Dear members of the 20th Northern Marianas House of Representatives: As a concerned citizen, taxpayer, and resident of the Marianas, I write to express my strong opposition to House Bill 20-149, a bill to abolish the Commonwealth Health Care Corp. and return its functions to the Department of Public Health, a line agency under the control of the governor.
When CHCC was established just eight years ago, it was with the goal of transforming our healthcare system to become “a professionally managed, nationally accredited, independent public healthcare institution that is as financially self-sufficient and independent of the Commonwealth government as possible” (Public Law 16-51, Section 2: Findings and Purpose). The Legislature found then that the Department of Public Health, as a line agency of the Executive Branch, was not operating as effectively as demanded by consumers, and was hampered by inefficiency, political controls, and difficulties in procurement, and staffing. Our healthcare system needed greater autonomy and flexibility to deliver critical services more efficiently, especially for the day-to-day operations of our sole public hospital and the health clinics on Saipan, Tinian, and Rota.
But the Legislature also acknowledged then that turning the Department of Public Health into a corporation didn’t mean that the government would no longer have to appropriate funds for hospital services. When the 16th House Committee for Health, Education, and Welfare, chaired by then-representative Ralph Deleon Guerrero Torres, recommended passage of the Healthcare Corporation Act, they noted that the Commonwealth Health Center “will continue to require governmental subsidy particularly for indigent care and medical referrals,” at least until the government could adopt by law a system for mandatory universal health coverage (House Standing Committee Report 16-30, p. 7). The hospital, under the auspices of the new corporation, would continue to provide care for all patients who entered its doors, regardless of their ability to pay.
Unfortunately, since its inception, CHCC has been woefully underfunded, largely due to the government’s failure to pay for indigent care, including the full local share for Medicaid services provided by the hospital. These are significant burdens for CHCC to bear, considering that nearly half of our people are uninsured, and that CHCC receives only 55 cents from the federal Medicaid share for every dollar spent caring for Medicaid patients. According to CHCC’s records, the hospital incurred nearly $14 million in uncompensated care for uninsured patients in fiscal year 2016 alone, and every year absorbs millions more in Medicaid services that are not reimbursed by the local government. In the last budget call, CHCC requested $16 million to pay for indigent care; the Legislature provided just $825,000.
Now, in two pages, House Bill 20-149 proposes to undo the last eight years of work to overhaul and improve our healthcare system, by dissolving CHCC altogether. But House Bill 20-149 does nothing to address the real problem, which is the chronic underfunding of CHCC. Instead, the bill would take us backwards to the old system, to make healthcare once again the function of a line department under the control of the governor. Why? The bill reveals little about its motivations. The legislative findings—a single sentence—merely state that CHCC is not meeting the needs of the people of the Commonwealth and should therefore be abolished.
But it is the Legislature that is not meeting the needs of CHCC. And as a beneficiary of CHCC, as a taxpayer, and as your constituent, I urge you to set aside House Bill 20-149 and focus on resolving the real problem of funding for CHCC. Members of the House have already identified various revenue sources to strengthen and support healthcare in the Marianas. You have the power and the mandate to deliver those needed funds to CHCC right now—without dismantling the organization, jeopardizing CMS certification, and destabilizing and politicizing the only healthcare system we have.
Please, do the right thing. Don’t take us backwards. Support our healthcare system, and give CHCC the funding it needs.
Sablan is a former lawmaker in the CNMI House of Representatives. This is her statement on House Bill 20-149.