Some clarity on the population without a medical plan in Puerto Rico


Neither the Ministry of Health nor the Health Insurance Administration (ASES) knows the exact number of people without health insurance in Puerto Rico, while initiatives to increase coverage for this population are just beginning.

in interview with Subway, Secretary of Health, Carlos Melado LópezYou Edna Marin Ramosi, Executive Director of ASESIt is estimated that the number of people without medical coverage will be around 240,000 to 300,000 people, or the equivalent of 10 to 13% of the population. However, he reiterated that it is difficult to determine the exact number due to a series of factors such as job loss, migration and acceptance of government health cards, Plan Vital.

In an opinion piece published this week SubwayFormer Health Director of the Municipality of San Juan and specialist in health system models, Ibrahim Perez, proposed a drastic reduction in employment-related health insurance. Data provided by Perez used Insurance Commissioner Alexander Adams To calculate in a recent press interview that 600,000 people in Puerto Rico are without health insurance. The data used by the doctor for the calculation was approximately 642,000 Puerto Ricans with work-related health insurance and was compared to the population estimate for the 2021 census survey, as well as d Other Groups Covered by Medicare. However, neither Adams nor the Health Secretary provided this outlet with an official number of people without health insurance or employer or business insurance.

“It’s something that’s always been a bit complicated, because it’s a number that fluctuates a lot, especially when changes have been made, for example, where Vital’s poverty rate has gone from 55% to 85% . (to be eligible),” insisted Melado López.

The Health Secretary said Governor Pedro Pierlusi’s public policy in Urrutia is to expand coverage to bring that level of poverty to 100%. However, Salud cannot prepare this proposal or any other proposal because it does not have the economic capacity to do so and depends on the money that the United States Congress decides to allocate.

“We are always on the lookout for how much federal money they are going to give us. In recent years we have seen that they only give us one year. In other words, I have to assume that I might not have any money next year. (…) I know that many people have proposed different models, but it must be understood that the model that is made must be approved by the federal government, because that is what brings us the most money. ”, lamented Melado López, indicating that the cost for the health system is approximately 4.2 billion dollars.

ASES data indicates that there are 1,277,348 beneficiaries of the vital regime. Add to that business plans, also called private medical plans, which cover 600,000 to 700,000 people.

In a vital plan, the insured life is distributed as follows:

  • First medical: 324,569
  • Mennonites: 172,759
  • mm: 318 927
  • Triple-S: 461,093

The outlet had requested annual data on the number of people insured under government-administered programs since the health reform was approved in 1993, but it was not received by the end of this edition.

According to Marin Ramos, another option would be to integrate cheaper coverage within Vital to reach the 10% of the disadvantaged population, but this is not a proposal for the immediate future, as this would require “staff”. , analyze and budget what they don’t have.

“We want to see how we can do something to make that number as small as possible. It requires a conversation, you have to build a project that we have, that we already have. There is something there and we want to see and then start working on that and then estimate at an actuarial level how much it will cost to see if we can eventually combine with the private sector, that they enter the private market. We have insurers, that they can accompany us to develop a project, towards a product at a lower cost than what they already have on a regular political market”, describes Marin Ramos.

Health and ASES officials stressed that no health center can deny services to a person even if they do not have a medical plan. Likewise, he highlighted the work carried out by 330 centers in different municipalities and mentioned it as a care option, even if it was limited.

who are they

According to the Insurance Commissioner, Puerto Rico is one of the cities where the majority of the population (90%) has a medical plan. Among them, the Vital plan represents 45%.

For the uninsured, according to the commissioner, this group is mainly made up of middle-class and petty-bourgeois university students.

“These are people who are in the labor market, but their personal income is not sufficient to cover the cost of the premium for a private medical plan and they generate income above the standard required to benefit from the critical plan. Certainly, because it is something that needs to be addressed, as we need to look for alternatives so that the whole population can have medical coverage,” Adams said.

For Adams, one option would be to relax federal regulatory standards to expand eligibility for a vital plan, an option that remains entirely in the hands of the US government, or to create less comprehensive and cheaper coverage. For.

Reduced occupational health insurance

Another variable to consider, according to Melado López, is to increase incentives for employers to contribute to the medical insurance of their employees. However, it also lacks the necessary data to guarantee its successful execution.

In this sense, Melado López and Marin Ramos confirmed that employer contributions to the Medicare plan have decreased significantly.

“Yes, of course, he came down. But, for example, right now I think (the contribution) is between 100 and 150 dollars. Maybe the person can put in $100, $150 more and that’s more or less the premium we have. We have a premium of $240 or $245 per month. I mean, it depends. A study should be done to see what the cost would be for a population that does not know what risk should be considered,” said Melado López.

For Gabriel Maldonado Gonzalezzo, Secretary of the Department of Labor and Human Resources (DTRH)Offering health insurance plans is a plus at job fairs and “in many cases, employers offer more than the minimum required by law in terms of wages and benefits in order to be more competitive in the labor market.

The secretary said that according to a survey of skills and occupations in high demand conducted by the Assistant Secretariat for Statistics and Publications, DTRH, 22.8% of the 4,000 employers surveyed in 2020 provided a medical plan to their employees. newly recruited.

This number is the highest percentage in the “benefits” line of employment, since only 13.1% offered leave of absence of more than 15 days, 12.6% offered productivity bonuses and 11.8% offered life insurance and retirement plans.

“Incentives such as better pay, medical plans, hiring bonuses and growth opportunities, as well as other non-economic issues such as training, performance recognition and remote or hybrid work options , are also effective as soon as a candidate arrives at the job fair. OR Otherwise, lead their search for work options that would benefit them,” Maldonado Gonzalez said.

Manuel Guillama Capella collaborated on this story.

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