Oct. 22, 2003 – Proposed national health legislation unveiled by the Democratic leadership of Congress on Tuesday includes a provision that would lift the cap on Medicaid payments to the insular territories and treat them the same as states where critical funding is needed.
The cap on Medicaid funding available to the Virgin Islands now is $5.59 million a year, based on per capita income. The territory receives about $436 in federal funding for each of the approximately 15,000 residents eligible for Medicaid assistance, while the national average for 2000 was $3,862 per eligible person. The disparity has long been a bone of contention between the V.I. and federal governments.
Delegate Donna M. Christensen called the Democrats' overall plan, designated the Health Care Equality and Accountability Act of 2003, the "investment that the country must make to bring wellness within the reach of every one of its residents." And she said, "it is an investment that must be made if we are ever to reverse the spiraling increases in the cost of health care in this country."
At a press conference Tuesday in Washington, D.C., Senate Minority Leader Tom Daschle said that "in America, minorities receive poorer quality health care than non-minorities — even when both groups have roughly the same insurance coverage, the same income, the same age and the same health conditions. This is more than a minority issue or a health care issue. It is a moral issue. It's also a serious economic problem."
House Democratic leader Nancy Pelosi said the measure "would help end these disparities." It "increases health coverage and access for minorities while improving research and government accountability," she said.
Medicaid is the major public financing program to provide health and long-term care coverage for the nation's low-income residents, and one in 10 Americans is covered, according to testimony before a V.I. Senate committee last year. The assistance is available to those with income of not more than $8,500 and savings of not more than $1,800 for a family of four. Those served include children, pregnant women, the elderly and the totally disabled.
While federal law provides for a 50/50 split in federal and state funding for the program, the V.I. government has ended up paying a much higher proportion because of the $5.59 million federal cap.
In Fiscal Year 2000, the Medicaid program served nearly 18,000 V.I. residents. For FY 2002, the figure was about 15,000. Bills in the territory for 2000 totaled about $15 million, with the federal government covering the maximum $5.9 million and the V.I. government picking up the rest. Christensen said the federal government restricts the allocation of Medicaid funds to the U.S. territories and Puerto Rico in part because they do not pay taxes into the Medicaid fund.
In FY 2000, 24 percent of the territory's Medicare distribution was to patients from birth to age 20, 48 percent was for ages 21-64, and 28 percent was for ages 65 and above. Stateside, the elderly and disabled account for 60 percent of the funding distribution, according to the V.I. Senate hearing testimony. (For details on the Medicaid benefits situation in the Virgin Islands, see "U.S., V.I. Medicaid inequities described".)
For years, delegates from the various territories repeatedly introduced legislation in Congress to remove the Medicaid cap, or to get it increased incrementally over a number of years. Brian Modeste, an aide to Christensen, said last year that removing the cap for the Virgin Islands would cost the federal government less than $10 million a year, and that removing it for all of the territories would cost more than $100 million.
At Tuesday's press conference in the nation's capital, Rep. Elijah Cummings, who chairs the Congressional Black Caucus, called the Democrats' pending bill "a milestone in our efforts to improve the life and livelihood of all Americans."
Rep. Hilda Solis, who chairs the Health Task Force of the Congressional Hispanic Caucus, said the bill will set the nation "on the right path for a healthier future" in several regards — including "improving health care access, ensuring that limited English proficient individuals can understand their health care options [and] encouraging more children to become doctors and nurses."
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