Author Affiliation: Department of Health & Human Services, Centers for Medicare & Medicaid Services, New York, New York.
Congress has played a major role in shaping the financing of health care services since the passage of the Social Security Act of 1965. Laws involving Medicare and Medicaid often include language about application in the US territories. Typically, formulas used for territorial Medicaid allocations direct most funding to Puerto Rico, the largest territory. With a population of 4 million, Puerto Rico accounts for 90% of the total territorial population and has a larger population than 26 US states and Washington, DC. This leads the US Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands, with population sizes between 70 000 and 170 000 people, to raise concerns about the impact of the current allocation methodology on their ability to strengthen a fragile health care infrastructure and respond to the changing demands of medical practice and service delivery.
Gutierrez N. Understanding Health Care Disparities in the US Territories. Arch Intern Med. 2011;171(17):1579-1581. doi:10.1001/archinternmed.2011.305