House Republicans have unveiled their alternative to the Affordable Care Act. Titled “The American Health Care Act,” it is available for download at

You might want to read the bill. However, you can find out how this proposed replacement for Obamacare will affect Puerto Rico by searching the text. Click CTRL+F and search for “Puerto Rico.”

Puerto Rico is not specifically mentioned in the bill at all.

Try “territories,” in case the drafters of the bill decided to include all the territories. You won’t find that word in the bill, either.

Does it matter?

You might think that it doesn’t matter if a new bill doesn’t mention Puerto Rico. The bill doesn’t mention Ohio, either. Isn’t Puerto Rico included by default whenever there is a new law?

No. When it comes to a bill like this one, Puerto Rico doesn’t automatically get whatever the 50 states get. As Jose Julian Alvarez Gonzalez put it in an article in the International Journal of Legal Information, “Under the doctrine of territorial incorporation, Congress, in legislating for Puerto Rico, may treat it as a state, worse than a state, or better than a state.

The territories, including Puerto Rico, were not included in all the rules of the Affordable Care Act. After the ACA was in place, people found that it wasn’t a great idea to have some parts of the act apply while other parts did not. For one thing, insurance had to be available to all, but there was no “individual mandate” — no requirement that people had to buy health insurance. That meant that many healthy people chose not to buy insurance. The insurance payments of healthy people subsidize the costs of health insurance. Without plenty of healthy young people buying insurance, the costs for insurance companies got out of hand.

Healthcare in Puerto Rico

Puerto Rico has different, and unequal, rules for Medicare and Medicaid, too. Read more about this issue. At its simplest, the situation is this: Puerto Rico gets much less healthcare funding than a state of the same size would. Puerto Rico has to pay for much more of the healthcare costs for its people than any state does.

In addition, Puerto Rico has been losing doctors for years. Hospitals have also been affected by the economic problems in Puerto Rico, so that supplies and other needs are not being met as they should be. People are leaving Puerto Rico in order to have better access to healthcare.

How can Puerto Rico be included?

When Puerto Rico becomes a state, the Island will be treated just as the 50 states are. States have rights and sovereignty. Statehood immediately solves the problem of The American Health Care Act, as well as inequity in Medicare and Medicaid funding.

Until that time, Puerto Rico should have specific language in The American Health Care Act that says how Puerto Rico will be affected. At this point, there are a lot of questions about the act. We don’t know what the act will look like when and if it becomes law.

But Puerto Rico should not have to wait and find out what problems arise, as was the case with the Affordable Care Act. Contact your legislators and let them know that you want Puerto Rico’s position made clear in the The American Health Care Act.



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