The Kaiser Family Foundation has published an update on the state of healthcare in Puerto Rico, six months after Hurricane Maria made landfall on the Island.

The first key point in the report is that there has been progress, but things are not back to normal in the U.S. territory. Electricity is still unstable, there is still a lot of structural damage that has not been repaired, economic recovery is just beginning, and people continue to leave in large numbers.

This is common knowledge.

But the Kaiser Foundation also reports that the situation is worse for health care. There are still gaps in medical services in Puerto Rico. Lack of reliable electricity has led to inadequate care for people who rely on oxygen, dialysis, and other medical treatments that require electricity. Insulin must be refrigerated and many kinds of medical equipment cannot be operated without stable electric power. For many people, six months of inadequate care have worsened illnesses that were under control before the hurricane.

The mental stress of the hurricane and its aftermath have also affected public health in Puerto Rico. PTSD, depression, and anxiety have increased significantly.

Medical professionals were leaving Puerto Rico before the hurricanes. Now there are serious shortages of doctors and other medical workers in Puerto Rico.

Before the storms

Kaiser, like many other observers, notes that healthcare faced challenges even before Hurricane Maria. Limitations in communications, transportation, and healthcare funding have been problematic for healthcare in Puerto Rico for many years. “These problems exacerbated existing difficulties, many of which stemmed from disparities in the federal government’s treatment of territories compared to states.,” the report says.

Puerto Rico already saw higher rates of diabetes, heart disease, and infant mortality than the 50 states. Part of this may stem from the fact that Puerto Rico’s poverty rate is much higher than that of any state. But federal healthcare funding in the territories is not equal to funding in the states. Medicaid is capped in Puerto Rico, but not in the states, and the federal government pays a smaller percentage of the costs than it would if Puerto Rico were a state.

This inequality has had long-term repercussions that left Puerto Rico healthcare in a difficult position even before the hurricanes. As recovery efforts dragged on, daily life continued to be challenging in Puerto Rico for many people. Unlivable homes, a lack of clean drinking water, and of course the ongoing problems with getting the lights back on had negative effects on the health of the population.

After the storms

Hospitals and clinics in Puerto Rico were prioritized for repairs and renewed power. Nonetheless, Kaiser reports that about 10% of clinics still do not have stable electricity. Five clinics are still using generators to provide power and five are operating out of mobile vans. One clinic was able to acquire solar power.

Many private medical providers have closed up shop or left the Island.

What’s more, emergency funding has been provided but the inequalities in federal healthcare funding for territories have not been fixed. Puerto Rico’s healthcare providers expect to see more financial problems as emergency funds as charitable donations run out. The new fiscal plan calls for deep cuts in medical spending, without any plans to reduce medical needs.

Puerto Rico is trying to rebuild from the 2017 hurricane season and to prepare for the 2018 hurricane season, while also coping with increased medical needs. These things are being accomplished with unequal Medicaid funding and reduced numbers of medical professionals.

As a state, Puerto Rico would have more federal healthcare funding and a strong voice in the legislature. Tell your representatives that Puerto Rico matters to you.



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