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More bad news for LBJ: Medicaid cuts on horizon

At a time, when the LBJ Medical Center is fighting to keep its doors open, a unified voice from U.S. territorial governors and delegates has failed to block Republicans from reducing Medicaid funding for the territories.

In a 30-21 vote strictly along party lines, the U.S. House Energy and Commerce Committee voted on Wednesday to repeal the Increased Federal Medicaid Funding Cap and Match Rate for Territories, after an amendment to save section 1204 of the health care reform act was offered by Donna Christensen (D-Virgin Islands).

Gov. Togiola Tulafono joined Guam Gov. Eddie Calvo, U.S. Virgin Islands Gov. John P. de Jongh Jr., Puerto Rico Gov. Luis G. Fortuno, and CNMI Gov. Benigno R. Fitial in asking the Energy and Commerce Committee “to vote 'no' on de-funding the territories, the Saipan Tribune reported yesterday.

In the letter to the committee on Tuesday, the governors wrote:

“As governors serving the over 4.5 million Americans who live in the Territories of the United States, we are writing in strong opposition to the proposed elimination of the funding provided to the Territories under the Patient Protection and Affordable Care Act.”

The letter urged Michigan Congressman Frederick S. Upton, Chairman of the House Committee on Energy and Commerce, and fellow House Republicans to abandon plans to deny funding granted to the territories under the Patient Protection and Affordable Care Act.

The historic health care reform law addressed discrimination against the territories and their four and a half million residents that had been maintained through statutory Medicaid caps and matching rates lower than those received by any U.S. state.

These limitations have hindered the access of U.S. citizens in the Territories to adequate health care, while imposing extreme fiscal hardships on severally constrained Territorial health budgets,” the letter states.

“It would be unfair in the extreme to single out the Territories,” the letter notes.

LBJ chief executive officer Mike Gerstenberger told Samoa News that “Medicaid accounts for 35% of our income — if slashed, then either someone else, i.e. the government —will have to pick up that burden, or we will wind up delivering less care. Those are our choices.”


The bill repeals a provision of the Affordable Care Act that provided for $6.3 billion in additional funding for Medicaid in the territories from Fiscal Year 2011 through 2019, and increased the territories' Federal Medical Assistance Percentage (FMAP) from 50 percent to 55 percent.

Republicans crafted the bill to meet spending targets stipulated in the recently-passed Ryan budget resolution, which requires the Energy and Commerce Committee to reduce the deficit by $96.76 billion over the next decade.

The bill was considered by the full Energy and Commerce Committee Wednesday, and is expected to be considered on the House floor in the coming weeks.

A statement Guam Delegate Madeleine Bordallo issued yesterday (portions of which were quoted in The Saipan Tribune) said that the Republican attempt to eliminate critical Medicaid funding for the territories shifts the funding problem back to the territories.

“Rather than working with us to remove the cap by decreasing the local match, the Republicans have reduced our funding. This funding has helped to provide critical services for residents in the territories who depend on Medicaid for health coverage, and the loss of these additional funds would negate important progress made toward reducing health disparities among the territories,” she said.

Bordallo said she has joined with her colleagues from the territories in sending a letter to the Committee chairman to request that he “reconsider” his proposal, which, if enacted, would have many adverse impacts for people residing in the territories.

“We will work to block this bill in the Senate,” she added.

While governors and delegates from CNMI, Guam, Puerto Rico and the U.S. Virgin Islands have issued statements to the media, neither Gov. Togiola Tulafono’s nor Cong. Faleomavaega Eni’s offices had issued releases or responded to questions from Samoa News at press time.


According to the federal Heath and Human Services figures, American Samoa had a Medicaid funding cap of $17.28 million for 2011. This is double what it was in 2007.

In 2011 there was an estimated Medicaid enrollment of 57,982, which is considered 88% of the population.

Faleomavaega explained in a March 2010 media release that under the bill, Section 1204 (the section rejected on Wednesday), “the Territories — Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Marianas Islands — will receive an additional $6.3 billion over a 9-year period in federal funding for Medicaid costs.

“American Samoa will receive $285.5 million in total Medicaid spending for the next 9 years, or an increase of over $180 million,” he said.