#Irma is a potentially catastrophic hurricane and will bring life-threatening wind, storm surge, & rainfall to portions of Puerto Rico today pic.twitter.com/ZcBstQu1ig
— NWS (@NWS) September 6, 2017
Puerto Rico is line to be hit hard. It is in line for massive destruction and disruption of its public health infrastructure. It is in line for a potential health crisis.
Puerto Rico’s Medicaid system is pervasive and unusual when compared to how Medicaid is run in states. MedPac has a good summary:
Federal funding
Federal Medicaid funding to Puerto Rico is subject to an annual funding ceiling specified in statute, which
grows with the medical component of the Consumer Price Index for Urban Consumers (CPI-U) (§1108(g))….
In general, once Puerto Rico exhausts its annual Medicaid and CHIP ceilings, it must fund its program with
territory funds. …
The Consolidated Appropriations Act of 2017 (P.L. 115-31) provided Puerto Rico with an additional $295.9 million. Puerto
Rico must contribute a non-federal share to access these funds, which is matched at its FMAP rate (CMS
2016a). After these funds expire or are exhausted, Puerto Rico will generally not be able to spend federal
dollars beyond the ceiling for Medicaid.6
Puerto Rico receives a fixed amount of money from the Federal government. After it goes through that money, it is out of luck. In good years, that money should be sufficient. In bad years when there is an external shock to the system like a Category 5 hurricane, who knows if that is sufficient. There may be additional money released by an emergency federal appropriation. There might not be additional money. The local cushion to mobilize resources is constrained by the block grant policy.
Adria McDowell
Couple this with Puerto Rico’s current financial troubles- yikes.
Puerto Rico shouldn’t expect any help from this administration, either.
JPL
@Adria McDowell: Now that Ted Cruz has decided the federal government can help, he’ll lead the way to ask for additional spending for Puerto Rico.
kidding
nycmt
Puerto Rico will have another outmigration to the mainland. Florida, Texas, New York. And they’re citizens and they vote.
OzarkHillbilly
That’s awfully optomistic of you David, considering it’s a Republican Congress, a lot of brown skinned Spanish speaking people, and last but not least all but officially bankrupt Puerto Rico about which the GOP has been saying for some time, “Fuck ’em.”
Another Scott
If circumstances like this help to finally destroy the idea that “block grants” are the solution to every problem, then that will be a good thing. Here’s hoping that millions of people aren’t hurt in the process of making that point. :-(
However, we can’t count on Teabaggers ever accepting that their ideology is ever wrong. We have to vote them out. There are only 61 days until Election Day 2017….
Cheers,
Scott.
Wapiti
Hopefully Dems are astute enough to tie emergency funding for Puerto Rico and the VI into the same bill as Texas (and maybe Florida, depending on how that goes). Not to make a point, but just to help people.
PPCLI
@OzarkHillbilly: Plus the fact that Puerto Rico doesn’t have voting representation in either the House or the Senate.
If only they were part of a country that repeats the slogan “taxation without representation is tyranny.” as a founding pronouncement…
PPCLI
@Another Scott: Republicans don’t support block grants because they mistakenly think they are a solution to a problem. They support them as part of a strategy to destroy the existing solutions and leave nothing remaining.
Amir Khalid
@JPL:
Ted Cruz believes Texas should get federal aid for disasters only because Texas voters will judge Ted Cruz on (among other things) his effectiveness in securing such aid. New Jersey voters don’t get to judge him at all, in his reckoning, so fuck’em. And Puerto Ricans — Americans living on American soil — don’t even get to elect US Senators, so fuck’em twice.
Betty Cracker
Had a text exchange a little while ago from a friend who lives in the USVI; wanted to let him know we’re thinking of him as the hurricane approaches. He said, “We’re in God’s hands now.” Gave me the chills.
ThresherK
@PPCLI: Yep. Block grants are just another way to Texas things up and then whine about how government doesn’t work.
Betty
Hello all, just popping in to let you know our island of Dominica was spared the ravages of Irma. Thanks for all the good wishes and prayers. Our friends to the north and west have not been so lucky so spare a thought for them. I can’t imagine how much suffering Puerto Rico is going through. Oops, as I’m writing this Irma decided to send us a farewell lash. Take care.
Snarki, child of Loki
@Adria McDowell: “Puerto Rico shouldn’t expect any help from this administration, either”
Trump being an expert on bankruptcy law, I expect him to load up PR with the mainland US debt, then leave them to deal with it.
Elizabelle
@Betty: Great to hear from you. Plz keep us posted on what you hear from other islands.
Did Dominica suffer any ill effects? Just a brush with a usual rainstorm?
Cermet
@Snarki, child of Loki: That might be a very big blessing – if all Puerto Ricans divided up the national debt – a few million each, then just like tRump, write that off their taxes for the rest of their lives! Win/win (except for all the bond holders here in the us … .)
chopper
@PPCLI:
exactly. goopers know block grants don’t and won’t work. that’s the entire point.
tobie
As many have said before in this thread, block granting is just a way of fulfilling Grover Norquist’s wet dream to shrink the govt enough to be able to flush it down the toilet. The rubes who support this and vote for this crap have no idea what it means. It’s just a sound byte they repeat because Rush or Hannity said it…and Rush and Hannity are on their side, the side of the white working class that minorities and elites are trying to silence at every turn. I finally saw the documentary The Brainwashing of my Dad and have been really haunted by it.
tobie
@Betty Cracker: @Betty: Sending good thoughts to both of you and all others in, or potentially in, Irma’s path.
gvg
@PPCLI: That’s actually complicated. They do not pay US income tax. They do pay a bunch of other lesser taxes like SS. they actually have an internal income tax but lowered it really low to attract rich Americans as a tx haven. I wonder if their recent financial problems isn’t something like why Kansas has a budget problem?
the other side of it is for decades they have been on the fence about becoming a state. for most of my aware life I have heard the polling is 1/3 independence, 1/3 state and 1/3 stay as it is. One of the issues is the income is low and prospects of the island getting better were poor so they were afraid to go full state and pay taxes. I know I have heard only a tiny bit of what is going on though and honestly I only heard this through random news stories. there has always been a lot of bigger news. I think it was a couple of years ago I heard the polling was changing to more wanting to be a state. Wiki said the tax law changes were about 2012. Lots of bad budget news recently. I think they need to want to be a state. I have always felt it shouldn’t be forced on them. I gather change seems scary but our constitution did not expect a long dragging of feet. Problem is right now we have a government of people scared of brown people voting them out of power which is almost about to happen. I bet they will resist PR becoming a state. Also english is not the primary language and thats going to flip a few lids even among liberals.
All I am saying is that it’s hard to give them representation under our Constitution if a territory doesn’t want to be a state. I know they are a bit different from a territory but still we didn’t invent a Constitution that fit this scenario. If they had decided they were ready sooner we wouldn’t have had to compromise into a muddle.
Another Scott
@PPCLI: You know that, and I know that, but the press presents their statements as reasonable arguments. Kinda the way bloodletting to balance the humors was the path to being cured of disease.
There comes a point when some arguments are no longer taken seriously. We need to speed that day’s arrival.
Cheers,
Scott.
a thousand flouncing lurkers (was fidelio)
By the way, the federal fiscal year ends 9/30/2017. So Puerto Rico may have already used up this year’s block grant, and be grimly holding on waiting for next year’s–which might all be used up by the end of November, if Irma’s list of injured is high.
gene108
@Another Scott:
We are dealing with people, who still argue tax cuts for the rich generate revenue for the government and will unleash never before seen levels of economic growth.
Don’t get your hopes up.
Barbara
@gvg: As you say, Puerto Rico is in purgatory to some extent because its citizens are conflicted about the direction of their future. Ultimately, I think that if they want to be part of the U.S., they should become a state because whatever tactical advantage they gain from being less than a state is short term and ultimately subject to the whims of Congress (e.g., the insolvency debacle), without the backstop of the 10th Amendment or other constitutionally protected states’ rights. One big issue for the island in not being a state is that it is subject to the Jones Act, which requires maritime commerce to utilize U.S. flag ships, which means that commerce is much more expensive than it needs to be. Puerto Rico is closer to the U.S. than Hawaii, and there really is no reason why it could not become a state. It would be hard for Congress to deny it statehood if its residents voted for it.
Barbara
@gene108: Just piling on here: Republicans will find whatever excuse is necessary and passes the sound bite test to attack or eliminate entitlements. It’s who they are.
gene108
@gvg:
Wouldn’t be an issue, if government offices had people, who spoke English and had phone prompts in English.
They have their version of “press 2 for English” gives you some options in English, but then the sub prompts are in Spanish.
Then you get to a live person, you have to wait on hold for 10 minutes until they find someone, who speaks not very much English. At which point you say fuck it, hire an accounting firm, where it seems the people are fluent in both English and Spanish, to get the paper work filled in. And as they know they have you, they feel free to price gouge a bit.
If you are part of a country, where most people speak English, they should do a better job to make sure folks from the mainland can communicate.
gene108
@Barbara:
In the Age of Trump, they are not worried as much about sound bites. We have a President, who is loved by the Republican voters, who is incapable of feeling shame.
I think shaming elected officials maybe a losing battle in the near future, with Trump as a roll model.
The Moar You Know
@gvg: Puerto Rico will not become a state so long as the GOP holds any of the branches of government at all. To be cold-blooded about it (and they are nothing if not cold-blooded) why would they? Both Senators and the House representatives would be Dems, and that wouldn’t have a hope of changing unless the GOP gets rid of their anti-Hispanic stance and platform. I’m not seeing that happen. Not in my lifetime, anyway.
Then there’s the whole “wanting to become a state” thing, which they have never had an overwhelming majority in favor of.
mai naem mobile
The GoP is hurrying up the Harvey aid package because they are betting that Irma will hit blue states as well as red states so they’ll have more leverage. I think the Ds should delay till next week and do a bug package and have leverage with the Texas congress critters.
Barbara
@The Moar You Know: Before the last election, it was not a given that every member of a federal delegation from Puerto Rico would be a Democrat. If Congress refused to accept Puerto Rico as a state because of such a crude political calculus, yes, it would be a self-fulfilling prophecy, that henceforth Puerto Rico (if it became a state) and other Latino voters in other states would be a lot more likely to vote for Democrats. The Republican hostility to Hispanics is basically insane, lizard brain stuff. It’s not as if the U.S. has never dealt with waves of non-English speaking immigrants in the past, and not even the remote past.
ETA: George Bush received 40% of the Hispanic vote. What happened?
Barbara
@mai naem mobile: Which blue states would that be? Alabama and Georgia? Florida is at best purple, and voted for Trump. Those are the three states facing the clearest threats at this point in time. They have a lot of power in Congress, but directing hurricanes to hurt liberals isn’t among them.
MomSense
@Betty Cracker: @Betty:
Glad you came through safely, Betty. And Betty Cracker, please be careful.
mai naem mobile
@Barbara: I may be wrong but I thought they said it was going up the Atlantic along the east coast which would hit some blue states. I didn’t say they were directing hurricanes, I said they would have more leverage with blue state votes if blue states were hurt. Right now with Harvey you have no leverage with blue state votes but have the Texas GOP wanting to vote for Harvey. Don’t expect the Texas GOP to reciprocate any help in the votes for Irma aid .
mai naem mobile
@Betty: I am glad you got through it okay. I was thinking about you yesterday evening when they said Irma was hitting the Leeward islands
Aleta
@gene108: People who treat the tax money they are asked to allocate as their own, by right of being elected, and resent any spending that doesn’t seem to directly benefit them.
Barbara
@mai naem mobile: States along the Atlantic don’t get blue until you arrive in Virginia. Any state in advance of that is at least as red as it is blue (e.g., NC) even if they have blue pockets (e.g., Charleston, SC). Actively hoping the hurricane takes out blue enclaves to offset leverage is pathetic.
Betty
@Elizabelle: Hi Eliabelle, we were were spared pretty much altogether. Lost electricity when that last lash hit this morning. The weather remains unsettled but not threatening. Damage was severe in Barbuda, St. Martin and Anuilla from what we are hearing. A frightening storm. Sorry for the late response as power was just restored.