The National Puerto Rican Coalition (NPRC) has launched its Health Care Equality for Puerto Rico project urging Congress and the Obama administration to include Puerto Rico equally in a healthcare reform to eradicate healthcare disparities on the island. Efforts are being conducted at the local, regional and national level to disseminate ads, a health policy briefing paper and a healthcare disparity fact sheet.

"Americans in Puerto Rico are excluded from various federal healthcare programs and receive limited funding in comparison with other citizens residing in the 50 states," said Rafael Fantauzzi, president and CEO of NPRC. "Puerto Rico loses no less than $2 billion in federal funding every year as a result of these inequalities and it's outrageous that these needed resources are lost because of a correctable statutory issue."

According to the NPRC, the most pressing healthcare disparities in Puerto Rico include:

Medicaid spending cap and DSH program

The federal contribution to Medicaid in Puerto Rico is authorized to be 50 percent of the program's cost. However, the island is only receiving 22 percent because of an arbitrary cap on federal funding. In addition, Puerto Rico is excluded from the Medicaid Disproportionate Share Hospital (DSH) program.

"The Medicaid spending cap must be removed and Puerto Rico should be provided access to the Medicaid DSH program," said Fantauzzi.

Medicare IPPS, DSH, Part D and Part B Programs

Medicare reimbursements under the Inpatient Prospective Payment System (IPPS) are determined for all U.S. jurisdictions other than Puerto Rico by using a standard formula. The special formula for Puerto Rico provides hospitals with less funding and Puerto Rico's low-income serving hospitals are not receiving fair payments from the DSH program.

Medicare Part D (prescription drugs) funding for the island is based on a limited block grant that does not meet current needs at a comparable rate to other U.S. jurisdictions. Additionally, U.S. citizens in Puerto Rico are not automatically enrolled for the Medicare Part B outpatient doctor program and have to pay fees for late enrollment.

The NPRC argues that the IPPS program should no longer employ the unique Puerto Rico-based formula. A Supplemental Security Income proxy could be used in place of the normal variable to ensure that DSH calculation for Puerto Rico hospitals reflects the actual patient population in these facilities. Additionally, direct subsidies should be provided for low-income beneficiaries in Puerto Rico under the Medicare Part D Program, and Puerto Rico's Medicare beneficiaries should be automatically enrolled in Part B.

Disparities in the treatment of veterans and military personnel

"Veterans and military widows under the age of 65 residing in Puerto Rico do not have access to the same health benefits in the TRICARE program as those that live in the states. It's imperative that the TRICARE Prime disparity be rectified by administering it equally in both the States and Puerto Rico," said Fantauzzi.

President Barack Obama has pledged to seek equal coverage of Puerto Rico in federal healthcare assistance programs. Through this project, NPRC hopes to increase awareness about all these inequities and influence decision makers in supporting equality for Puerto Ricans.