The obvious health equity gap in the Democrats’ drug pricing plan

The obvious health equity gap in the Democrats’ drug pricing plan

wASHINGTON – As Democrats near the largest review of the benefit of Medicare prescription drugs in 20 years, they are ignoring an obvious health equity issue: unequal treatment for low-income adults aged 65 and over in Puerto Rico .

Puerto Rico residents pay the same Medicare taxes as other Americans, but are entitled to less help than other seniors when it comes to paying pharmacy drug premiums and prescription drug costs. Despite the speeches of all Democrats on health equity in this Congress, they have not incorporated a bill that leveled the playing field.

Right now, only adults aged 65 and over who earn less than 85% of the federal poverty level, or $ 11,552 per year, are eligible for extra help in Puerto Rico. If the same patient lived in a state like Florida, he would qualify even if he reached 150% of the poverty level, or $ 20,385. A group representing insurers across the territory estimates that roughly 120,000 to 150,000 people fall into that benefit gap now.


“There is a human side. Does a grandmother’s health situation in Florida, Alaska, Texas or Tennessee have more value than Puerto Rico? Morally, the answer is no, “said George Laws García, executive director of the Puerto Rico Statehood Council.

Puerto Rico residents are American citizens, but they may be treated unequally under many federal programs because they live in a territory rather than a state. The legal authority for Congress to establish discriminatory policies for the residents of the territories stems from a series of Supreme Court decisions that are based on racist stereotypes, but persist today as the country’s law. Island cases, as they are known, establish a legal framework that states that the Constitution does not fully apply to residents of United States territories. The first cases were decided in 1901.


One case claimed that residents of Puerto Rico were not entitled to the full rights of US citizens in part because the citizens of the territories are “alien races, different from us in religion, customs, laws, taxation methods and ways of thinking”.

Puerto Rico residents continue to struggle for equal federal benefits. In one case earlier this year, Jose Luis Vaello-Madero is suing the government because his federal disability benefits were stolen when he moved from New York to Puerto Rico. The Supreme Court resoundedly ruled against him in an 8-1 decision, but Conservative Judge Neil Gorsuch has indicated that there may be an opening to cancel island cases in the future.

“The island cases have no basis in the Constitution and are based instead on racial stereotypes. They deserve no place in our law, “she wrote in a concurring opinion.

D.Democratic lawmakers have introduced legislation over and over again, starting in 2014, to close the prescription drug subsidy gap in Puerto Rico. The latest version is led by Senator Bob Menendez (DN.J.).

The extra perks could make a big difference to the people who qualify. Grants help seniors pay monthly premiums, meet annual deductibles, and pay out-of-pocket expenses when they pick up medicines at the pharmacy counter.

The Social Security Administration estimates that the extra benefits are worth about $ 5,100 per year. This is not a definitive number for every patient, as some people with higher income levels may receive partial help. This year, patients who received full benefits paid no more than $ 3.95 for a generic drug or $ 8.85 for any brand-name drug.

Right now, adults aged 65 and over in Puerto Rico who have an income below 85% of the federal poverty level are getting some subsidies to help with prescription drug costs, but it’s not the same as the level. that state residents receive, said Roberto Pando Cintron, president of the Medicaid and Medicare Advantage Products Association of Puerto Rico. About 120,000 and 150,000 low-income beneficiaries in Puerto Rico who receive no aid now could benefit if the territory’s residents received equal subsidies, he said.

Despite advocates’ claims, the policy is set to be ignored at the most critical time for Medicare prescription drug benefit in two decades.

Menendez believes the Democrats’ domestic spending package is not perfect, a spokesman said, but acknowledges he is making investments to lower drug prices, extend insurance subsidies, and tackle climate change.

“He will continue to be a champion for Americans in Puerto Rico, regardless of whether it is Medicare, Medicaid or other areas,” the spokesperson said.

If Congress manages to completely redesign the Medicare Part D program, which it probably will soon, it may not return to reform the program for a long time.

The broader drug pricing reform includes elements that would no doubt benefit territorial residents as well, such as an annual $ 2,000 cap on out-of-pocket costs, a negotiation mechanism that could reduce costs for some expensive drugs and penalties for drug manufacturers who raise prices quickly.

However, it does not address the issue of fairness and leaves the status quo for residents of territories who work with limited resources and try to afford their drugs.

“Puerto Rico is a huge blind spot in these political debates,” García said.

T.The Supreme Court’s permission to treat residents of Puerto Rico and other territories differently under federal programs has also fundamentally shaped access to health care for residents of the territory.

Puerto Rico gets less Medicaid funding than it would if it were a state, due to the fact that Congress maintains unfair terms of payment. And unlike the states, Puerto Rico’s Medicaid funding is also limited. Medicaid funding for the territory will collapse starting December 13 unless Congress intervenes.

This means that it is difficult for doctors and hospitals to plan ahead and invest in their own facilities. Uncertainty over funding also makes it difficult to recruit and retain doctors, and the government has less funding to improve patient benefits.

And it’s not just people born and raised in Puerto Rico who get fewer health benefits. For example, a US citizen could live in New Jersey for most of their life and pay taxes to Medicare, but that person’s federal benefits would be reduced if they decide to retire in Puerto Rico.

“This different treatment leads to tangible health disparities. They have become lifelong discriminatory treatment, “said Jaime Torres, president of Latinos for Healthcare Equity.

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