With the challenge against the Affordable Care Act (lovingly called “Obamacare” by its opponents and pundits) all argued out, the nine Supreme Court justices have until June to draft up a decision. The tension will be palpable as the lifetime appointees will debate and decide on the fate of President Obama’s landmark legislation.
The Court could decide to: 1) hold off a decision based on Anti Tax Injunction Act (probably not); 2) leave the law on the books but strike out the Individual Mandate; or 3) decide that the mandate cannot stand, and as such, the entire law has to go down with it.
Much has been said about the effects any of these decisions would have on the U.S. as a whole, but the effect of the entire law being struck down on Puerto Rico has gone largely unnoticed. When Newt Gingrich and Mitt Romney tried to court the Puerto Rican vote in March (the latter much more than the former), they did not flinch on their stand on Obamacare.
Why the significance? Because Puerto Rico would lose, overnight, $700 million dollars to its health program’s budget that comes specifically from Obamacare.
Under Puerto Rico’s health care program (formerly “La Reforma” and now “Mi Salud”) lower income families (who meet the income threshold) can visit any doctor, or specialist, from a list of doctors who participate in the government’s plan for as little as $5 dollars a visit.
When enacted in the mid 90’s, failure to properly budget for the program resulted in skyrocketing deficits for the health program under Governor Pedro Rosselló. His successor, Governor Sila Calderon, slashed the number of people who could be eligible under the program. Finally, under Governor Fortuño, the program was revamped and expanded (more families can qualify now, and a visit to a specialist does not require a referral). However, much to the dismay of the GOP’s discourse on big government, Puerto Rico has been able to reform and expand its healthcare program (to nearly 1.5 million people) precisely because of the extra $700,000,000.00 that Obamacare gives Puerto Rico. The program right now carries a nearly $2 Billion dollar budget, with a great portion coming from the Federal Government. A hefty sum that would disappear if the Justices strike down the entire law (just like Romney wants).
It is highly disappointing that the Puerto Rico government did not bother in filing a “friend of the court” brief to defend its nearly billion dollar partition of the law, arguing that the entire law could stand regardless of the mandate. The Republican leaning government did not have to embrace a program its party objects to, but it could have made an argument to avoid striking the entire law down over one (albeit important) provision.
It is also highly disingenuous for the GOP to court Puerto Ricans, both on the Island and in the Mainland, while actively trying to mortally wound one of the ruling party’s landmark programs (ironically, health care). By striking the portion of the law that expands Medicare’s reimbursement to Puerto Rico until 2019 to the tune of nearly 6.3 billion dollars, Puerto Rico’s health care program would immediately go back to the red, forcing it to wean off many vulnerable families from the program.
However, this is an issue that could easily be fixed if Congress treated Puerto Rico in the same way it treats the other 50 states when it comes to Medicare/Medicaid reimbursements. Although Puerto Ricans (on the Island) do not pay federal income tax, we do pay Medicare/Social Security/Medicaid taxes. And yet, Medicare only reimburses 75% of the costs incurred (a matter that our Commissioner Resident, Pedro Pierluisi is trying to remedy with the Puerto Rico Medicare Reimbursement Equality Act of 2012).
The Justices will soon decide over a law that affects 1/6 of the U.S. economy. Depending on how they rule, they may also end up mortally wounding Puerto Rico’s health care program.