Wednesday, September 28, 2022

A little clarity about the population without a medical plan in Puerto Rico

Neither the Department of Health nor the Health Insurance Administration (ASES) is aware of 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 Metro, Health Secretary, 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 between 10% and 13% of the population. However, he reiterated that it is difficult to pinpoint the exact number due to a range of factors such as job loss, migration and acceptance of government health cards, Plan Vital.

In an opinion column published this week MetroFormer Director of Health of the Municipality of San Juan and Scholar of Health System Models, Ibrahim Perez, proposed a drastic reduction in employment linked 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 about 642,000 Puerto Ricans with work-related health insurance and was compared with the population estimate for the 2021 Census Survey, as well as with other groups under Medicare insurance coverage. , However, neither Adams nor the Secretary of Health provided this medium with an official number of people without health insurance or employer or commercial insurance.

“It’s something that has always been somewhat complicated, because it’s a number that fluctuates a lot, especially when changes were made, for example, where Vital’s poverty level rose from 55 to 85 percent. (to be eligible)”, insisted Melado López.

The health secretary said Governor Pedro Pierlusi’s public policy of Urrutia lies in expanding coverage to raise that level of poverty to 100%. However, Salud cannot prepare this or any other proposal because it lacks the economic capacity to do so and relies 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 give us only one year. In other words, I have to start with the premise that I might not have money next year. (…) I know that many people have proposed different models, but it has to be understood that the model that is made must be approved by the federal government, because it is what gives us the biggest money Used to be. ,” lamented Melado López, indicating that the cost to the health system is about $4.2 billion.

ASES data indicates that there are 1,277,348 beneficiaries of the vital scheme. Add to this business plans, also known as private medical plans, that cover 600,000 to 700,000 people.

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

  • First Medical: 324,569
  • Mennonite: 172,759
  • mmm: 318,927
  • Triple S: 461,093

The medium had requested annual data on the number of people insured under government-administered programs since the approval of health reform in 1993, but they were not received at the end of this edition.

According to Marin Ramos, another option would be to incorporate a less expensive coverage within Vital to reach the 10% of the population that is disadvantaged, but this is not a proposal for the immediate future, as it would require a “staff”. , analyze and budget what they do not have.

“We want to see how we can do something to make that number as small as possible. It requires a conversation, it needs to build a project that we have, we already have.” There is something and we want to see, 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 support us to develop a project, towards a product at a lower cost than what they already have in a regular policy market”, described Marin Ramos.

Health and ASES officials stressed that no health center can deny service to a person even if he does not have a medical plan. Similarly, he highlighted the work done by 330 centers in different municipalities and mentioned it as an option for care, though 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 is 45%.

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

“They are people who are in the workforce but their income out of pocket is not enough to be able to cover the premium cost of a private medical plan and they generate income above the standard required to qualify for the critical plan. Certainly, because this is something that needs to be addressed, to the extent that we have to look for alternatives so that the entire population can get medical coverage,” Adams said.

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

Reduces occupational health insurance

Another variable to consider, according to Melado López, is increasing incentives for employers to contribute to their employees’ medical insurance. However, it also does not have the data to guarantee its successful execution.

Along these lines, both Melado López and Marin Ramos confirmed that employer contributions to the Medicare plan have decreased significantly.

“Yes, of course it has come down. But, for example, right now I think (contribution) is between 100 and 150 dollars. Maybe the person can put $100, 150 more and that’s more or less the premium that 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 is not sure how much risk should be considered,” said Melado López.

For Gabriel Maldonado Gonzalezzo, Secretary of the Department of Labor and Human Resources (DTRH)Offering Medicare plans is an asset at job fairs and “in many instances, 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 Greater Demand conducted by the Assistant Secretariat of Statistics and Publications, DTRH, 22.8% of the 4,000 employers interviewed in 2020 provided a medical plan to their newly recruited employees.

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

“Incentives such as better pay, medical plans, recruitment bonuses and growth opportunities, along with other non-economic issues such as training, performance recognition and remote or hybrid work options, are also effective the moment an applicant arrives at the fair of employment. OR Otherwise conduct their search for work options that would benefit them,” Maldonado Gonzalez said.

Manuel Guillama Capella collaborated on this story.

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