico.

In 2008, when you were campaigning for President, your campaign position papers acknowledged that Medicare levels for Puerto Rico were “insufficient” and you promised that you would “work closely with the government of Puerto Rico and Congress to strengthen the federal government’s investment in the health of the people of Puerto Rico.” Clearly, this promise has been broken. Puerto Rico’s healthcare system was already teetering before CMS went forward with these cuts and the consequences of this decision will be dire. Moreover, given that healthcare is more than 20% of the Island’s GDP these cuts will have devastating consequences for Puerto Rico’s already vulnerable economy.

We will continue to mobilize the entire Puerto Rican community and our many friends and allies to fight this outrageous discrimination against the people of Puerto Rico. The healthcare system of Puerto Rico cannot sustain this blow. We implore you to act now to address this injustice.



Speaker of New York City Council

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