Around 300,000 Puerto Ricans without medical plan
By John McPhaul
jpmcphaul@gmail.com
The Finance Committees of the House of Representatives and the Senate, chaired by the Rep. Jesús Santa Rodríguez and Sen. Juan Zaragoza Gómez, respectively, held a joint public hearing on the House Joint Resolution 307 to evaluate the budget of Health Insurance Administration (ASES by its Spanish acronym), in which they heard testimony that 300,000 Puerto Ricans don’t have health insurance.
The public hearing was attended by Roxanna Rosario Serrano, interim executive director of ASES and Carlos Negron, the agency’s director of finances.
Rosario Serrano explained that currently 10% of the population on the Island are not covered under a medical plan, which is equivalent to about 300,000 people.
‘’At the moment, our main focus is to find solutions so that these people can benefit and therefore we will be carrying out initiatives to extend the coverage,” she said.
Also, she stated that the projection of federal funds establishes matching funds based on the state contribution and certified population based on continuing poverty level; which presently represents 85% of the federal contribution.
Regarding the budget of the agency, the Acting Executive Director explained that to be able to meet pragmatic commitments, ASES needs availability of resources to receive matching federal funds. Currently, the government agency does not directly receive federal contributions. Refunds of federal funds are processed through the Department of Health-Medicaid.
Similarly, Rosario Serrano stressed that the budget requested by ASES for the next fiscal year 2022-2023 is $3.9 billion. One of the main challenges, according to the official, is the number of employees for the operation of the agency.
‘’A few years ago ASES had around 122 employees, now we have 75,’’ she said.
In what corresponds to the Vital Health Plan of the Government of Puerto Rico, ASES has five employees working in the “call center” to serve 1.5 million beneficiaries.
Faced with this situation, Rep. Juan Oscar Morales Rodríguez commented that, ‘’It is surprising that they have not come today to claim that they need more personnel. Remember something. if the Board is not required, they will do nothing for you. Really, with that quantity of employees, I highly doubt that you can give a service of excellence to all to beneficiaries, and that’s why the insurers laugh at us because we don’t have the tools to be able to question their irregularities”
To deal with this challenge, Negrón clarified that “already we requested $8 million that contemplates 125 employees of a restructuring that we submitted and it is already approved. The current expense of the 75 employees is $5 million.
Negron maintained that ASES’s greatest expense is with medicines.
Given the increase in beneficiaries, now the expense is higher. Before it was around $796 million and currently the spending is $900 million. In turn, the president of the Finance Committee together with Rep. Morales Rodríguez, demanded that ASES be more aggressive when it comes to issuing fines to insurers.
‘’Do not settle fines with insurers. Giving them a $200,000 fine is like a pennies for them. If the acts have no consequences, they will continue to commit violations of the regulations,’’ commented Morales Rodríguez.
Finally, legislator Santa Rodríguez concluded by saying that the ‘’purpose of these hearings is to evaluate each budget and determine what are the gaps or main challenges of each agency to find solutions in order to provide a service of quality to each constituent and achieve adequate stability in the finances of the country’’.