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Navigating Recovery: Health Care Financing and Delivery Systems in Puerto Rico and US Virgin Islands

Issue Brief
  1. Congressional Task Force on Economic Growth in Puerto Rico, Report to the House and Senate, December 20, 2016, https://www.finance.senate.gov/imo/media/doc/Bipartisan%20Congressional%20Task%20Force%20on%20
    Economic%20Growth%20in%20Puerto%20Rico%20Releases%20Final%20Report.pdf
    .

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  2. Peter Shin, Jessica Sharac, Marie Nina Luis, and Sara Rosenbaum, Puerto Rico’s Community Health Centers in a Time of Crisis, (Washington, DC: The George Washington University, Milken Institute School of Public Health, Department of Health Policy and Management, December 2015), https://publichealth.gwu.edu/sites/default/files/downloads/GGRCHN/Policy%20Research%20Brief%2043.pdf.

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  3. Richard V. Reeves and Katherine Guyot, Keeping our PROMESA: What the U.S. can do about Puerto Rico’s Fiscal Crisis, (Washington, DC: The Brookings Institution, September 2017), https://www.brookings.edu/research/keeping-our-promesa-what-the-u-s-can-do-about-puerto-ricos-fiscal-crisis/.

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  4. Congressional Task Force on Economic Growth in Puerto Rico, Report to the House and Senate, December 20, 2016, https://www.finance.senate.gov/imo/media/doc/Bipartisan%20Congressional%20Task%20Force%20on%20
    Economic%20Growth%20in%20Puerto%20Rico%20Releases%20Final%20Report.pdf
    .

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  5. Jeremy W. Peters, “In the Virgin Islands, Hurricane Maria Drowned What Irma Didn’t Destroy,” New York Times (September 27, 2017), https://www.nytimes.com/2017/09/27/us/hurricane-maria-virgin-islands.html.

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  6. Josh Michaud and Jennifer Kates, Public Health in Puerto Rico after Hurricane Maria, (Washington, DC: Kaiser Family Foundation, November 2017), https://www.kff.org/other/issue-brief/public-health-in-puerto-rico-after-hurricane-maria/.

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  7. Ibid.

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  8. “Evidence Indicates a Range of Challenges for Puerto Rico Health Care System,” U.S. Department of Health and Human Services (HHS), Office of the Assistant Secretary for Planning and Evaluation (ASPE), January 2017, https://gonzalez-colon.house.gov/sites/gonzalezcolon.house.gov/files/wysiwyg_uploaded/Puerto%20Rico%20Assessment--Embargoed.pdf.

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  9. Ibid.

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  10. “Virgin Islands Health Information Exchange Strategic & Operational Plan”, Response to Health Information Technology State Grant Program, January 15, 2011.  https://www.healthit.gov/sites/default/files/usvi-hie-sop_12-15-11.pdf

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  11. “Puerto Rico Medicaid and CHIP Program Information,” Centers for Medicare and Medicaid Services (CMS), accessed November 21, 2017, https://www.medicaid.gov/medicaid/by-state/puerto-rico.html.

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  12. “Medicaid and CHIP in Puerto Rico,” Medicaid and CHIP Payment and Access Commission (MACPAC), October 2017,   https://www.macpac.gov/publication/medicaid-and-chip-in-puerto-rico/.

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  13. The additional Marketplace funds are also available through FY 2019 and can only be accessed after the first source of ACA funding has been depleted.

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  14. “Medicaid Financing and Spending in Puerto Rico,” Medicaid and CHIP Payment and Access Commission (MACPAC), August 2017, https://www.macpac.gov/publication/medicaid-financing-and-spending-in-puerto-rico/ and “Medicaid Financing and Spending in the US Virgin Islands,” Medicaid and CHIP Payment and Access Commission (MACPAC), August 2017, https://www.macpac.gov/publication/medicaid-and-chip-in-the-u-s-virgin-islands/.

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  15. “Medicaid Financing and Spending in Puerto Rico,” Medicaid and CHIP Payment and Access Commission (MACPAC), August 2017, https://www.macpac.gov/publication/medicaid-financing-and-spending-in-puerto-rico/.

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  16. Medicaid Financing and Spending in the US Virgin Islands,” Medicaid and CHIP Payment and Access Commission (MACPAC), August 2017, https://www.macpac.gov/publication/medicaid-and-chip-in-the-u-s-virgin-islands/.

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  17. Congressional Task Force on Economic Growth in Puerto Rico, Report to the House and Senate, December 20, 2016, https://www.finance.senate.gov/imo/media/doc/Bipartisan%20Congressional%20Task%20Force%20on%20
    Economic%20Growth%20in%20Puerto%20Rico%20Releases%20Final%20Report.pdf
    .

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  18. Congressional Task Force on Economic Growth in Puerto Rico, Report to the House and Senate, December 20, 2016, https://www.finance.senate.gov/imo/media/doc/Bipartisan%20Congressional%20Task%20Force%20on%20
    Economic%20Growth%20in%20Puerto%20Rico%20Releases%20Final%20Report.pdf
    .

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  19. Trevor Houser and Peter Marsters, America’s Biggest Blackout, (New York, NY: Rhodium Group, October 2017), http://rhg.com/notes/americas-biggest-blackout.

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  20. Frances Robles, Kenan Davis, Sheri Fink, and Sara Almukhtar, “Official Toll in Puerto Rico: 64. Actual Deaths May Be 1,052,” New York Times (December 9, 2017), https://www.nytimes.com/interactive/2017/12/08/us/puerto-rico-hurricane-maria-death-toll.html?_r=0.

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  21. United States Senate, Committee on Energy and National Resources Hearing, Hurricane Recovery Efforts in Puerto Rico and the U.S. Virgin Islands, November 14, 2017, statement of Hon. Ricardo Rosselló, Governor of Puerto Rico, https://www.energy.senate.gov/public/index.cfm/files/serve?File_id=EFF569D6-FA29-414D-9538-E4B9D02D6F43; United States Senate, Committee on Energy and National Resources Hearing, Hurricane Recovery Efforts in Puerto Rico and the U.S. Virgin Islands, November 14, 2017, statement of Kenneth E. Mapp, Governor of U.S. Virgin Islands, https://www.energy.senate.gov/public/index.cfm/files/serve?File_id=A2538A49-2953-4BA1-8C94-0807E62050A5.

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  22. United States Senate, Committee on Energy and National Resources Hearing, Hurricane Recovery Efforts in Puerto Rico and the U.S. Virgin Islands, November 14, 2017, statement of Kenneth E. Mapp, Governor of U.S. Virgin Islands, https://www.energy.senate.gov/public/index.cfm/files/serve?File_id=A2538A49-2953-4BA1-8C94-0807E62050A5.

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  23. Ibid.

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  24. H.R. 569/H.R. 2266: Congress passes $36.5 billion aid package on 10/24/17. Signed by President on 10/26/17. (https://www.congress.gov/bill/115th-congress/house-bill/2266/actions) and H.R. 601: Congress passes $15 billion in hurricane relief on 9/8/2017. Signed by President on 9/8/2017. (https://www.congress.gov/bill/115th-congress/house-bill/601/actions).

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  25. Thomas Kaplan, “White House Requests More Disaster Aid but Also Seeks Cuts as Deficits Rise,” New York Times (November 17, 2017), https://www.nytimes.com/2017/11/17/us/politics/trump-disaster-relief-hurricanes-wildfire-tax-cuts.html?_r=0.

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  26. “Hurricane Maria Update,” Federal Emergency Management Agency (FEMA), October 19, 2017, https://www.fema.gov/news-release/2017/10/19/4339/hurricane-maria-update.

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  27. “Hurricane Irma and Maria Response,” U.S. Army Corps of Engineers, November 15, 2017, http://www.usace.army.mil/Hurricane-Irma/Daily-Progress-Graphic/.

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  28. “Puerto Rico Begins the Transition from Response to Recovery,” Federal Emergency Management Agency (FEMA), November 27, 2017, https://www.fema.gov/news-release/2017/11/27/4339/puerto-rico-begins-transition-response-recovery.

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  29. Robert Kadlec, “Providing Care and Restoring Health Services in Puerto Rico,” U.S. Department of Health and Human Services (HHS), Office of the Assistant Secretary for Preparedness and Response (ASPR) Blog, October 19, 2017, https://www.phe.gov/ASPRBlog/pages/BlogArticlePage.aspx?PostID=286.

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  30. Ibid.

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  31. Robert Kadlec, “Providing Care and Restoring Health Services in Puerto Rico,” U.S. Department of Health and Human Services (HHS), Office of the Assistant Secretary for Preparedness and Response (ASPR) Blog, October 19, 2017, https://www.phe.gov/ASPRBlog/pages/BlogArticlePage.aspx?PostID=286; “HHS Activates Aid for Uninsured U.S. Islands Residents Needing Medicine,” U.S. Department of Health and Human Services (HHS), November 2, 2017, https://www.hhs.gov/about/news/2017/11/02/hhs-activates-aid-uninsured-us-virgin-islands-residents-needing-medicine.html.

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  32. “Hurricane Harvey Medicaid and Children’s Health Insurance Program (CHIP) Frequently Asked Questions,” Texas Health and Human Services Commission, November 22, 2017, https://apps.hhs.texas.gov/documents/hurricane-harvey-faq.pdf.

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Appendix
  1. The World Factbook, 2017. Washington, DC: Central Intelligence Agency, Accessed November 2017, https://www.cia.gov/library/publications/the-world-factbook/index.html.

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  2. 50 States and DC and Puerto Rico Estimates: U.S. Census Bureau; 2016 American Community Survey 1-Year Estimates, Table S0501; using American FactFinder, http://factfinder.census.gov. U.S. Virgin Islands Estimates: U.S. Census Bureau; 2010 Census of the Island Areas, Table DP-2; using American FactFinder, http://factfinder.census.gov.

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  3. The World Factbook, 2017. Washington, DC: Central Intelligence Agency, Accessed November 2017, https://www.cia.gov/library/publications/the-world-factbook/index.html.

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  4. 50 States and DC and Puerto Rico Estimates: U.S. Census Bureau; 2016 American Community Survey 1-Year Estimates, Table B03002; using American FactFinder, http://factfinder.census.gov. U.S. Virgin Island Estimates: U.S. Census Bureau; 2010 Census of the Island Areas, Table DP-1; using American FactFinder, http://factfinder.census.gov.

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  5. The World Factbook, 2017. Washington, DC: Central Intelligence Agency, Accessed November 2017, https://www.cia.gov/library/publications/the-world-factbook/index.html.

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  6. 50 States and DC and Puerto Rico Estimates: U.S. Census Bureau; 2016 American Community Survey 1-Year Estimates, Table DP03; using American FactFinder, http://factfinder.census.gov. U.S. Virgin Island Estimates: U.S. Census Bureau; 2010 Census of the Island Areas, Table DP-3; using American FactFinder, http://factfinder.census.gov.

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  7. Reported for adults 18 and older. Kaiser Family Foundation analysis of the 2016 Behavioral Risk Factor Surveillance System.

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  8. Birth Rate and Life Expectancy Estimates: The World Factbook, 2017. Washington, DC: Central Intelligence Agency, Accessed November 2017, https://www.cia.gov/library/publications/the-world-factbook/index.html. Other Health Status Estimates: Reported for adults 18 and older. Kaiser Family Foundation analysis of the 2016 Behavioral Risk Factor Surveillance System.

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