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

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

WASHINGTON — As Democrats move closer to the biggest overhaul of the Medicare prescription drug benefit in 20 years, they are ignoring a glaring health equity problem: the inequality of low-income adults age 65 and older in Puerto Rico.

Puerto Rico residents pay the same Medicare taxes as other Americans, but they are entitled to less help than other older adults when it comes to paying their pharmacy drug premiums and prescription drug costs. For all the Democrats’ speeches about health equity at this Congress, they haven’t included any legislation that would level the playing field.

Currently, only adults age 65 and older who earn less than 85% of the federal poverty line, or $11,552 per year, are eligible for supplemental assistance in Puerto Rico. If the same patient lived in a state like Florida, they would qualify even if they accounted for up to 150% of the poverty line, or $20,385. A group representing insurers in the area estimates that between 120,000 and 150,000 people currently fall into this subsidy gap.


“There’s a human side to that. Is a grandmother’s health more important in Florida, Alaska, Texas, or Tennessee than in 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. Congress’s legal authority to issue discriminatory policies against residents of territories stems from a series of Supreme Court decisions based on racial stereotypes, but which survive to this day as the law of the country. The so-called Insular Cases establish a legal framework stating that the Constitution does not fully apply to residents of US territories. The first cases were decided in 1901.


In one case, it was found that residents of Puerto Rico were not entitled to the full rights of U.S. citizens in part because the Territories’ citizens are “alien races, differing from us in religion, customs, laws, methods of taxation, and ways of thinking.” “.

Puerto Rico residents continue to struggle to receive equal federal benefits. In one case earlier this year, Jose Luis Vaello-Madero sued the government for having his state disability pension taken away when he moved to Puerto Rico from New York. The Supreme Court ruled strongly against him 8-1, but Conservative Justice Neil Gorsuch hinted there might be a way to overrule the island cases in the future.

“The island cases have no basis in the Constitution and are instead based on racial stereotypes. They don’t deserve a place in our law,” he wrote in a unanimous statement.

DDemocratic lawmakers have introduced legislation since 2014 to close the prescription drug subsidy gap in Puerto Rico. The latest release is led by Sen. Bob Menendez (DN.J.).

The added benefits could make a world of difference for the qualified individuals. The grants help older adults pay monthly premiums, meet their annual deductibles, and pay their expenses when picking up medication from the pharmacy counter.

The Social Security Administration estimates that the additional benefits are worth about $5,100 a year. This is not a definitive number for every patient, as some people with higher incomes can receive partial help. That year, patients receiving full subsidies paid no more than $3.95 for a generic drug or $8.85 for any brand-name drug.

Currently, adults in Puerto Rico who are 65 or older and earn less than 85% of the federal poverty line receive some subsidies to help cover prescription drug costs, but this is not at the level 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 are not receiving aid now could benefit if territory residents received equal subsidies, he said.

Despite pleas from supporters, the policy is being ignored at the most critical juncture for Medicare’s usefulness for prescription drugs in two decades.

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

“He will continue to be a champion of Americans in Puerto Rico, whether on Medicare, Medicaid or other areas,” the spokesman said.

If Congress succeeds in completely redesigning the Medicare Part D program, which it likely will soon, it’s possible that it won’t return to reforming the program for a long time.

The broader reform of drug pricing includes elements that would undoubtedly benefit residents of the areas as well, such as raising prices rapidly.

However, it fails to address the issue of equity and leaves the status quo for residents of areas who work with limited resources and try to afford their medicines.

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

TThe Supreme Court’s permission to treat residents of Puerto Rico and other territories differently under federal programs has also profoundly impacted the access to health care for residents of the territories.

Puerto Rico receives less Medicaid funding than any state as Congress adheres to unfair payment formulas. And unlike states, Puerto Rico’s Medicaid funding is also limited. Medicaid funding for the area will begin to decline beginning Dec. 13 unless Congress intervenes.

This means it is difficult for doctors and hospitals to plan ahead and invest in their facilities. Uncertainty about funding is also making it difficult to recruit and retain doctors, and the government has fewer resources to improve patient services.

And it’s not just people who were born and raised in Puerto Rico who receive fewer health services. A US citizen, for example, could spend most of their life in New Jersey and pay taxes on Medicare, but that person’s federal benefits would be cut if they chose to retire in Puerto Rico.

“This differential treatment leads to tangible health inequalities. It has become permanent, discriminatory treatment,” said Jaime Torres, president of Latinos for Healthcare Equity.

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