Showing posts with label Puerto Rico. Show all posts
Showing posts with label Puerto Rico. Show all posts

October 26, 2016

Clinton’s Secret for Winning Fl: Arriving Voters from PR

Last Wednesday morning contained an unusual landmark in the endgame of the 2016 election season: the first time in months that Central Floridians could confidently buy a plantain without being hassled about their level of civic engagement.
Throughout the year, their region has been overrun with clipboard-grasping canvassers listening for the distinctively accented Spanish of native Puerto Ricans. While in most states registration drives focus on college campuses and African-American neighborhoods—the standard marketplaces where canvassers find non-registrants who skew Democratic—Florida has presented a distinct demographic opportunity. The center of the state, across several counties sprawling outward from Orlando, has been a destination for one of the most significant domestic diasporas in recent American history. The debt crisis that has been roiling Puerto Rico for the last two years has forced residents to flee the island in droves, with many settling in Florida’s Orange and Osceola counties.
“From senior citizens to 22-year-old college students, anybody who’s anybody is moving here from Puerto Rico,” Clyde Fasick, a student from the Universidad Interamericana de Puerto Rico working on Democratic presidential nominee Hillary Clinton’s campaign in Osceola. 
From senior citizens to 22-year-old college students, anybody who’s anybody is moving here from Puerto Rico.” Clyde Fasick, Hillary Clinton campaign organizer
Four years ago, President Barack Obama won 60 percent of Florida’s overall Hispanic vote, compared to Republican Mitt Romney’s 39 percent. This year, some national and Florida polls have pegged GOP nominee Donald Trump’s support among Latinos below 20 percent—a difference that could place this ultimate swing state securely into Clinton’s column, if her campaign can reach its turnout goals. Trump and Clinton each scheduled multiple days in Florida this week, no doubt aiming to reach the 2 million Hispanic voters who now make up roughly 16 percent of registered voters in the state. And in contrast with South Florida’s Cuban-Americans, a swing constituency both sides have long struggled over, Puerto Ricans in the state look this year to be an overwhelmingly Democratic bloc, requiring not ideological persuasion, but the arduous labor of registration and mobilization.
In a report released by WikiLeaks after Clinton campaign chairman John Podesta’s e-mail account was hacked, the campaign’s analytics team determined that nearly one-quarter of the work required to win Florida was registering new voters. In comparison, that number was less than 10 percent in Wisconsin, and nearly 60 percent in North Carolina. (The Clinton campaign has declined to verify the authenticity of the hacked e-mails.) Some of that work has been taken on directly by Clinton’s campaign, under the auspices of the consolidated field effort it runs with the Florida Democratic Party, but the campaign also benefits from the attention of non-profit groups that coordinate work among themselves. (As non-profits, they are forbidden from sharing their plans with Clinton’s campaign, though signaling sometimes takes place through the media.)

Despite Florida’s hallowed swing-state reputation, its well of 554,000 persuadable voters is shallow—a relatively small share of the electorate. Obama was able to keep this state blue for the past eight years in large part because Democrats have a sizable advantage when it comes to the number of supporters they can attempt to mobilize, with more than 60,000 targets than what's available to Republicans. (Four years ago, after more than 8 million ballots cast in the state, Obama won by about 73,000 votes.)

Trump may seek help from the 60 percent of persuadable voters who are over the age of 50—especially men. But this year, almost every other key demographic groups seems to be tilting in Clinton’s favor. There are nearly 30 percent more women in Florida who lean Democrat than Republican—a gap that is 10 points wider than the split among men. Clinton also has more than twice as many mobilization targets than Trump within the state’s swelling Hispanic communities. 
She may find additional support among the state’s 415,000 Republican-leaning Latinos, many of whom appear to be standing behind incumbent Republican Senator Marco Rubio as he distances himself from Trump. If Clinton can turn out the entirety of her coalition and peel off 45 percent of Latinos who’ve leaned toward the GOP in the past, she could win the Sunshine State without the help of a single persuadable voter.

Ground Forces

Last Tuesday afternoon, three Clinton canvassers stood outside Kissimmee Meat & Produce, looking to slow those entering and exiting just long enough to ask whether they were registered. The independently owned supermarket sits in Osceola County’s 410th precinct, where, according to a Clarity Campaign Labs analysis, 42 percent of the 246 voters who have registered since the 2014 elections are likely to be Puerto Rican. Not all are recent transplants from the island: some were raised in Florida and are just reaching voting age; others are retirees relocating from large Puerto Rican communities in New York, New Jersey, and Illinois.
Not long ago, Democrats worried that the new arrivals would become a key swing bloc. These voters do not come with partisan loyalties—Puerto Rico’s two parties are not split on a left-right axis as much as by their support for statehood—so even people who are enthusiastic about voting can become paralyzed when prompted to check a box attached to a party name. Clinton has been vocal about her support for Puerto Rico's right to vote on whether it should be a state—past polling suggests such a measure would pass comfortably—while Trump has signaled he is open to the possibility of statehood. “I realize some of them don’t recognize which candidate is Democratic and which is Republican,” says José Castellanos, who supervises a team of four canvassers for Mi Familia Vota. “As soon as I say a certain name, they react.”

Earlier this year, Democrats were aggressively testing messages they thought could sway new transplants to line up with Democrats, mostly by contrasting party leaders’ backing for a federal bailout of the island with Republican opposition. The communications department of Clinton’s Florida campaign has treated San Juan as a local media market, working as assiduously to place stories in El Nuevo Dia de Puerto Rico as in the Sun-Sentinel. New transplants are as likely to read news from their former home as from sources in the Orlando media market.
To help target narrowly tailored messages to these voters via digital ads and direct mail, Civis Analytics, a firm working for the pro-Clinton super-PAC Priorities USA, built a statistical model to predict the ethnicity of every Hispanic voter. Florida is among the states where citizens have been historically required to identify their race or ethnicity when registering to vote, but forms don’t distinguish Puerto Ricans from, say, Colombians or Venezuelans. “It’s very important to differentiate Cubans from non-Cubans in Florida,” says Matt Lackey, vice president for research and development. The Civis analysis found Colon and Nieves were the last names that most over-index among Puerto Rican voters, compared to Morejon and Llanes among their Cuban peers.
It turned out that it did not take much persuasion to move the new Puerto Ricans into Clinton’s column. Latino Decisions, a polling firm that supplies her campaign with research on Hispanic public opinion, found Clinton winning 74 percent of the vote to Trump’s 17 percent, with an even larger margin among the subset of those born on the island. The island-born viewed Clinton more favorably, and Trump more unfavorably, than their mainland-born peers. And within both groups, only 11 percent of voters said the debt crisis was the most important issue to them, behind even “immigration or deportations”—even though as citizens those issues are unlikely to affect Puerto Rican families directly. In Florida’s Senate race, Puerto Ricans were split between the Cuban-American Rubio and his challenger, Patrick Murphy, with the island-born leaning toward the Democrat, and mainland-born slightly preferring the Republican.
So Democratic campaigners shifted Puerto Ricans from targets for persuasion to pure mobilization opportunities. They would not need to be convinced to vote for Clinton, sure, but they did need to be registered and then mobilized to participate, in a place with a very different electoral culture.
Unlike foreign immigrants, as U.S. citizens, Puerto Ricans are all immediately eligible to vote, and many are more habituated to voting than many Americans. Puerto Rico has some of the world’s highest voter-turnout rates, which observers credit both to the fact that Election Day is an official holiday and to the block-party atmosphere that inspires. For years, Puerto Ricans voted at a higher rate than Finns; the only countries in the hemisphere with higher participation rates made voting compulsory. Even though turnout for the island’s quadrennial elections has fallen in recent years, it is still 10 points higher than for presidential contests on the mainland.
That hasn’t always translated into similar participation for Puerto Ricans on the mainland, where their turnout rates lag behind the population as a whole. (Civis Analytics projects turnout among Florida Puerto Ricans this year to be 10 points lower than among Cubans.) “When people come to vote here, it’s heavy,” says Fasick. “It’s a more festive feeling back home.” Organizers have been working to recreate some of that spirit in Central Florida, snaking the boisterous automotive caravans known as caravanas through Orlando and Kissimmee. Clinton’s campaign has started blasting music at local phone banks as volunteers make calls.
 The aggressive registration push was scheduled to climax on Tuesday, Oct. 11, the deadline to submit completed applications to county officials. But the arrival of Hurricane Matthew, which had kept Central Florida canvassers inside for two straight days, prompted a judge to extend the deadline by a day, and then by another six. While Democratic politicians and lawyers celebrated the week-long extension as a victory for voting rights, tacticians were not so enthusiastic. They had already planned for Oct. 12 to be the day they transitioned into get-out-the-vote activities, taking the volunteers who had become deft at registering citizens and training them for the doorstep and phone conversations that would turn them into voters. “It doesn’t matter if they’re registered if they don’t vote,” says Castellanos.
Story has been updated to more precisely characterize Hillary Clinton's position on Puerto Rican statehood.
This is the seventh in a series of eight Battlegrounds 2016 stories on the unique arithmetic that governs presidential elections in battleground states. Read more about how the battleground game is played.

—With assistance from Andre Tartar

July 15, 2016

IT’S official. Puerto Rico has about as much sovereignty as a United States colony

[San Juan, Puerto Rico]  IT’S official now. Puerto Rico has about as much sovereignty as a United States colony.

The word came down from Washington in mid-June, in two Supreme Court rulings that insult our pride as self-governing United States citizens.

One said our courts lacked the power of state courts to try local criminals separately after federal prosecutors weighed in. The other said we must go hat in hand to Congress if our public utilities are to get debt relief. Unlike states, we cannot help them seek bankruptcy protection.

A third insult — from Congress — came as we reached the brink of default two weeks ago. As it finally consented to debt relief, the Senate also approved an oversight board that could tell our elected government how to handle our finances.

In vulgar street talk here, Puerto Rico has been stripped naked and put on show to be shamed.

This after we’d grown up being told we had a unique, privileged relationship with the United States — we were full citizens, free to migrate north, and autonomous to govern our own affairs. A bit like a state, without surrendering our Latin personality.

But now it is clear that was a charade. We’ve learned how much it left us at the mercy of an unsympathetic Washington. Even as he offered debt relief, the Senate’s majority leader, Mitch McConnell, Republican of Kentucky, rubbed it in. “The U.S. territory of Puerto Rico is in crisis,” he declared.

Territory? Really? I thought — as did Justice Stephen G. Breyer in his dissent from the prosecutorial powers ruling — that Washington granted us a far better status in 1952. As the United Nations pushed for global decolonization, Justice Breyer wrote, we and the Truman administration entered into a social contract that made us neither colony nor state, but something new, called a “commonwealth” in English and, in Spanish, an "estado libre asociado” (free associated state).

My generation, the baby boomers, was told autonomy made us equal but exceptional as citizens, and indeed there were advantages. Tax breaks initiated in the 1970s attracted employers like pharmaceutical producers. Billions of federal dollars flowed to us. All we had to do was behave, serve in the military when called (I was wounded in Vietnam as a combat medic), and not call ourselves a “colony.”

Dissenters advocating statehood warned that “self-government” was a mirage without a vote in Congress, or for president. Still, Congress never showed interest in accepting a bicultural Hispanic state that had more workers than jobs.

There were occasional nationalist uprisings. But Puerto Ricans have never been good at rebellion. Instead, we jabbered away about our politics. And every few years we replayed the same referendum: Statehood? Independence? Stay autonomous?

A clear majority never emerged, partly because the plebiscites were just theater. The results weren’t binding on us, nor on Congress. And we didn’t want to fracture a close-knit island society over that.

So we drifted, even as globalization began undermining what competitive advantages we had; in 1996, Congress even withdrew the tax exemptions that had lured statesiders to invest in industry here.

Today, those industries, jobs and many stateside banks have fled, private employment has cratered, and our debts are due. Our main employer is our destitute government. Emigration and violent crime have soared. In recent years, hundreds of thousands of compatriots have left, bringing to more than five million the number of Puerto Ricans living in the states, according to the Pew Research Center; local demographers estimate that only 3.4 million remain here.

An image, passed down many years ago by my grandfather, haunts me now, in this terrible summer.

Grandpa Chu was a little boy during the Spanish-American War, living near where the last, short battle for Puerto Rico was fought at Asomante, in the island’s central mountains. Afterward, United States troops searched house to house for arms, ordering inhabitants to stay home.

The first “Americano” whom Grandpa Chu saw frightened him; he had eyes like hailstones in a freckle-spattered face. All the soldiers were stone-faced and humorless, even when showered with local hospitality. He stared at them, not knowing what to expect.

Now I feel something similar, after the triple whammy of political reality we have endured. I ask how we can help ourselves. This much has become clear to me: Puerto Ricans must first rediscover our inner political strengths, and unite to demand that Congress, within a decade, allows us a binding referendum on our island’s status.

The choices would be statehood, with whatever consequences for our culture and economy, or independence, with its own economic pitfalls and challenges.

“Autonomy” would not be a choice. It has been drained of all appeal by promises broken over the decades, and indignities recently inflicted; it should be put to rest as the sham it was all along.

This won’t be easy. Puerto Ricans will have to organize politically where members of Congress can hear us — their own districts. For that, we can call on perhaps four million enfranchised compatriots of voting age stateside to form a huge bloc to campaign — and vote — in our support.

In short, we must demand the respect due every United States citizen by using that most powerful weapon of democracy: one person, one vote.


Rafael Matos, a former writer and editor at The Associated Press, The Miami Herald and The San Juan Star, is a co-editor of “Noticia y Yo,” an anthology of Puerto Rican journalism from 1935 to 1980.

May 24, 2016

Sanders to Block Help for Puerto Rico

Sanders says he will be blocking help for Puerto Rico by saying that is not good enough for Island’s Commonwealth. But he is unable to have any other plan in place that could possibly be approved by a Republican Congress and not having the ugly side effects of having Doctors, Policemen and everyone employed by the government go without pay.  The Independent on the Uk reported the following this morning:
Breaking from President Barack Obama and the White House, Senator Bernie Sanders is blasting a putative deal to install an oversight board to return order to Puerto Rico’s ruinous finances saying it would make things worse not better for the island’s residents.  The salvo fired by Mr Sanders threatens significantly to complicate the path ahead for an accord hammered out just last week by the Republican and Democrat leaderships in the House of Representatives with explicit White House support.
In a letter to colleagues in the US Senate, Mr Sanders urges them to reject the plan when it comes to their chamber for a vote, saying it would make a “terrible situation even worse”. He made the intervention with at least one eye on his battle for the Democratic nomination - one of the very last Democrat primaries will be held on the island in two weeks on 5 June. 
As it stands now, the proposal would give extensive powers to the new authority to introduce severe social spending cuts and restructure the island’s $70 in debt. Puerto Rico has already defaulted on almost $1bn in debt payments and is set to miss a bigger $2bn payment on 1 July. 
The tropical and essentially bankrupt isle, which as a territory of the US is neither an actual state nor a sovereign country in its own right - islanders have US passports, however, and can vote for presidents - is also struggling with a roughly $40bn shortfall in state pension obligations.   
While the government of Puerto Rico in San Juan had been begging Congress to do something to help it deal with the default crisis, it did not favour establishing an oversight board with such wide discretion essentially to run rough-shod over the island’s own elected representatives.
That is at the heart of the Mr Sanders’ objections.  The Senator claims, for instance, that the new “unelected and undemocratic oversight board” would give the Governor leeway to slash the minimum wage to a paltry $4.25 an hour for as long as five years. 
"We must stop treating Puerto Rico like a colony and start treating the American citizens of Puerto Rico with the respect and dignity that they deserve," he wrote to Senate colleagues. 
Puerto Rico is in a ten-year slump that has spurred an accelerating exodus to the US mainland. For the population of about 3.5 million left behind, the crisis has seen rapidly deteriorating services, including shuttering of schools and hospitals, and rising taxes.
With more than 67 delegates up for grabs in the 5 June primary, both the Hillary Clinton campaign and Mr Sanders have been vigorously courting its voters.   Former President Bill Clinton also spent part of last week hopscotching between its biggest cities. 
On his own swing through the island last week, Mr Sanders said it was time to end the twilight status of the island.  He urged the holding of a new referendum giving islanders a chance to choose between remaining with the status quo, becoming the 51st state of the US or cutting the cord and becoming a sovereign nation. 
"It is time for the people of Puerto Rico to be allowed to take charge of their political future and for the United States of America to redefine its legal relationship with the people of this Island," Sanders said at one rally in San Juan. “The people of Puerto Rico should not and cannot provide colonial like treatment of its citizens, the people of the United States cannot continue colonial-like relationship with the people of Puerto Rico.” 
Mr Sanders, who has vowed to keep battling Ms Clinton all the way to the Democratic Convention even though he has virtually no chance to stop her becoming the party’s nominee, has also gone further than her or anyone else arguing that the only short-term solution for Puerto Rico is a federal reserve bail-out, a step that would be anathema to Republicans. 
“If the Federal Reserve could bail out Wall Street, it can help the 3.5 million American citizens in Puerto Rico improve its economy and lift its children out of poverty,” he said. “Under current law, the Federal Reserve has the authority.”
Editorial from Adam Gonzalez, Publisher

Trying to take something away without being able to replace it with anything else is not what the People of Puerto Rico need. Is this the best plan for Puerto Rico?
No, the best plan for Puerto Rico would  have been to let it rearranged its debts like any other state would. That time passed already.  Since Puerto Rico is not a state is has been punished like if it was Puerto Rico’s fault it was taken over by the United States Army and Navy and made into a colony after the Spanish-American war. At this point in time where Puerto Rico is in default, this is the best deal the White House has been able to get from a Republican Congress that wont even fund a new vaccine for a new virus that’s threatening to make a lot children handicapped. Is Sanders saying he could do better? May be that is the same kind of thinking that’s telling him he can still win when he is already lost.
Mr. Sanders keeps giving us surprises on the political field as a sore looser and not a team player.     So far with his opposition to the person with the greatest number of delegates and less than 90 delegates to win the Primaries. At the same time not only is He giving ammunition to Trump but having the virtual winner fight on two fronts. He knows he can’t win on the present situation so he most be waiting for Clinton to be indicted and put in jail. May be she will break an ankle? For people like me who does not take most politicians seriously all these can be fun and games as long as people don’t start getting hurt. I think Sanders should have found a different way to get attention and to fight the White House for not supporting him in a different format. Would it be because he sees the present gubernatorial administration in Puerto Rico too aligned with the DNC?  Who according to him it has been very unfair to him like if it was their fault he is lost. Maybe he was no treated right when he was there(PR) or he listened to the Independent party there confusing it with his independants here.  The Independents in PR want nothing to do with the US and ask for independence for the island calling it still a colony. Up to this point I have not said one cross word about Sanders but now he is hit me in the heart by taking this Island and using it to get some political mileage on his now never-ending quest to live in a house it seems he is not qualify to live in. He is proven he is just like any other politician willing to play with people’s well being for political mileage.

August 13, 2015

Mass Gay Wedding in Ex-homophobic Puerto Rico


More than 60 gay couples are preparing to exchange vows at a mass wedding in Puerto Rico, celebrating a U.S. Supreme Court ruling affecting the socially conservative U.S. territory, organizers said Wednesday.
Most of the couples are Puerto Ricans, but others from Haiti, the Dominican Republic, Cuba and Venezuela also are participating in the event scheduled for Sunday in San Juan's colonial district.
"This is a historic event for all of Puerto Rico," said organizer Ada Conde, an attorney who had filed a federal lawsuit seeking to have her gay marriage recognized in the U.S. territory prior to the Supreme Court decision. "This is not a show. This is not a parade. This is a solemn event to celebrate the fruit of our sacrifice."
Conde said she anticipated protests and noted that police officers would be posted at the ceremony.

 Puerto Rico until recently prohibited same-sex marriage and the recognition of such marriages, but the government struck down those laws after the Supreme Court decision. Officials also now allow gay couples to adopt children, and two couples have already begun that process, said Nancy Vega, director of the island's demographics office.
Among those getting married Sunday is Maritza Lopez, who has been with her partner for 39 years and was among those who filed a lawsuit against Puerto Rico’s government.
"You would think that after 39 years I wouldn't be nervous, but I am," she said with a laugh. "I have butterflies in my stomach. I didn’t think any of this was going to happen so quickly."

Previously, the administration of Governor Alejandro Garcia Padilla had approved several measures in in favor of the gay community, including one that prohibits employment discrimination based on gender or sexual orientation and another that extends a domestic violence law to gay couples. This week, the governor also signed two executive orders that will allow transgender and transsexual people to change their gender on their driver’s license and protect their rights when seeking medical services.

By DANICA COTO Associated Press

August 3, 2015

Death in PR 5,000 Doctors Leave the Island-Only the beginning


MAYAGÜEZ, P.R. — The first visible sign that the health care system in Puerto Rico was seriously in trouble was when a steady stream of doctors — more than 3,000 in five years — began to leave the island for more lucrative, less stressful jobs on the mainland.

Now, as Puerto Rico faces another hefty cut to a popular Medicare program and grapples with an alarming shortage of Medicaid funds, its health care system is headed for an all-out crisis, which could further undermine the island’s gutted economy.

On an island where more than 60 percent of residents receive Medicare or Medicaid — an indicator of Puerto Rico’s poverty and rapidly aging population — the dwindling funds have set off outpourings of concern among patients and doctors, protest rallies and intense lobbying in Washington.
Protestors in San Juan's financial district demanded the island's public debt not be paid to bondholders.  Puerto Rico, Running Short of Cash, Misses a Debt Service DeadlineJULY 15, 2015
Paseo de Diego, a pedestrian corridor in San Juan, P.R., that once buzzed with shops and shoppers, sits nearly empty, as businesses have closed.Despair and Anger as Puerto Ricans Cope With Debt CrisisJULY 3, 2015
And while the crisis is playing out most vividly today, its cause dates back decades and stems, in large part, from a vast disparity in federal funding for health care on the island compared with the 50 states. This disparity is partly responsible for $25 billion of Puerto Rico’s $73 billion debt, as its government was forced to borrow over time to keep the Medicaid program afloat, according to economists.

Dr. Johnny Rullán, right, a former secretary of the island’s Health Department, is lobbying for equal funding.CreditDennis M. Rivera Pichardo for The New York Times

Dr. Johnny Rullán, right, a former secretary of the island’s Health Department, is lobbying for equal funding. Credit Dennis M. Rivera Pichardo for The New York Times
“These are a cascade of cuts that will have disastrous, gigantic implications,” said Dennis Rivera, the chairman of the Puerto Rico Healthcare Crisis Coalition, a group of doctors, hospitals, health care advocates, unions and insurance companies lobbying the Obama administration and Congress. “Health care in Puerto Rico is headed for a collapse.”

He added, “If we pay the same Medicare taxes and Social Security taxes, we should be treated equally.”

In January, the federal government is supposed to cut payments to Medicare Advantage plans in Puerto Rico by 11 percent. The plans, offered by private companies, are a popular alternative to Medicare, often providing extra benefits and accessibility.

Three-quarters of the Medicare population on the island is enrolled in Advantage, and patients, many of them poor and chronically ill, worry about the impact of the cuts on costs and benefits.

The cuts are expected to lead to higher co-pays for medication and hospitalization, among other things, said Dr. Richard Shinto, the president and chief executive of InnovaCare, an insurance company with three Advantage plans in Puerto Rico.

“There will also be certain services we might have provided in the past that we can’t now,” Dr. Shinto said. Free rides to doctor’s offices are an example.

In addition, several hundred doctors are already losing their contracts with major managed care companies. InnovaCare has terminated 200 contracts, Dr. Shinto said.

“That’s one way on the island we are trying to manage the significant revenue reductions we’re to have — narrow our network of physicians,” he added.

This is in part because of how doctors practice here; they tend to be in solo practices, making it difficult to meet all requirements. Lower funding levels also complicated efforts to meet standards.
The island’s Medicaid program — called Mi Salud, or My Health — serves nearly 1.6 million people, or 45 percent of the island’s population, the largest share in the United States, and it is also struggling, said Ricardo Rivera, the executive director of the Puerto Rico Health Insurance Administration, which carries out the Medicaid program.

Health care makes up 20 percent of the Puerto Rican economy, which has been in a slow decline as manufacturing jobs have disappeared and the government has borrowed more than it could pay back. Because of the island’s precarious finances, the Medicaid program lacks access to credit and is so short on cash that it owes providers $200 million, a figure it has whittled down from $350 million. It is also spending a one-time $6.4 billion federal grant at a much faster pace than expected, Mr. Rivera said.

The Medicaid program, which relies on both federal and commonwealth funds, could run out of the grant money as early as the end of 2016, three years earlier than anticipated, Mr. Rivera said. This could mean that 900,000 people will have to be dropped from the program.

Puerto Rico cannot use the federal health insurance exchange under the Affordable Care Act, and it chose not to create its own exchange because its citizens do not pay federal income taxes and thus are not eligible for the subsidies that make exchange plans more affordable.

A spokesman for the Centers for Medicare and Medicaid Services said the agency was aware of the growing concerns and was working weekly with a group of politicians, health care officials, advocates and insurance companies here to find solutions. So far, none have been offered.

The reduction in Medicare Advantage funding is meant to bring federal payments for that program more in line with traditional Medicare fee-for-service rates in Puerto Rico. Advantage plans on the mainland have received cuts in recent years for the same reason, although generally not as big.

But Puerto Rican officials and health care experts have long criticized the federal formula for calculating its fee-for-service rates as unfair, and point out that even the Virgin Islands, a much smaller commonwealth, gets considerably more money for Advantage.

Puerto Rican lawmakers and doctors warn that it will be more expensive for the United States to ignore the problem for one reason: Those who need medical care can quickly settle with relatives on the mainland, where it is pricier.

 Medical records at Dr. Luis Vicenty’s office. 
The crush of doctors who have left Puerto Rico have created a serious shortage of specialists.Credit
                                                                                 Dennis M. Rivera Pichardo for The New York Time

“My message to the federal government is simple: If you continue to treat Americans living in Puerto Rico poorly, they will exercise their rights and move to the U.S. mainland, where they will immediately be entitled to equal treatment,” said Pedro R. Pierluisi, Puerto Rico’s nonvoting delegate in the House of Representatives.

Sitting in the waiting room of his doctor’s office in this large, poor Puerto Rican city, Santos De Hoyos, one of the 275,000 patients who are on both Medicare Advantage and Medicaid, said he was bracing for higher co-pays for medication. At 63, he has a heart ailment, asthma and diabetes and takes numerous medications, including one that costs $150 per dose.
“If the medical plan stops covering it or I lose the plan, I die,” said Mr. De Hoyos, a former worker at a canned tuna factory. “I am praying that God puts his hands into this.”

Mr. De Hoyos typifies the health care challenges facing Puerto Rico, which has among the highest rates of diabetes and asthma in the United States. The same is true of Mayagüez, a city that once relied on manufacturing but now depends greatly on the health care industry.

“There are health conditions on the island that are just mind-blowing,” said Sara Rosenbaum, a professor of health law and policy at George Washington University. “You’ve got a tremendous burden of poor health, tremendous costs, a tremendously dependent population and a Medicaid program whose per-capita payment is a fraction of the U.S. per-capita rate.”

In San Juan, the Puerto Rican capital, beds in hospital emergency rooms line the hallways. There are so few nurses that people often hire their own private nurses during hospital stays.

Doctors, too, are preparing themselves.

“Medicare Advantage allows us to live and pay our bills,” said Dr. Carlos Román, a family doctor here. “And the companies are not going to cut into their profits; they will cut into our pay and limit treatments, services and medicine.”

Dr. Luis R. Vicenty, 55, a longtime Mayagüez internist, recently received termination letters from two Advantage companies.

Like many doctors from the island, a group that is well-trained, board-certified and bilingual, Dr. Vicenty received a job offer on the mainland, at a hospital in Washington State.

The crush of doctors who have left has created a serious shortage of specialists. Most medical school graduates do not even bother looking for jobs here; almost none are available, and those on the mainland typically pay double.

“Doctors can leave,” Dr. Vicenty said. “So this will get worse.”

Easy solutions to the health care crisis do not exist, mostly because it stems from the disparity in funding, something that only Congress can change. Mr. Pierluisi has introduced legislation to address some of the problems.

Puerto Rico’s health care woes began in 1968, when Congress placed a cap on Medicaid in the United States territories that sharply limited the federal government’s contribution.

For Medicaid, this means that Puerto Rico typically gets $373 million a year from the federal government and has to pick up the rest of the $2.5 billion tab, Mr. Rivera of the Puerto Rico Health Care Coalition said. Last year, Oklahoma, which is wealthier than Puerto Rico, received $3 billion from the federal government, according to data compiled by the coalition. Mississippi, also not as poor as the island, received $3.6 billion.

A similar discrepancy exists with Medicare and Medicare Advantage. Puerto Rico’s Medicare reimbursement rates for doctors are 40 percent lower than the mainland’s, and the Medicare Advantage program is paid 60 percent of the average rate in the states, according to coalition data.

Dr. Johnny Rullán, a health care expert who was once head of the island’s Health Department, said Puerto Rico was not asking for more. It was asking for equity.

“We just need equal funding,” he said. “That will take care of the problem.”

A version of this article appears in print on August 3, 2015, on page A1 of the New York edition with the headline: PUERTO RICANS BRACE FOR CRISIS IN HEALTH 

June 12, 2015

Statehood for Puerto Rico is Growing


Puerto Rico’s path towards statehood is stronger than ever. In fact, we can state that the almost 3.6 million American citizens in this United States Territory are living their final days of this, immoral colonial status. That’s a fact, not an opinion.
The statehood movement, both on the Island, as well as in the States, has grown exponentially during the past 30 years. The evidence is overwhelming. The facts are there for everyone to observe.
In Puerto Rico, the New Progressive Party (NPP), which seeks statehood, have grown from a purely second political option to a commanding position only rivaled by the Democratic Party dominance over U.S. politics in the 1940s.
Since its inception in the Island’s political landscape back in 1967, the NPP has consistently increased its number of affiliated voters, a distinction no other party can claim. More to the point. In the last four elections the NPP has been the only party to topple the 48 percent mark, and in 2008, the party got almost 54 percent of the vote, something unprecedented in a multi-party system.
Even in the last electoral process, when the NPP’s candidate for governor loss by less than .02 percent, the party took more votes than its rival (48.4 to 48.2 percent).
In 2012 the statehood movement achieved its greatest victory so far when it won, hands down and without any doubt, a political status referendum. This is a sharp contrast to the marked decline in support for the current territorial status.
According to the official results of Puerto Rico’s State Electoral Commission, 54 percent (970,910 out of 1,798,987) of eligible electors voted ‘No’ to remain in the current political status. Furthermore, 61 percent of the people (834,191) voted in favor of our Island joining the Union as the 51st state. As of the others options in the ballots, Free Association gathered 33 percent of the vote (454,768), while Independence generated 5.4 percent (74,895).
That’s a resounding fact.
As the statehood forces increase on the Island, so does in the States. For the first time in history an admission bill, in accordance with the will of the people of Puerto Rico, was filed in the U.S. Senate.
Our Resident Commissioner, the Island’s sole member of Congress (without a floor vote), Pedro Pierluisi, has presented two admission bills in the House of Representatives.  
In the last two years, powerful U.S. Senators have called for grating statehood to the Island, including Ron Wyden (D-Ore.), Lisa Murkowski (R-Alaska) and Martin Heinrich (D-N.M.), among others.
 La Fortaleza(Governor’s Residence)
Puerto Rico has spent nearly 116 years as an American territory. That’s long enough,” Heinrich said. That’s a sentiment we have felt from most members of Congress every time we visit Washington DC.
Another factor in our growth has been the large number of Puerto Rican living in the States. For example, in Florida, the statehood forces need to be reckon with. Orange County alone is home to more than 150,000 Puerto Ricans. Overall, Puerto Ricans now number nearly one million statewide and represent 28 percent of Hispanic registered voters — closing in on a Cuban population of 1.3 million.
Even media outlets, not only the U.S., but in Europe as well, have consistently reported about the growing influence of statehood for the Island. It’s no more a matter of ‘what if’, it’s just ‘when it will be’.
Forget the silly arguments regarding the language and culture. Puerto Rico, as in the case of every state (Texas, Hawaii, Alaska, Nebraska, and so for) will maintain its own identity. The Congress and the White House, not only understand this, but supported because, after all, America is a multicultural Nation since its very beginning.
To those who for decades have supporter the admission of Puerto Rico into our great Nation, as an equal partner, your passions are paying off immensely. The statehood movement is more robust and stronger than ever.
Jose Aponte Hernandez
Hernandez was Speaker of the House of Representatives of Puerto Rico from 2005 to 2009.

May 5, 2015

In a Surprisingly Nice Move Governor of PR Legalizes Med Marijuana

In a surprise move, Puerto Rico's Governor Alejandro García Padilla signed an executive order legalizing the use of medical marijuana in the U.S. territory. The order, which was heavily debated in Puerto Rico since 2013 but never put to a public vote, went into immediate effect. The Caribbean island joins 23 other U.S. states in decriminalizing medical marijuana, The Associated Press reports
We're taking a significant step in the area of health that is fundamental to our development and quality of life," García Padilla said in a statement. "I am sure that many patients will receive appropriate treatment that will offer them new hope." The governor added that several studies conducted in the United States demonstrated that cannabis can assist in pain relief from serious diseases.
"These studies support the use of the plant to relieve pain caused by multiple sclerosis, AIDS virus, glaucoma, Alzheimer's disease, migraine, Parkinson's and other diseases that often do not respond to traditional treatments," García Padilla added. "This administration is committed to ensuring the health of all citizens residing in our country. Hence the medicinal use we are adopting is an innovative measure to ensure the welfare and a better quality of life for these patients."
Although Puerto Rico will relax its stance on medical marijuana, it plans on passing a state law that will establish "a distinction between medical and non-medical uses." Even pro-marijuana activists in Puerto Rico were taken aback by the sudden nature of the executive order, as many questions remain over how the plan would be instituted.
For instance, no decision has been made whether Puerto Rico will grow its medical marijuana crop in the country or import the drug. García Padilla said the secretary of the health department would arrive with a more detailed plan of action for medical marijuana within three months.
Puerto Rico becomes the latest U.S. territory or state to either peel back the restrictions on medical marijuana or decriminalize weed entirely. New York is readying its own (albeit restrictive) medical marijuana plan, while voters in Florida resoundingly support a measure to legalize the drug for both medicinal and recreational purposes. The federal government also ended their prohibition of medical marijuana.

March 24, 2015

In a Historic Change Puerto Rico Wants Gay Marriage Instituted

 US Quarter honoring Puerto Rico

A Religious Governor that has continually said that his religious believes could not allow him to support gay marriage has suddenly seen the light that we don’t elect public servants for their religion anymore but for the good they can do to the whole community keeping religion on the sidelines.
 Puerto Rico's Justice Department announced Friday that it will not defend the U.S. territory's laws banning gay marriage in a major turnaround for the socially conservative island that surprised many.
Justice Secretary Cesar Miranda said that the government can no longer continue to discriminate against the gay community.
"It's neither fair nor correct to defend the constitutionality of that law," he said. "Same-sex couples cannot get married and therefore do not have access to those rights. They should be available to all those who love each other, who take care of each other, who work and contribute to this society like everyone else."
The announcement comes a year after several gay couples in Puerto Rico filed a lawsuit challenging the constitutionality of Puerto Rican laws that define marriage as between a man and a woman, as well as those that prohibit same-sex marriage and the recognition of such marriages.
The territory's Justice Department had defended the laws before a federal judge who upheld them, but the case has been appealed to the 1st U.S. Circuit Court of Appeals in Boston, and Miranda said the department will no longer intervene.
Hundreds celebrated the news in Puerto Rico, including Johanne Velez, an attorney and consultant who married her partner in New York in 2012 and is one of the plaintiffs in the lawsuit.
"It is a historic day, and we are ecstatic," she said in a phone interview. "When we say it is historic, we are changing the lives of people not just for us, but around us. We hope that it will make society a better place for future generations.”

Miranda made the announcement a week after a group of legislators from Gov. Alejandro Garcia Padilla's party said they supported gay marriage, including Senate President Eduardo Bhatia. While the governor has repeatedly stated that he is not in favor of gay marriage, he said he supports the change.
"Everyone knows my religious beliefs, but it's not up to political leaders to impose our creeds," he said. "We have to push for the progress of civil and human rights under equal conditions for everyone."
Thirty-seven U.S. states allow same-sex marriages, a number that has quadrupled in the last two years. The U.S. Supreme Court is expected to issue a ruling by the end of June regarding several same-sex marriage cases that would also apply to Puerto Rico and four other U.S. territories.
Opposition lawmakers and religious leaders criticized Friday's announcement and accused Garcia of imposing changes instead of consulting with the public and holding a referendum.
"This is a slap in the face to Puerto Rican society," said legislator Maria Milagros Charbonier. "The government should not be playing around with issues as delicate as that of family, which is the cornerstone of our island."
Amarilis Pagan, spokeswoman for a local equal rights committee, said in a phone interview that advocates will now push Puerto Rico's government to reverse a law that bans adoptions by same-sex parents. The island's Supreme Court upheld the law in a 2013 ruling following an appeal by a Puerto Rican woman who sought to adopt a teenage girl that her partner of more than 20 years had given birth to through in vitro fertilization.
Puerto Rico's legislature has approved several measures in recent years in favor of the gay community, including one that prohibits employment discrimination based on gender or sexual orientation, and another that extends a domestic violence law to gay couples. 
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