Puerto Rico’s governor is ripping the Biden administration’s proposed Medicare overhaul, saying the poorly thought-out changes end up treating the island’s elderly US residents like second-class citizens.
Gov. Pedro Pierluisi claimed that the alterations to payments for services to the 640,000 Puerto Rican residents in the government’s Medicare Advantage program would amount to an $800 million loss for the US commonwealth.
The cuts would “further exacerbate the disparities by effectively imposing the largest federal healthcare funding cut in Puerto Rico’s history,” Pierluisi said in a scathing March 7 letter to federal Health and Human Services Secretary Xavier Becerra, a copy of which was obtained by The Post.
“A reduction of this magnitude would dramatically impact Puerto Rico’s entire healthcare system and economy. More importantly, it would seriously and directly affect the most vulnerable citizens in our society,” the governor said.
The US healthcare system pays insurers a flat fee for every person they sign up, plus extra money if the patient has certain medical issues. But the federal government found that some insurers were falsely ascribing conditions to scores of patients, thus increasing the companies’ bottom line at the expense of taxpayers.
So the White House plan is to have some of the particularly abused conditions, including mild depression and diabetes with complications, removed from the extra-payment list.
Unfortunately for economically disadvantaged regions such as Puerto Rico, a disproportionate number of residents have medical issues that are being eliminated, meaning free coverage drops, experts say.
“Given our beneficiaries on the Island have a disproportionately high prevalence of these conditions, the proposed revisions…. will lead to an evidently unintended, yet unduly negative impact in Puerto Rico compared to the average among the states,” Pierluisi said.
The governor also noted that many Puerto Rican seniors are enrolled in Medicare Advantage because they are ineligible for other Medicare services afforded to mainland residents in the states.
He complained that historically, the US has provided lower reimbursement rates to Puerto Rico for Medicare and Medicaid programs and that the latest changes in formulas worsen already existing disparities.
“I am deeply concerned that it is inconsistent with the Biden Administration’s proposals for a permanent fix to the already aggravating disparity in MA [Medicare Advantage] rates for the island,” the governor said.
Three of New York’s Congress members of Puerto Rican heritage — Reps. Alexandria Ocasio-Cortez (D-Bronx/Queens), Nydia Velazquez (D-Brooklyn, Queens, Manhattan) and Ritchie Torres (D-Bronx) — had no comment to The Post on Tuesday.
That infuriated some critics, who note that there are so many Puerto Ricans residing in New York City that the island is affectionately called the Big Apple’s “sixth borough.”
“Where’s Nydia Velázquez? Where’s AOC? People who care about Puerto Rico should be up in arms, but they’re nowhere,” raged a source close to New York’s Puerto Rican community.
HHS did not respond to a Post query about Pierluisi’s criticism regarding Medicare.
The Biden administration, in a statement released Friday, said the overhaul of funding formulas for Medicare Advantage were aimed at cracking down on rampant waste and fraud in the program and will eventually guarantee the solvency of the Medicare program.
“This year’s update strengthens Medicare for our seniors and Americans with disabilities,” Becerra said at the time.
“We are committed to ensuring private companies are holding up their end of the deal to provide quality care to beneficiaries and that payments to these companies are accurate. Together with President Biden’s Budget, this update protects Medicare for beneficiaries today and beyond 2050.”
In a press release, HHS said the Biden administration will start recovering improper payments made to insurance companies in Medicare Advantage.
HHS said it anticipates a payment increase for Medicare Advantage plans overall of 3.32% from 2023 to 2024, or a $13.8 billion increase.
Pierluisi is a member of the New Progressive Party, which supports US statehood for Puerto Rico.
He sought to soften the blow of his criticism in his letter by initially telling Becerra, “I know first-hand of your commitment to help Puerto Rico’s American citizens have access to adequate medical services, which has included increased funding to our Medicaid program.
“I applaud your steadfast support and know you are committed to executing President Biden’s plan to implement administrative fixes to enhance the longstanding and rapidly growing MA funding inequities for Puerto Rico, relative to the rest of the United States.”