People in the U.S. territory of Puerto Rico may not be grappling with the botched Obamacare website rollout, but the program could spell disaster for the island, which is facing a financial crisis and where half the population already is dependent on free health insurance, members of the island's medical community warned.
Puerto Ricans, who are born U.S. citizens, do not enroll on the healthcare.gov because their government decided not to offer health-insurance exchanges, which offers private plans.
Instead, the Affordable Care Act, commonly dubbed Obamacare, has mostly arrived on the island in the form of a $6.3 billion social welfare check allocated to the government to continue to pay for its Medicaid and for its separate, free state-run insurance program called "Mi Salud," between 2014 and 2019.
And that could be disastrous for Puerto Rico.
Roughly 1.7 million Puerto Ricans already depend on free health insurance in the island and local doctors are concerned that the additional financial infusion to the program will make the territory even more dependent on welfare.
Critics in the medical community said the move could prove to be a disaster, considering the U.S. territory is already deemed as the “Next Detroit” and "America's Greece."
The island's government is over $70 billion in debt and about 45 percent of Puerto Ricans have incomes below the U.S. federal poverty line and nearly 40 percent of all households receive food stamps.
Despite the bleak economic outlook, Puerto Rico’s surprisingly low 7.2 percent uninsured rate is actually second-lowest compared to all states, behind Massachusetts.
“Our healthcare system is going to be entirely a welfare system," warned Dr. Guillermo Tirada, an internal medicine specialist in Puerto Rico for 18 years. "It's sad."
Because of its U.S. territory status, Obamacare gave Puerto Rico the choice to either allocate $925 million dollars — of the total $6.3 billion package destined to the island — toward establishing health care insurance exchanges or to opt to use the money to fund its Medicaid program until 2019.
The nearly bankrupt government took the second option and is channeling the funds through "Mi Salud," something critics like Dr. Tirada said was a wrong and desperate step in the government's desperate search for temporary financial relief.
The move, critics said, takes Puerto Rico further away from a free market privatized health care system and speeds up the ongoing exodus of doctors, who are flocking to the U.S. mainland in search of higher salaries and better reimbursements from insurers.
According to Puerto Rico's Medical Licensing and Studies Board, the number of doctors in Puerto Rico dropped by 13 percent in the last five years, from 11,397 to 9,950. The biggest loss was among primary care physicians and specialists.
Dr. Jesus Alvarez, a "maternal fetal medicine specialist," left the island in April. He was one of just five MFM specialists on the island and is now working at Hackensack Medical Center in New Jersey.
"The reimbursement from Medicaid and Mi Salud is abysmal and the public hospitals don’t have the infrastructure to deal with an influx of patients and regulations," Dr. Alvarez said. "For the physicians to survive, they can see 20 patients in one day in the U.S., but in Puerto Rico they have to see 50."
Ricardo Rivera, Puerto Rico's point person in managing the island's Obamacare funding, denied that the objective is government-sponsored universal health care access.
"The end goal is to improve the economy," he told Fox News Latino. "And as people find jobs they will move out of the ‘Mi Salud’ program and into private insurance plans."
Another major concern for doctors like Alvarez and Tirada is that the Puerto Rican government has hired a third party private insurance company, Triple S, to handle claims, billing, and the ins and outs of the government’s public insurance program.
Tirada said putting Obamacare money in the hands of just one private insurance company is going to put profits ahead of patients and physicians.
"The more claims that get denied, the more money the government will save and the more money the private insurer will make," Alvarez said.
But Rivera, who holds the position of executive director of the Puerto Rico Health Insurance Administration, said that he's just as concerned about smart expenditures as anyone else.
"I'm in line with the doctors,” he said, adding that he currently has 16 auditing programs running through his office to make sure those under Medicaid and Mi Salud get quality services.
“I cannot just go on the word of a manage care organization, they have all the incentive in the world to lie to me,” he said.
For now, Puerto Rico has the funding to continue offering public health services, but with unemployment hovering around 15 percent and with 55 percent of the population out of the labor force, the question is how will the island sustain its health care system past 2019.
“We don’t know what’s going to happen but we’re not alone," said Rivera. "We have 50 other states asking the same questions."
Bottom line, he said, it's about striking a balance.
“We are trying to approach how can we maximize all the resources around us and we need the private sector.”