Addressing Medicare Abuses in Puerto Rico: Advocacy for Fair Healthcare Access

2023-07-05 22:45:30

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In a letter sent to congressmen, the Secretary of the Department of Health, Carlos Mellado López, asked to address the lack of jurisdiction that the Government of Puerto Rico has to supervise insurers under the Medicare Advantage contract and to be able to combat abuses of the program that affects the population of the island.

Also, that policies focused on reducing disparities in access to medical care be implemented.

“To put an end to arbitrary and unfair practices that undermine the trust of our patients and limit access to health services, we need legislative action and the support of the federal Secretary of Health, Xavier Becerra, to empower the regional office of Health Centers Medicare and Medicaid Services (CMS), the Department of Health and the Insurance Commissioner of Puerto Rico to effectively combat systemic abuses within the Medicare program to which they currently have no jurisdiction,” said Mellado, noting that he has the support of Nydia Velázquez and Raúl Grijalva, with whom he maintains a close collaboration. In addition, in previous meetings with the 27 congressmen, he has elaborated on the disparity in funds that the island receives and the unfair practices of insurers that affect the services that 93 percent of the population receives from Medicare.

The letter from the Secretary of Health is addressed to 27 congressmen, who were asked to increase “permanent” funding and close the coverage gaps in the federal health plan for US citizens residing on the island. Also, that they include Puerto Rico in the incentives related to poverty and adjust regional factors such as the Average Geographic Adjustment.

According to the doctor, Medicare Advantage rates were 24 percent below the national average in 2011, now they are 41 percent below the national average. 37 percent below the lowest state, Hawaii, and 22 percent below the next lowest jurisdiction, the US Virgin Islands.

Mellado also took advantage of the letter to insist that the Department of Health and Human Services (HHS) and CMS can develop specific policies that address the irregular and unfair practices that prevail in the Puerto Rico health system. , which directly contradicts the local government’s efforts to retain medical professionals on the island.

Currently, there are regarding 648,000 Medicare Advantage beneficiaries on the Island, representing 93% of Medicare beneficiaries eligible for Parts A and B. This represents the highest Medicare Advantage penetration in the nation. In addition, the Puerto Rico Medicaid Program provides health care coverage to approximately 298,000 people with dual eligibility (both Medicare and Medicaid).

“We are going to continue advocating in the federal capital until we achieve that our people have equal benefits as American citizens that we are. It is unsustainable that Puerto Rico is the only jurisdiction in which the local Medicaid program does not pay the $164.90 monthly premium for Medicare Part B for dual-eligible beneficiaries,” he added.

Currently, Puerto Rico is excluded from crucial health programs and benefits:

Lack of the Medicare Savings Program, which covers Part B costs for our impoverished patients and the elderly population. Disparity in the Medicare Advantage benchmark to correct for inequity and balance the impact of the risk scoring model change (2024-2026). Exclusion from the Medicare Part D Low Income Subsidy (LIS) program to help pay drug costs for low-income beneficiaries up to 150% FPL. Supplemental Security Income (SSI) exclusion, making Medicare Advantage even more important for low-income beneficiaries who receive help paying Part B premiums. Lack of Medicaid Savings Program (MSP) and Security Supplemental Security Income (SSI) which means that most low-income Medicare beneficiaries must use their Social Security payments to pay their Part B premiums.

In addition, he recalled that the prevalence of diabetes in Puerto Rico is 19.5%, compared to 10% in the continental United States. Likewise, 43% of our population suffers from hypertension, compared to 33% on the continent. The cost of living in Puerto Rico is high and more than half of our population lives below the federal poverty level.

This is another of Secretary Mellado’s initiatives to oversee federal programs such as Medicare Advantage and Medicaid and promote equality in these programs. In recent days, the Secretary and the Health Insurance Administration (ASES) sent notifications of fines to the four insurers of the Vital Plan for almost $300 million.

List of Congressmen to whom the letter was sent

Congressman Raul M. Grijalva

7th District Arizona

Congresswoman Nydia M. Velázquez

7th District Brooklyn

Congressman Troy Balderson

12th District of Ohio

Congressman Pete Aguilar

31st District, California

Congressman Jodey C. Arrington

19th District Texas

Congressman Hakeem Jeffries

U.S. House of Representatives

Honorable Luis Velez

Fifth Ward Councilman

City of Paterson

Senator Victor M. Torres, Jr.

Senator, 25th District

Congressman A. Drew Ferguson IV D.M.D.

Third District of Georgia

Congressman Neal P. Dunn, M.D.

Second District of Florida

Congressman Aaron Bean

Fourth District, Florida

Congressman Ruben Gallego

3rd District, Arizona

Congressman Robert J. Menendez

8th District, New Jersey

Congressman Steny H. Hoyer

5th District Maryland

Congresswoman Debbie Lesko

Arizona, 8th District

Congresswoman Carol D. Miller

First District of West Virginia

Congresswoman María E. Salzar

27th District Florida

Congresswoman Diana Harshbarger

1st District, Tennessee

Congresswoman Kat Cammack

3rd District of Florida

Congresswoman Claudia Tenney

24th District, New York

Congressman Michael C. Burgess, M.D.

26th District, Texas

Congressman H. Morgan Griffith

9th District, Virginia

Congressman Brett Guthrie

Second District of Kentucky

Senator Ted Budd

North Carolina

Senator Roger Wicker

Senator for Mississippi

Congressman Morgan Griffith

Ninth District, Virginia

Senator Ron Wyden

Senator for Oregon

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