Van Hollen, Democratic Senators Warn of Public Health Crisis in Puerto Rico, Urge Health Dept. to Take Action

Today, U.S. Senator Chris Van Hollen joined a coalition of Senators in calling on the U.S. Department of Health and Human Services to provide additional resources and better coordinate efforts on the ground in the face of a growing public health crisis in Puerto Rico and the U.S. Virgin Islands following Hurricanes Irma and Maria to ensure the more than 3.5 million American citizens living there can safely access the quality health care they need.

"Even before Hurricanes Irma and Maria hit the U.S. territories, the islands' health care system was suffering from the ongoing economic crisis. The islands are grappling with physician shortages, Medicaid programs facing an impending funding cliff, and widespread disparities in Federal health programs-and that was before hurricane season," the lawmakers stated in a letter to Acting Health and Human Services Secretary Don Wright. "We are grateful for the public health emergency declaration in Puerto Rico and the U.S. Virgin Islands, but more can and should be done to help Americans impacted by these disasters."

The senators stressed that much of the islands' power and communication networks are out and, according to the Federal Emergency Management Agency (FEMA), it will take months before power is fully restored. Only 17 hospitals in Puerto Rico have electricity, and the two hospitals on the Virgin Islands have been severely damaged. Hospitals have been forced to prioritize patients, ration services, and forgo elective surgeries.

At least 40 lives have been lost, and with scant resources, 100-degree temperatures, and abundant standing water increasing the breeding grounds for disease-carrying mosquitos, there is growing concern the death toll could rise without greater assistance.

"Given the devastation we described, we ask you to provide the necessary support to meet the immediate needs of Puerto Rico and the U.S. Virgin Islands, as well as provide long-term relief," the letter continued. "It is imperative that we do all we can to prevent a large-scale public health crisis from developing by providing the high-level coordination and stewardship of federal resources."

Senator Van Hollen was joined by Senators Bob Menendez (D-N.J.), Bill Nelson (D-Fl.), Kirsten Gillibrand (D-N.Y.), Cory Booker(D-N.J.), Edward Markey(D-Mass.), Tammy Baldwin (D-Wisc.), Elizabeth Warren (D-Mass.), Richard Blumenthal (D-Conn.), Kamala D. Harris (D-Calif.), Martin Heinrich (D-N.M.), Tim Kaine (D-Va.), and Sherrod Brown (D-Ohio).

The lawmakers urged the administration to provide not only immediate relief to the islands' but long-term relief as well, as the islands' begin to recover. Specifically, the letter requests necessary funding and emergency support for the islands' Medicaid programs along with assistance in coordinating and prioritizing electric restoration to hospitals, health clinics, nursing homes, and pharmacies.

As leading voices in Congress to help prevent the collapse of the islands' health care system, the lawmakers argued that the U.S. territories' "Medicaid cliff" will be exacerbated by the recent disasters. In Puerto Rico and the Virgin Islands, the Medicaid program is subject to a block grant that will cap funding during recovery regardless of the greater demand.

"While the territories' Medicaid programs received a one-time increase of $7.3 billion in federal funding to last through 2019, they are spending it at a faster rate than anticipated, with needs only expected to expand in the aftermath of these storms," the letter stated.

The full text of the letter is follows and can be downloaded here.

October 6, 2017

The Honorable Don J. Wright

Acting Secretary

U.S. Department of Health and Human Services

Washington, DC 20201

Dear Acting Secretary Wright:

We write today to request your support in ensuring the dire situation impacting 3.5 million Americans in Puerto Rico and the U.S. Virgin Islands in the wake of Hurricanes Irma and Maria does not become a full-blown public health crisis as well. To that end, we urge HHS to provide the funding, expertise, support and coordination necessary to ensure the islands' residents can access the health care they need as they need it.

Even before Hurricanes Irma and Maria hit the U.S. territories, the islands' health care system was suffering from the ongoing economic crisis. The islands are grappling with physician shortages, Medicaid programs facing an impending funding cliff, and widespread disparities in Federal health programs-and that was before Irma and Maria. We are grateful for the public health emergency declaration in Puerto Rico and the U.S. Virgin Islands, but more can and should be done to help Americans impacted by these disasters.

Recent news reports show that the islands' power and communication networks remain nonfunctional. Only 17 of Puerto Rico's hospitals have electricity. Both hospitals on the U.S. Virgin Islands have been catastrophically damaged with one already condemned by the Army Corps of Engineers. The Governor of the Virgin Islands has publicly indicated his expectation that both will have to be knocked down and rebuilt entirely to be suitable for patient readmissions. Hospitals are rationing services, forgoing elective operations, and making difficult decisions on prioritizing patients due to limited facilities, equipment, medication, communication, fuel and power. The remnants of the storm have complicated relief efforts by making movement on the islands difficult and the standing water has raised concerns about the threat of increasing breeding grounds for mosquitos. To date, forty people have died on both islands and it is imperative we act so that number does not increase.

Compounding these troubles, the Federal Emergency Management Agency indicated it could be months before power is restored. This will have far-reaching consequences. As we know from the tragic deaths of 12 nursing home residents in Florida, the lack of power coupled with the 100-degree temperatures will place at-risk the lives of the islands' oldest and sickest residents. Moreover, we have heard concerns that the power outages have made it difficult for patients to obtain cash to pay for medications and prevented health providers from accessing necessary insurance and provider information.

Moreover, the U.S. territories' "Medicaid cliff" will only be exacerbated by the storms. Medicaid is critically important to hurricane recovery efforts. In the states, Medicaid is structured to respond to public health emergencies and natural disasters. As the needs go up, because program eligibility increases due to lost jobs or homes or health needs grow, federal funding automatically goes up in response. However, the Medicaid programs in Puerto Rico and the U.S. Virgin Islands are subject to a cap that will not adjust at all for the greater demand as the islands recover.

While the territories' Medicaid programs received a one-time increase in federal funding to last through 2019, they are spending it at a faster rate than anticipated, with needs only expected to expand in the aftermath of these storms. For example, under this "Medicaid Cliff" Puerto Rico will be forced to revert to a lower $357.8 million allotment per year once it spends down the supplemental funding, which is far less than what the island actually needs to provide health services for their most vulnerable populations. The islands need adequate resources and our support if they are to recover and rebuild.

Given the devastation we described, we ask you to provide the necessary support to meet the immediate needs of Puerto Rico and the U.S. Virgin Islands, as well as provide long-term relief. We urge you to include the necessary funding and emergency support for Medicaid and other health care programs in any future emergency request your administration submits to Congress. We also ask for your assistance in coordinating with the islands to restore power and communication to priority locations, such as hospitals, nursing homes, health clinics, pharmacies, dialysis facilities, claims offices, among others to help restore the islands' health infrastructure. These facilities are responsible for meeting the islands evolving health demands and responding to public health concerns, including the Zika virus.

Furthermore, we encourage you to deploy individuals trained in disaster management of health care systems to coordinate with local officials and the U.S. military to best meet the needs of the various health care providers, ensure efficient distribution of resources, and rapidly respond to the islands' shifting health care needs.

The challenges facing Puerto Rico and the U.S. Virgin Islands are extraordinary and the road to recovery will be long and hard. It is imperative that we do all we can to prevent a large-scale public health crisis from developing by providing the high-level coordination and stewardship of federal resources. We stand ready to work with the Administration to ensure Puerto Rico and the U.S. Virgin Islands emerge from this tragedy.

Sincerely,