Jenniffer González presents legislation to guarantee access to healthcare in Puerto Rico

Press Release

The Resident Commissioner, Jenniffer González Colón, seeks to do justice to Medicare recipients with the filing of three measures that would seek to eliminate penalties and equal the treatment of beneficiaries of the territories to that of the states. All three measures are co-authored by Florida Congressman Darren Soto.

HR 1826 seeks to amend Title XVIII of the Social Security Act to eliminate penalties for late enrollment under Part B of the Medicare program for persons residing in Puerto Rico, if such persons enroll within 5 years of being entitled to the benefits of Part A of said program.

Medicare Part B is one that provides coverage for medical appointments, outpatient services, medical equipment, dialysis among other preventive medical services. Contrary to the United States, in Puerto Rico, beneficiaries are not automatically enrolled and if they do not do so in the initial 7-month period, a lifetime penalty of 10% of the premium is imposed for each year of delay.

According to the Centers for Medicare and Medicaid Services (CMS) for 2017 in Puerto Rico there were approximately 38,343 Medicare beneficiaries who paid lifetime penalties of $ 20.3 million annually for late registration in Part B.

With this legislation, the commissioner seeks to eliminate the discriminatory treatment of American citizens residing on the island, which is imposed a penalty only for living in a territory.

Medicare Part D is part D that covers prescription drug costs through private plans approved by the federal government. To help pay for this program, the federal government approved the Low Income Subsidy (LIS). This subsidy provides assistance to those citizens who are below 150% of the federal poverty level, for the payment of the insurance premium to which the beneficiary of Part D is eligible, deductibles and copayments.

Currently, this translates into aid for individuals whose annual income does not exceed $ 19,140 or $ 25,860 for married couples and for individuals with modest assets less than $ 17,226 for individuals or $ 23,274 for couples in 2020. The LIS does not apply to territories regardless of that the same percent is deducted from their wages for Medicare as American citizens residing in the states, without receiving the same benefits.

Instead of LIS, governments in the territories are allocated a fixed amount of funds to provide prescription drug assistance to low-income Medicare beneficiaries - in other words, only for dual eligible beneficiaries. Currently, annual funding for Puerto Rico is only $ 59 million, which is substantially less than the total amount that low-income Medicare beneficiaries in Puerto Rico would receive if eligible for LIS.

In addition, before accessing federal funds, each government of the territory is required to contribute or match the funds for the payment of drugs covered by Medicare Part D, but for various reasons the governments have not been able to comply with the requirement of corresponding matching, accessing less funds than assigned. This matching requirement does not apply to states.

According to the opinion issued by Judge Young in the case of Peña Martínez v. US Department of Health and Human Services, there are approximately over 500,000 people in Puerto Rico who could benefit from this program. The Center for a New Economy estimates that Puerto Rico residents could receive up to $ 2.5 billion in annual benefits under the LIS, a notable difference to the $ 59 million the island receives today for being a territory.

To correct this discrimination, the congresswoman filed two measures.

HR1825 seeks to amend Titles XVIII and XIX of the Social Security Act to make premium subsidies and cost-sharing available to low-income beneficiaries of Medicare Part D residing in Puerto Rico or another territory of the United States. .

And HR1823, to amend Title XIX of the Social Security Act to remove the matching requirement for a territory to use federal funds allocated for Medicare-covered Part D drugs for low-income people.

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