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There's a health care crisis unfolding in Puerto Rico, Guam and other U.S. territories. It's called the Medicaid cliff. These islands are facing a combined shortfall of more than a billion dollars next year. They say unless the U.S. Congress acts, they'll need to make drastic cuts to their Medicaid programs and that their patients' lives are on the line. NPR health policy reporter Selena Simmons-Duffin reports.
SELENA SIMMONS-DUFFIN, BYLINE: Sandra King-Young is the Medicaid director for the South Pacific island of American Samoa. She says because of the Medicaid cliff, her government had to make a choice - keep the island's one hospital running or shut down the referral program that sends patients to New Zealand when they need services they can't get on the island. They chose to shut down the referral program at the end of the year.
SANDRA KING-YOUNG: So all the patients that are in New Zealand right now getting cancer treatment or recovering from total knee replacements or bypass heart surgery, we are waiting for all of them. They have to return.
SIMMONS-DUFFIN: She says one patient who needs a year's worth of cancer treatment will only get six weeks. Other patients who need treatments in New Zealand that wouldn't be done by the end of the year have been told they can't go.
KING-YOUNG: Now, tell me if that's acceptable in the United States to stand by and say, oh, sorry, we can't give you that stent or that pacemaker, so it's likely that you'll have a stroke or heart attack, and that's it. That's what it means not to have enough Medicaid funding for the territories.
SIMMONS-DUFFIN: When it comes to Medicaid, the U.S. territories are treated differently than states are. The federal government contributes a certain amount of money to Medicaid based on what states spend, and states get more if their population is low-income.
In the territories, it doesn't work that way. Even though their populations are low-income, the amount the feds chip in is fixed at a low rate. Also, the territories can only get federal funding up to a certain ceiling every year. And historically, that ceiling hasn't been high enough to fully fund the programs. States have no ceiling.
In 2011, Sandra King-Young explains, this picture changed.
KING-YOUNG: In the last eight years under the Affordable Care Act, we had money.
SIMMONS-DUFFIN: Specifically, $7 billion for the territory's Medicaid programs. But it was a one-time thing, and most of that money just expired at the end of September, thus the cliff and the tough choices these territories like American Samoa are making. King-Young points to news coverage in the 1960s that described her island as America's shame because it was so neglected by the federal government.
KING-YOUNG: Right now, this is the United States' shame in the islands.
DARREN SOTO: She's right that this is a shame. And it's one that we, at least in a bipartisan fashion in the House, are looking to address in an expeditious fashion.
SIMMONS-DUFFIN: That's Congressman Darren Soto, a Democrat from a district in central Florida with a huge Puerto Rican population. He introduced a bill that would allocate about $3 billion a year for the next four years. In the House, it has bipartisan support.
SOTO: We're in active negotiations with the Senate, but there is some opposition to our bill in the Senate.
SIMMONS-DUFFIN: Opponents question the billions of dollars the territories are asking for and argue there needs to be better oversight of these funds, particularly in Puerto Rico, which has dealt with corruption allegations. Still, Soto says he's optimistic a bipartisan deal will get through Congress soon. Michal Rhymer-Browne hopes he's right. She's a health official in the U.S. Virgin Islands.
MICHAL RHYMER-BROWNE: The urgency is here for us to let our congressional members know even going to January is extremely dangerous.
SIMMONS-DUFFIN: She says by then, they'll need to start cutting their Medicaid rolls, removing people from the program.
RHYMER-BROWNE: It's already catastrophic for our territories. We really need them to make a move.
SIMMONS-DUFFIN: She says it's not clear that urgency is being felt by lawmakers on the mainland.
Selena Simmons-Duffin, NPR News.
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