1098: Puerto Rico’s Health Care Crossroads

JOHN SHEEHAN:

This is Public Health Review Morning Edition for Thursday, April 2, 2026. I'm John Sheehan with news from the Association of State and Territorial Health Officials.

Today, we hear about the urgent challenges facing Puerto Rico's health care system. We're joined by Dr. Victor Ramos, secretary of health for Puerto Rico, who will discuss the looming expiration of enhanced Medicaid funding in 2027, a shift that could strip away a third of Puerto Rico's health care resources and force difficult decisions about services, staffing, and access to care. I spoke with Dr. Ramos at this year's recent Spring Leadership Forum in Washington, D.C.

Dr. Victor Ramos, welcome to the show.

VICTOR RAMOS:

Thank you for inviting me to the show.

SHEEHAN:

Absolutely. So, Victor, what are you seeing at this year's Leadership Forum and what were you hoping to see?

RAMOS:

I think that it's a very complete forum that you have the part with the Congress, the part with the Administrative Department of the Executive Branch, and all the policy issues that has to work during all the year with different calls that we have all the years. And also, I thought it's very, very important for us for seeing what's happening in D.C. because we have in Puerto Rico, we have a Director of Puerto Rico Federal Affairs Office, and they have the lobbyists, but the people of Puerto Rico lobbyists not only help lobbyist status, electrical grid, PROMESA, and the fiscal board, many things. And sometimes what ASTHO’s saying that is going to happen soon, the first thing that we heard is by ASTHO about cutting the funds and then started moving to not happen that different things. And I think that ASTHO is important for me.

SHEEHAN:

We on this talk, show what happened in D.C. And I get the sense that you sort of just answered this, but from your perspective in your role, the Secretary of Health, what are you seeing as some of the biggest strains on your health system?

RAMOS:

Now we have in September 2027, the finish of the Medicaid deal that unless the other territories, we have 76% not permanent, only temporal FMAP. If we go down to 55%, we're going to lose about one third of the money and need to get people out, service out, that we are working soon with that, with the Governor Cray, a very big group that include the government sector, the private health sector, the private commerce to go on lobby to the Congress that we are doing before and work to try to at least extend what we have now. But also, we think that with our poverty labor, we apply with the 83%, that is the most high in the Medicaid. And also we have program that not having in the island, for example, the long-term care that is very important for the people. We don't have the service and the Medicare saving program that is Part B of Medicare, which Medicaid fund to the patient are duals. The people of Puerto Rico, that's us, need to pay $202 every month for paying the part B. In the United States, it's paid by the Medicare saving program. We also don't have low income subsidy. And what happened? Not only migrate the physician and the other healthcare provision, migrate the patient. If the patient needs, for example, long-term care, move to a state and have apply for SSI, SNAP and some service that we don't have in Puerto Rico, as it's more expensive for the United States than giving out the adequate money for running correct healthcare system in Puerto Rico. And we are now in this process. We also have different on the other island. We have Medicare Advantage. We have a lower benchmark than all the place in the United States, including the other islands. And it's not really a reason for that happen. And we try to fix that in CMS. And we are working to change that on CMS. The other thing that are working in Puerto Rico is now with the military service. There are many more soldiers are in Puerto Rico and in the waters near Puerto Rico. The medical center of Puerto Rico, we receive all the soldiers from the island and from the chiefs by helicopter when have some medical issues. And we treated them in the medical center. And we more able to do that for the nation. But we think that we need to treat fair in the Medicare and Medicaid side.

SHEEHAN:

And what do you predict will happen when the enhanced Medicaid match expires in September? What is that going to mean on the ground?

RAMOS:

We are going to work that since now, since the governor created the committee one month ago for go early to do the job and at least extend what we had. When the governor previously was resident commissioner, when she arrived to position in two months, come the Medicaid cliff and everybody needs to run to fix that. And now we have time for doing the actuary of issues, the data that they need, the actuary of sense that they need for what we need for Medicaid. I think that we're going to do the process. I'm going to at least extend what we have.

SHEEHAN:

What does a long-term fix look like? What does Congress need to do?

RAMOS:

I think that really need to get the permanent FMA for all the territories and eliminate the gap. Definitely is what is for me the same that as the state.

SHEEHAN:

And what kind of messages does ASTHO and federal elected officials need to hear to keep this agenda going?

RAMOS:

I think that ASTHO does the policy briefing that held off in what we are doing with our committee. And we include the briefing ASTHO in what we are doing with our committee. And it's a joint partnership to do the lobbies for the Medicaid. What do you want to make sure that we hit on? I think that, obviously, we, the government in Puerto Rico is a government that is pro-state government. I think we think that Puerto Rico vote for being a state more than three to four times recently. I think that is the mainly form to get parity on the program, to get the state. We were still working to be a state that is part of the public policy that the people vote in the election. And it's important to us to complete the other teams. And Puerto Rico is heavily working with the electrical grid. And the problem that we have since Maria with our electrical grid, the company that was previous contract is not doing well their job. We are suing for get out that company and get other company for get the job done. For example, the company have the generation come late than the company that have the transmission. And I made a lot of work and a lot of moving of the federal money and the transmission. Company is not doing the work. The other team is the federal oversight board that we have by PROMESA. We need to finish that. That is more than 10 years. We need to comply with the requirement to finish the oversight board and the elected officials make the decision more than the board.

SHEEHAN:

Well, Victor Ramos, thanks so much for joining us.

RAMOS:

Thank you.

SHEEHAN: Dr. Victor Ramos is secretary of health for Puerto Rico. We spoke with Dr. Ramos at this year's Spring Leadership Forum in Washington, D.C.

Pull up a chair and join ASTHO for a fireside chat with a subject matter expert in radiation readiness communications, Jessica Weider. In this webinar titled, “Past, Present, and Future Reflections from a Radiation Readiness Professional.” Jessica will share reflections on her career and insights from her experience in radiological preparedness and emergency communications. This webinar will include discussions around key considerations for effective radiological risk communication from a public health preparedness perspective, including coordinating messages across partners and addressing public concern and false and misleading information. Find a link to the webinar in the show notes.

This has been Public Health Review Morning Edition. I'm John Sheehan for the Association of State and Territorial Health Officials.