Washington is so far sending a clear but indefensible message that Puerto Rico is separate and unequal when it comes to health care reform. In the final rounds of negotiations, Congress must deliver a bill that ends the unfair treatment of Americans living in U.S. territories.

As we learned earlier this week, the Obama administration is pushing for the Senate's version of health care reform, with some adjustments. But in doing so, the White House is failing 4.4 million Americans living in Puerto Rico. This backtracks from earlier assurances that it would protect the territories.

The Senate health reform plan the President Obama endorses undermines the progress laid out by the House. The House plan addressed the steep disparities in health care funding between states and U.S. territories: Puerto Pico, American Samoa, Guam, the Northern Mariana Islands, and the Virgin Islands.

Currently, the federal government covers less than 25 percent of Medicaid services in the territories. AARP (American Association of Retired Persons) notes that Medicaid support in the states approximates $330 per participant per month compared to $20 per participant in Puerto Rico.

The Senate bill raises the federal spending cap for Medicaid in the territories to 35 percent from 30 percent. But as Puerto Rico's Resident Commissioner Pedro Pierluisi has pointed out, this change is worth a mere $15 million a year, or $135 million over the life of the bill.

There are more blows that would jeopardize the health of Puerto Ricans. The Senate plan not only cuts the House's proposal for the territories by $9 billion, but also outrageously excludes them from a health insurance exchange.

This drive – to deliberately leave Puerto Ricans and others at the margins of health care access – pronounces Puerto Rico's second class citizenship. It is as if the U.S. territories are being punished for geographic separation and a political status they never decided on. As the Hispanic Federation of NY has emphasized, citizens from Puerto Rico should not feel forced to leave the island, disrupt their families, and lose their jobs to receive health care access elsewhere.

More than 40 congressional districts include at least 15,000 individuals of Puerto Rican heritage. With the implications of not delivering equitable health reform for Puerto Rico – increased migration to states and bearing the costs of the lack of parity – elected officials, in particular from the eastern seaboard, should be fighting for fair treatment.

The federal government takes no pause when it comes to marching off soldiers from Puerto Rico into war. But it appears to use a different standard when it comes to the health of Puerto Rican families.

At today's health care summit in Washington and beyond, we fully expect the New York delegation to Congress, in particular Senators Chuck Schumer and Kirsten Gillibrand, and Senate Majority Leader Harry Reid to be at the frontlines of this critical fight and to deliver an outcome that reflects the House's fair legislation.