LEGISLATIVE RESOLUTION memorializing the United States Congress to pass
and the President to sign both the Improving the Treatment of the U.S.
Territories Under Federal Health Programs Act of 2015 (H.R. 2635), and
the Puerto Rico Chapter 9 Uniformity Act of 2015 (H.R. 870)

WHEREAS, It is the sense of this Legislative Body to memorialize the
United States Congress to pass and the President to sign both the
Improving the Treatment of the U.S. Territories Under Federal Health
Programs Act of 2015 (H.R. 2635), which would make improvements to the
treatment of the United States territories under the Medicare and Medi-
caid programs, and the Puerto Rico Chapter 9 Uniformity Act of 2015
(H.R. 870); and
WHEREAS, According to the 2010 Census, Puerto Ricans make up 9% of New
York City's total population and New York State contains 23% of all
Puerto Ricans in the United States; and
WHEREAS, Puerto Ricans are United States citizens who pay the same
Medicare taxes, yet the island receives less healthcare funding than any
of the 50 states; and
WHEREAS, Enrollment numbers show that up to 60% of the Island's popu-
lation receives their health care through Medicare, Medicare Advantage
or Medicaid; and
WHEREAS, Even though these public programs are such a large portion of
Puerto Rico's health care industry, practitioners receive much smaller
Medicare and Medicaid reimbursement rates than those received by their
counterparts on the mainland; and
WHEREAS, The amount of funding that the federal government provides to
support the Medicaid program in territories is capped although there is
no limit in matching funds for states; and
WHEREAS, The federal contribution to states for Medicaid ranges from
50% for the wealthiest states to 83% for the poorest states, however
territories are capped at 50%; and
WHEREAS, The situation is so bad that some advocates estimate that one
doctor a day leaves Puerto Rico to go work in the states; and
WHEREAS, One study found that compared with hospitals in the states,
hospitals in the U.S. territories have significantly higher 30-day
mortality rates and lower performance levels on every standard of care
measured in the study; and
WHEREAS, The Patient Protection and Affordable Care Act (ACA) of 2010
provided $6.4 billion in additional Medicaid funding to Puerto Rico from
Fiscal Year 2011 to the end of Fiscal Year 2019; and
WHEREAS, With this additional funding running out in the coming years
and the territory's current disastrously low funding rate, Puerto Rico
will have to come up with billions of dollars starting in 2018 or
dramatically reduce its Medicaid program; and
WHEREAS, Puerto Rico is currently facing one of the greatest fiscal
and economic crises in its modern history and the austerity measures
needed for its fiscal well-being are sure to take a toll on public
health services; and
WHEREAS, Pedro R. Pierluisi, Puerto Rico's resident commissioner to
the U.S. Congress, introduced the Improving the Treatment of the U.S.
Territories Under Federal Health Programs Act of 2015 (H. R. 2635); and
WHEREAS, Starting in Fiscal Year 2017, the bill would provide the
territories, including Puerto Rico, with state-like treatment by elimi-
nating the funding cap for Medicaid and calculating reimbursement based
on a territory's per capita income; and
WHEREAS, H.R. 2635 would amend the Social Security Act to include the
territories in the Medicaid disproportionate share hospital program

(which provides funding to hospitals that treat a high percentage of
low-income and uninsured patients), from which they have always been
excluded; and
WHEREAS, The legislation would also improve the formula for the Medi-
care disproportionate share hospital program in Puerto Rico, as the
current formula calculates payments based on the number of patients
enrolled in the federal Supplemental Security Income program, a program
that was not extended to Puerto Rico; and
WHEREAS, H. R. 2635 would also change the base rate for Puerto Rico's
hospitals to be equal to those in the states; and
WHEREAS, The bill would establish a reasonable floor for Medicare
payments to compensate for a Medicare formula that many believe is
disadvantageous to Puerto Rico and results in insufficient payments to
physicians; and
WHEREAS, H. R. 2635 would also cut in half the annual fee on insurers
in territories that was created in the ACA, since the purpose of the fee
was to help offset the cost of the ACA and territories are not eligible
for many of the benefits provided in the ACA; and
WHEREAS, If the government does not intervene, hundreds of thousands
of patients in Puerto Rico could see a dramatic decrease in their
healthcare coverage; and
WHEREAS, We need to act now to save Puerto Rico's healthcare system;
and
WHEREAS, The Commonwealth of Puerto Rico is struggling with a weak
economy, declining population and crushing debt obligations; and
WHEREAS, The unemployment rate in Puerto Rico has remained consistent-
ly high and currently stands at around 11.6%; and
WHEREAS, According to the U.S. Census, Puerto Rico's poverty rate is
about 45% or nearly twice that of Mississippi, the poorest state in the
Union; and
WHEREAS, Puerto Rico's financial plight is also distressing to the
many New York City residents who have called the island their home, or
have family and friends who live there; and
WHEREAS, Due to economic pressures the Puerto Rican population has
declined, in contrast to the U.S. population which has increased; and
WHEREAS, Puerto Rico holds over $73 billion dollars in public sector
debt, much of which is held by its state-run corporations, such as the
Puerto Rico Electrical Power Authority; and
WHEREAS, Puerto Rico is neither an independent nation, nor a U.S.
state, but rather a U.S. territory; and
.SO DOC A R1082 RESO TEXT 2015
WHEREAS, Puerto Rico may not manipulate its currency to satisfy debt
obligations as an independent nation might; and
WHEREAS, According to U.S. law, as currently written, Puerto Rico's
municipalities, and their publicly-owned corporations, may not claim
bankruptcy in the way that the municipalities of states, such as
Detroit, may; and
WHEREAS, In an effort to fill the gap in the law, the Puerto Rican
government passed the Puerto Rico Public Corporations Debt Enforcement
and Recovery Act ("Recovery Act"), which would have authorized certain
government-owned corporations to restructure their debt; and
WHEREAS, In February of 2015, a court ruled the Recovery Act was
inconsistent with federal law; and
WHEREAS, Without the Recovery Act or access to bankruptcy, Puerto
Rico, and its residents-who are United States citizens-will be unable to
avail themselves of orderly and established bankruptcy processes common
under federal law; and

WHEREAS, The Puerto Rico Chapter 9 Uniformity Act of 2015 would amend
Title 11 of the United States Code to treat Puerto Rico as a state for
the purposes of adjusting the debts of municipalities; and
WHEREAS, Access to bankruptcy for the Commonwealth would provide an
orderly, established, process for both debtors and creditors that
balances public and private interests; now, therefore, be it
RESOLVED, That the Congress of the United States be and hereby is
respectfully memorialized by this Legislative Body to pass and the Pres-
ident to sign both the Improving the Treatment of the U.S. Territories
Under Federal Health Programs Act of 2015 (H.R. 2635), and the Puerto
Rico Chapter 9 Uniformity Act of 2015 (H.R. 870); and be it further
RESOLVED, That copies of this Resolution, suitably engrossed, be tran-
smitted to the President of the Senate of the United States, the Speaker
of the House of Representatives, and to each member of the Congress of
the United States from the State of New York.