It’s the first request from a group of Republicans in Congress to direct extra Medicaid dollars to Puerto Rico, where Hurricane Maria recently caused widespread wreckage. Democrats have demanded a disaster aid package, but the White House has yet to propose one and Trump has defended his administration’s slow response in the territory.
Puerto Rico was already facing a Medicaid funding cliff when extra dollars provided to it through the ACA expire at the end of this year. It and other U.S. territories receive proportionally less federal Medicaid reimbursement than states.
Energy and Commerce spokesman Zach Hunter said Republicans on the committee worked closely with Jenniffer González-Colón, Puerto Rico’s nonvoting representative in Congress, to develop the funding proposal after she wrote to them asking for additional money for the hard-hit area.
The funding, which would be provided to Puerto Rico over a two-year period, would be part of a package to fund the Children’s Health Insurance Program, community health centers and other health-care extenders. Congress officially missed the deadline on Oct. 1 to extend funding for the programs, although most states have a few more months before their dollars run out.
The Energy and Commerce Committee plans to mark up the bill Wednesday, the same day the Senate Finance Committee will consider its own CHIP bill. Both bills would maintain for two years extra CHIP funding laid out under the ACA, and then phase it out.
But while the Finance Committee has so far stayed away from the sticky issue of how to pay for its measure — typically the biggest sticking point to passing any bipartisan legislation through Congress — Energy and Commerce Chairman Greg Walden (R-Ore.) is laying out specific ways to pay for the whole package.
The Energy and Commerce bill proposes the following funding mechanisms:
— Charging higher Medicare premiums to seniors earning more than $500,000: $6 billion.
— Allow states to dis-enroll lottery winners from Medicaid: $400 million.
— Shorten the grace period for ACA enrollees who don’t pay their marketplace premiums from 90 days to 30 days: $5 billion.
— Redirect money from the ACA’s prevention and public health fund to community health centers: $5.5 billion.
— Strengthen Medicaid’s third-party liability policy by making it easier for state programs to avoid some medical costs if they’re already covered by private plans or other government programs: nearly $4 billion.
No Energy and Commerce Democrats have signed onto the bill, but Hunter said Republican members are “continuing discussions” until the markup on Wednesday.