Governor supports GOP bill correcting Medicare disparities

Puerto Rico Federal Affairs Administration Executive Director Gabriella Boffelli

By THE STAR STAFF

Gov. Jenniffer González Colón welcomed a new push from Republican members of the U.S. House of Representatives urging the Department of Health and Human Services (HHS) to correct long‑standing disparities in Medicare Advantage (MA) funding that have left Puerto Rico at a structural disadvantage compared with the states and other territories.

In a letter to HHS Secretary Robert F. Kennedy Jr., Rep. Greg Murphy (R-N.C.) -- co‑chair of the House Republican Doctors Caucus -- led a group of 14 lawmakers in calling on HHS and the Centers for Medicare & Medicaid Services (CMS) to use existing administrative authority to establish, beginning in 2028, a national minimum benchmark set at 70% of the Average Geographic Amount (AGA). That level already applies to the U.S. Virgin Islands, which receives higher MA payments than Puerto Rico.

The letter, signed by House lawmakers including Don Bacon (R-Neb.), Gus Bilirakis (R-Fla.), Mario Díaz‑Balart (R-Fla.), Carlos Giménez (R-Fla.), María Elvira Salazar (R-Fla.) and Amata Coleman Radewagen (R-American Samoa), marks a significant development in González Colón’s broader effort to secure equitable Medicare Advantage payments for the island’s older adults.

“My administration will continue advancing initiatives to ensure fairer access to health services for the people of Puerto Rico, and those efforts are already producing concrete results,” González Colón said.

She thanked her former colleagues in Congress “for raising their voices in favor of Puerto Rico.”

Murphy emphasized that chronic underfunding “continues to weaken the Medicare Advantage program in Puerto Rico and in other regions of the nation with disproportionately high enrollment.” Bacon added that fixing the system is preferable to maintaining a model that pushes providers and patients to leave the island in search of better‑funded health systems in the states.

Puerto Rico has the highest Medicare Advantage participation rate in the United States: more than 670,000 older adults -- about 96% of all Medicare beneficiaries on the island -- rely on MA for their health coverage. Yet benchmark rates remain roughly 41% below the national average and about 20% below those applied in the U.S. Virgin Islands.

Puerto Rico Federal Affairs Administration (PRFAA) Executive Director Gabriella Boffelli noted that workers in Puerto Rico contribute to Medicare under the same federal payroll tax rules as workers in the states.

“They deserve a payment system that reflects the current reality of Medicare Advantage, not one based on an outdated methodology,” she said.

She added that the proposed administrative fix would strengthen patient access, support providers, improve chronic disease management and bolster long‑term program sustainability nationwide.

The congressional push follows CMS’s finalization of the 2027 Medicare Advantage Rate Notice earlier this year, which granted Puerto Rico a 4.01% increase -- higher than the national average of 2.48%. While the adjustment was welcomed by the medical community and the González Colón administration, officials argue that deeper structural reform remains necessary.

Boffelli credited the coordinated work of health providers, patient organizations, private‑sector partners and the Governor’s Multisectoral Health Working Group for keeping the issue at the forefront in Washington.

“The significant progress achieved reflects the strength of this broad coalition,” she said, adding that the administration remains committed to collaborating with the Trump administration, Congress and all relevant stakeholders to advance practical reforms that strengthen Medicare Advantage for older adults in Puerto Rico and across the United States.

As Medicare Advantage enrollment continues to grow nationwide, Puerto Rico’s experience underscores broader challenges the program may face if its payment methodology is not modernized.