Disparate Health Care in Puerto Rico: A Battle Beyond Statehood
The University of Pennsylvania Journal of Law and Social Change, Forthcoming
49 Pages Posted: 2 Oct 2020
Date Written: May 30, 2020
For close to a decade now, Puerto Rico has been saddled with a public debt crisis and has been forced, as a result, to borrow the funds needed to cover nationwide expenses like health care. When Puerto Rico stopped repaying its mounting debt in 2016, the U.S. Congress formed the federal PROMESA Board to oversee Puerto Rico’s finances and to determine its future fiscal policies. Nevertheless, the PROMESA Board’s attempt to control public debt by reducing budget deficits has further weakened an already devastated health care system. The island, often a target of natural disaster in the form of hurricanes, is financially insolvent and beset by other national, health-related obstacles such as poor infrastructure; heavy disparities between private and public health care programs as a result of a failed privatization and regionalized system; and a scarcity of doctors owing to continued migration to better pay on the mainland.
By reflecting on the consequences of a health care system the origins of which are in legal transplants and which has been the target of multiple unsatisfactory institutional arrangements — legacies of the colonial relationship between the island and the U.S. mainland — this Article attempts to explain why Puerto Rico’s health care system remains in crisis and inquires with respect to which policy-based tools might be used to address such crisis. This Article concludes that all policy attempts to date have failed and will continue to do so for as long as a foundational problem persists – that is, the unconstitutional, disparate treatment of U.S. citizens living in Puerto Rico compared to those Americans living on the mainland. Finally, this Article advances a primary policy recommendation that policymakers must first address the equal protection of the law — in general and as it applies to healthcare — rather than the political battle for statehood, the federal control and planning over Puerto Rico’s finances, or additional temporary federal funds and disaster relief.
Keywords: Puerto Rico, health, health care, disparate treatment, discrimination, equal treatment, fifth amendment, right to health, statehood
Suggested Citation: Suggested Citation