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Introduction of the Insular Area Medicaid Parity Act

Floor Speech

Date: Jan. 11, 2021
Location: Washington, DC

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Mr. SABLAN. Madam Speaker, President-elect Biden has pledged to address the healthcare disparity in minority communities that the coronavirus pandemic has laid bare. One longstanding disparity is that our national Medicaid program does not reach all Americans with full coverage.

The Northern Mariana Islands, American Samoa, Guam, Puerto Rico, and the U.S. Virgin Islands are subject to a hard, statutory limit on federal Medicaid support, unlike the states and the District of Columbia. This cap means that preventative care and treatment for the poorest Americans in the insular areas will always be less available than for Americans elsewhere.

The final Obama-Biden administration budget proposal, for fiscal year 2017, addressed this systemic inequity by proposing an alignment of insular area Medicaid programs with the rest of the nation, first by removing the cap on Medicaid funding, so that it would no longer operate as a block grant in any insular area.

Congress has also acknowledged this inequity. We acted to provide more Medicaid funding for the insular areas by substantially lifting the cap through P.L. 116-94, Further Consolidated Appropriations Act of 2020. Provisions in P.L. 116-127, the Families First Coronavirus Response Act created equity between the states and the insular areas with respect to the increase in the federal-local match for Medicaid. Families First, also, provided additional federal dollars for the insular area Medicaid programs. But our actions were temporary. These funding increases expire at the end of fiscal year 2021.

Now, Congress must act again. And in doing so, we must create an enduring policy that safeguards the health of the poorest Americans in our insular areas.

To achieve that goal, I am introducing the Insular Area Medicaid Parity Act. My bill aligns with President-elect Biden's pledge to address healthcare disparities in minority communities by repealing the arbitrary cap on Medicaid for Americans in the insular areas.

By repealing the cap, we will be doing more than just ensuring there are sufficient resources to face the coronavirus crisis. We will be setting up the healthcare systems in the insular areas to respond to the next public health challenge, whatever it may be. Most important of all, we will ensure that day-after-day and year-by-year those with the smallest incomes and no access to other insurance receive the care that will keep them healthy and help ward off debilitating disease.

We will, also, be providing a level of certainty to healthcare providers--in the public and private sector--that will encourage investment in the health industry in the insular areas, which by any measure lags the rest of the nation. And by doing so we will create a virtuous cycle of rising quality of care powered by rising access that will benefit all at every income level.

The pandemic has brought home this truth: none of us can truly remain well, while some of us are ill. Now it is time for Congress to fully commit to making sure the poorest in the insular areas are treated equitably.

I thank my colleagues who joined me in introducing this legislation-- Chairman McGovern, Chairwoman Velazquez, Chairwoman DeLauro, Chairman Nadler, Mr. Cleaver II, Mr. San Nicolas, Ms. Radewagen, Mr. Espaillat, Ms. Lee, Ms. Moore, Mr. Cardenas, Ms. Bonamici, Mr. Sires, Ms. Barragan, Mr. Garcia, Mr. Hastings, Mr. Carson, Mr. Case, Ms. Clarke, Ms. Jackson Lee, Ms. Napolitano, Ms. Norton, Ms. Meng, Mr. Castro, Mr. Butterfield, Mr. Trone, Ms. Ocasio-Cortez, Ms. Gonzalez-Colon, Ms. Kelly, and Ms. Chu.

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