Territories’ healthcare face challenges

Access, financing, and labor are just a few of the major healthcare challenges the U.S. territories face—challenges that force patients, like in the CNMI, to seek medical attention in other countries, thereby increasing costs.

This was the message that Matthew Deleon Guerrero conveyed during the Senior Plenary Session of the Interagency Group on Insular Areas last Friday at the U.S. Department of the Interior in Washington, D.C.

Deleon Guerrero is the chief of staff of Gov. Ralph DLG Torres. He represented Torres in the meeting since the CNMI governor was still on Saipan, hosting the visiting U.S. congressional delegation headed by Rep. Rob Bishop (R-Utah), last week.

The delegation visited Saipan at the invitation of Delegate Gregorio Kilili C. Sablan (D-MP) and learn firsthand the immigration and workforce issues that affect the CNMI. They also visited Tinian to look into the U.S. military’s planned activities and Rota for the National Park Services study.

Deleon Guerrero said that 36 percent of the CNMI’s population was either under the Child Health Insurance Program or Medicaid in 2015. “[But] according to the most recent data available, 46 percent of the population is without any type of health insurance coverage while 51 percent live on income at or below the federal poverty line.”

“With a greater percentage of individuals and families living beneath the poverty line than the national average, limited financial resources hinder us from providing quality and affordable health care. As a result, many [of our] residents are forced to seek the care they need off-island, at a greater cost.”

He added that the CNMI’s Medicaid program is the main source of health coverage that a third of residents avail of. “The CNMI’s program essentially acts as a block grant…which is statutorily set at a low Federal Medical Assistance Percentage of 55 percent.”

“The CNMI would be eligible for a percentage far beyond the current arbitrary percentage if FMAP were to be calculated in the same manner as it is for the states. Calculating FMAP based on need would recognize, and better provide for, our large low-income population and provide greater coverage to the many citizens born and raised on U.S. soil in the CNMI who cannot afford to pay for health insurance.”

He said the federal cap on Medicaid dollars is also a burden in getting efficient health services. “The constrained budget limits the [CNMI] Medicaid’s office to better explore opportunities to innovate the delivery of services to increase efficiency, lower expenditures, and improve patient outcomes. These concerns are not new to the federal government, nor are they unreasonable.”

The Bipartisan Congressional Task Force on Economic Growth, which oversaw Puerto Rico’s debt crisis, stated in their December 2016 report that territories should also be treated in a more equitable and sustainable manner under the Medicaid program.

Interior Secretary Ryan Zinke, acting Interior Assistant Secretary for Insular Areas Nikolai I. Pula Jr., Deputy Assistant to the President for Intergovernmental Affairs Justin R. Clark, Senior White House adviser Douglas W. Domenech, Govs. Lolo Moliga (American Samoa), Eddie Calvo (Guam), and Kenneth Mapp (U.S. Virgin Islands), and representatives from the departments of Health and Human Services and Treasury were also at the meeting.