Puerto Rico’s health crisis demonstrates just how dumb the latest Trumpcare big idea is

[ Originally published on this site as post ]

The latest Trumpcare salvo, Graham-Cassidy, has failed for now, but it’s not done. Sen. Lindsey Graham (R-SC), the guy who admits he knows absolutely nothing about healthcare reform, is convinced he and Bill Cassidy (R-LA) have hit on the right formula, and that this will be the framework for replacing the Affordable Care Act.

Graham happened to be getting his haircut at the same time as former Sen. Rick Santorum, R-Pa., who had an idea: Why not distribute health care spending through block grants to the states? That’s what a Republican Congress did in the 1990s to overhaul the nation’s welfare system, which ultimately won the signature of Bill Clinton, a Democratic president.

Hurricane Maria just blew that whole idea out of the water. Here’s how. Right now, Congress is figuring out how to get more Medicaid dollars to Puerto Rico because its Medicaid funding already ran out once this year, even before the hurricane.

How does that happen? you ask. Isn’t Medicaid an open-ended program that has flexibility built in, so that there will always be funding to answer critical need when things like natural disasters happen? Yes, but not for Puerto Rico. Since 1968, Puerto Rico’s Medicaid funding has been capped—it can never get more than a 50 percent match from the federal government and what’s more, it’s annual funding is capped as well. It is operating under a Medicaid block grant. And when the money in that block grant runs out because you’ve been hit by a category 5 hurricane, oh well.

Yes, the same kind of block grant that Graham and Cassidy envision for all the health care. The results in Puerto Rico are dire.

There has been an accelerated decline in the number of physicians, as doctors left the island for economic security. Due to insufficient pay and training, doctors have migrated to the mainland. Seventy-two of Puerto Rico’s 78 municipalities have been deemed medically underserved by the U.S. Health Resources and Services Administration (HRSA). As patients require more concentrated care, finding a specialized doctor becomes more cumbersome: 23 percent of municipalities had a shortage of pediatricians, 68 percent had a shortage of OBGYNs, and 64 percent had a shortage of psychiatrists.

A helluva way to provide health care, huh? Just the kind of approach you would expect from people who think health insurance is broken when premiums paid by healthy people help subsidize care for sick people.