Puerto Rico presses Congress to prevent ‘Medicaid cliff’

Puerto Rico Gov. Pedro Pierluisi (D) said Thursday that a looming “Medicaid cliff” and a slew of political and economic challenges all come back to the island’s status as a U.S. territory.

The debate over status will remain at the core of the island’s politics indefinitely, he said, unless Puerto Rico becomes a state or a sovereign nation.

“Whenever I’m told about prioritizing, I say the status issue permeates everything else. It is an existential issue. You always have to deal with this issue until you resolve it,” Pierluisi told The Hill in an interview.

“When you look at what the resident commissioner needs to do, or I end up doing as well as governor, [it] is consistently claiming for equal treatment as fellow American citizens,” said Pierluisi, an adamant supporter of statehood for Puerto Rico.

The latest issue to shine a spotlight on the deficiencies of the territorial arrangement with the U.S. is the allocation of Medicaid resources to the island’s more than 3 million residents.

Both Pierluisi and Resident Commissioner Jenniffer González-Colón (R) spend considerable time lobbying Congress to change the way the federal government distributes Medicaid funding to Puerto Rico.

Unlike all 50 states and the District of Columbia, Puerto Rico is not guaranteed a certain percentage of Medicaid resources in the federal government’s annual budget. Instead, Congress determines Medicaid funding that in the past has lasted anywhere from two years to seven years.

Now, new funding is needed for fiscal 2022, which starts in October.

“I wouldn’t have to be dealing with this if we were a state. But I am because I have no choice,” said Pierluisi.

Puerto Rico’s periodic “Medicaid cliff” is rife with political tension, since a failure to secure funding would likely have catastrophic consequences for the island’s teetering health care system.

The debate over future funding reached new levels last week when local daily El Nuevo Día published a story quoting Fiscal Control Board Executive Director Natalie Jaresko saying the territory needed “fair” treatment rather than “parity” when it comes to Medicaid.

House Natural Resources Committee Chairman Raúl Grijalva (D-Ariz.), whose committee has certain jurisdictional oversight of Puerto Rico, blasted Jaresko in a letter Wednesday, saying her comment, “however well meaning, only serves to make it possible for Congress to give Puerto Rico and the other territories half a loaf instead of full parity.”

Shortly after the El Nuevo Día story, Pierluisi called Jaresko’s remark “unacceptable” on Twitter and accused the Fiscal Control Board of “failing Puerto Rico” in advocating for the territory on Capitol Hill.

Pierluisi has somewhat softened his criticism of Jaresko but still argues that Puerto Rico needs predictability in federal funding to expand its Medicaid program.

“I always talk about equal treatment because that’s my mantra, that’s what I request all the time: Treat us equally as American citizens,” he said.

“If we become technical when you talk about parity, you’re talking about something that is not permanent in nature. It’s basically, ‘Give us roughly the same amount of funding that a state gets for a specific period of time,'” Pierluisi added.

“When you talk about equal treatment it’s basically saying, ‘Hey, amend the enabling law or the statute that applies to the federal program involved and treat us exactly like a state.'”

Pierluisi’s vision of statehood rests on that idea — that the territory has the capacity to manage a transition period to amend its tax code and local laws over a period of time to achieve equal footing with the other states.

Many opponents of statehood — those who want to remain a territory or seek independence — have also sought a better deal for territories on Medicaid and other social services, regardless of their opposition to a permanent union between Puerto Rico and the United States.

“The irony of this all is you see proponents of the other options also asking for equal treatment or becoming mute when we request equal treatment. It’s doublespeak,” said Pierluisi.

“Either you join the union on equal footing or you part ways and request some assistance from the U.S., but you cannot have it both ways.”