A lawsuit filed in federal court seeks to have the manner in which Congress allocates health funds in Puerto Rico as unconstitutional, claiming discrimination against the US citizens living in the island.

Consejo de Salud de Puerto Rico, Inc. (Med Centro) and two Medicaid beneficiaries appeared before federal court to demand parity in fund allocations for Medicaid, Medicare, and the State Children’s Health Insurance Program (SCHIP).

The legal action claims that Congress is violating the Fifth Amendment to the United States Constitution by affording a different and discriminatory treatment in the allocation of health funds in Puerto Rico, which is why the plaintiffs ask the court to intervene, so as to put a halt to ‘the continued pattern of discrimination [that] will perpetuate a second-class health care system for United States citizens residing in Puerto Rico.’

According to the complaint, Congress is penalizing US citizens living in Puerto Rico by treating them differently from citizens living in other states. The document remarks that, for all intents and purposes, Puerto Rico is an incorporated territory, and that its citizens have the same rights as all other citizens living in the 50 states.

‘The de facto Congressional incorporation of Puerto Rico throughout the past century has extended the entire Constitution to the island, and today entitles the territory and United States citizens residing in Puerto Rico to the enjoyment of all rights and obligations under the Constitution. Under the Equal Protection Clause, a heightened level of scrutiny is available to protect the United States citizens living in Puerto Rico from discriminatory federal legislation,’ reads the complaint.

It has been said that, if the court refuses to intervene, Puerto Rico will not have the funds it needs to continue operating the public health system this year. Consejo de Salud de PR (Med Centro) is a non-profit corporation that offers primary health care services through federal funding, as part of the Section 330 Federal Health Center Program.

‘Puerto Rico is facing an imminent Medicaid funding crisis, putting nearly one million United States citizens at risk of losing their health-care coverage,’ states the complaint, which was filed by Med Centro, Eduardo Martínez Tull, and Víctor Montalvo Martell against US Health Secretary Alex M. Azar.

The lawsuit also raises concerns regarding the fact that, contrary to the way health funds are allocated in the states (according to a formula based on per capita income), funds are allocated in the island by means of a set statute with a maximum limit. This means that Puerto Rico is receiving less money than it is entitled to. The document reiterates that Puerto Rico is the jurisdiction with the lowest per capita income in all of United States.

It also argues that the island showed a poverty rate of 46.2% in 2014, the highest in the US, which means it should receive the maximum federal medical assistance percentage allowable (83%), instead of the cap imposed by Congress.

The complaint adds that the economic development task force created by PROMESA acknowledged that the disparity in federal health funds has exacerbated the island’s financial woes.

According to the plaintiffs, Puerto Rico is receiving a discriminatory treatment when such a cap is imposed for health fund allocations, and they demand an allocation of $2.1 billion, which is what the island should receive to take care of its disadvantaged populations. Some of the changes implemented in the health reform launched by former President Barack Obama had increased the funds received since 2010, although it was still less than what should have been allocated. Besides, these funds are ending in

2018.

‘Plaintiff Med Centro is required to provide health care services to Medicaid beneficiaries in the same

manner as if it were located in any of the 50 States,’ the document points out.

It emphasizes that discriminating against Puerto Ricans has affected the most vulnerable members of society –children, seniors, and people with low resources, — since more than half the population receives health care services through Medicaid funds.

The complaint says that the consequences of having an inadequate health fund allocation system will affect ‘the weakest link on the chain in the healthcare system: providers and patients.’