Puerto Rico’s Health-Care Crisis Threatens the Mainland

Puerto Rican immigrants -- many of them sick and in need of care -- are flocking to the states in unprecedented numbers. New York has volunteered to help the island, but it may not be able to.

Just a few years ago, New York had a health-care crisis on its hands. The state was spending $50 billion a year on Medicaid in 2011 -- more than any other state in the country. Health-care officials in New York worked together to bring down spending, and last year the state introduced an $8 billion plan to repurpose its whole program, with a focus on outpatient care and community health. But now the state is facing another threat to its health-care system: Puerto Rico. America’s biggest territory continues to find itself in serious financial trouble, with a current debt of $72 billion, which the territory’s governor has declared “not payable.”

Health-care spending is partly to blame: More than 60 percent of the population is dependent on Medicaid or Medicare, but the federal government only covers 15 percent of those expenses. To put that in perspective, Mississippi -- the state that most closely resembles Puerto Rico in terms of poverty -- usually has around 75 percent of its Medicaid expenses reimbursed by Washington. To make matters worse, this year Puerto Rico is set for an 11 percent cut to its Medicaid Advantage system, thanks to the Affordable Care Act (unless Congress steps in to postpone or cancel the cuts).

Why does that matter to New York? Because there are already more than a million Puerto Rican immigrants living in the state, more than anywhere else on the mainland. More people leaving the island likely means more people moving to New York. If the Medicaid Advantage cut does happen, health-care experts say more than a million new immigrants could be coming to the mainland in the next year -- many of them sick and in need of care. That influx would put an unprecedented burden on New York’s Medicaid system, threatening to cripple progress the state has made in recent years...