The Puerto Rican flag flies near the island's Capitol building in San Juan. With another debt deadline looming, health care has become an important issue to be addressed, especially for Puerto Ricans enrolled in Medicare or Medicaid.
The Puerto Rican flag flies near the island's Capitol building in San Juan. With another debt deadline looming, health care has become an important issue to be addressed, especially for Puerto Ricans enrolled in Medicare or Medicaid. - 
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Tuesday marks the latest deadline for cash-strapped Puerto Rico. The group in charge of putting together a comprehensive plan to restructure Puerto Rico’s debt has been told to deliver the plan to the governor by Tuesday. But given Puerto Rico’s inability to reach other deadlines, many experts say they wouldn’t be surprised if the deadline was pushed back again.

But as nearly half of the island’s residents are enrolled in Medicare or Medicaid, healthcare is one item in the debt restructuring plan that might need more immediate action. 

Rafael Cox Alomar, a law professor at the University of the District of Columbia, says the Clinton administration abolished a tax break that had, for years, brought investment to the island. Many pharmaceutical and medical supply businesses subsequently moved to the mainland.

Puerto Rico's lack of competitiveness harps "back to the Clinton years, and the mismanagement and lack of commitment and strategy that administration showed in its dealings with Puerto Rico," he says. "It’s sad to say, but it’s the truth.”

People have steadily been leaving Puerto Rico for the mainland since the 1990s, and the island is on track to lose another half million people by 2050. Dr. David Lenihan, president and CEO of Puerto Rico's Ponce Health Sciences University, says Puerto Ricans who decide to stay may or may not have access to healthcare.

“We’re kinda screwed," he says. "Because it’s not like living on the mainland, where if you’re on Medicare or Medicaid, your doctor just bills the federal government. We don’t have that right. The government has said, 'You’re a territory so you don’t have the right to do it.' So what happens is, the government gives a block grant down to PR and if you spend it all, you can’t go get more money.”

That could leave patients without access to healthcare. Senators introduced legislation last month to eliminate that cap on the grant for Puerto Rico’s Medicaid. Professor Charles Venator Santiago, a professor of political science at the University of Connecticut says, if adopted, it would treat the territory more like a state.

“There would have to be local reforms in the island, because the public healthcare system we have there is fairly corrupt," he says. "There has to be a lot more accountability, and it can be done. It can be done quickly if the federal government would move forward, but I don’t see that impetus right now."

There’s no hard deadline for restructuring Puerto Rico’s healthcare funding issues, but it’s inseparable from its larger debt problem and demands a solution. For one thing, if funding for Medicare and Medicaid runs out, the island’s residents don’t have the safety net of the Affordable Care Act.

 

Follow Andy Uhler at @AU_Marketplace