U.S. Officials Told That CNMI Is In 'Midst Of A Healthcare Crisis'

Governor's chief of staff attending Interagency Group on Insular Areas meeting in Washington, DC

By Cherrie Anne E. Villahermosa

SAIPAN, CNMI (Marianas Variety, Feb. 28, 2017) – The commonwealth is “in the midst of a healthcare crisis,” the governor’s chief of staff Matthew Deleon Guerrero said in his remarks at the senior plenary session of the Interagency Group on Insular Areas, Wednesday, in Washington, D.C.

Healthcare in the CNMI, he added, as in most of the territories, faces major challenges in the areas of access, financing, and labor,

In 2015, he said, 36 percent of the population was enrolled in either Medicaid or the Child Health Insurance Program or CHIP.

“According to the most recent data available, 46 percent of the population is without any type of health insurance coverage, while 51 percent of the population live on incomes at or below the federal poverty line.

“With a greater percentage of individuals and families living beneath the poverty line than the national average, limited financial resources hinder us from providing quality and affordable healthcare. As a result, many residents are forced to seek the care they need off-island, at greater cost.”

Deleon Guerrero said the CNMI’s Medicaid program is “the primary source of coverage for approximately one third of our residents.”

The CNMI’s program, he added, essentially acts as a block grant with a fiscal year limitation of total federal assistance, which is statutorily set at a low Federal Medical Assistance Percentage or FMAP of 55 percent.

“If the FMAP were to be calculated in the same manner as it is for the states, the CNMI would be eligible for a percentage far beyond the current arbitrary percentage. Calculating the FMAP based on need would recognize, and better provide for, our large low-income population and provide greater coverage for the many citizens born and raised on U.S. soil in the CNMI who cannot afford to pay for health insurance.”

Deleon Guerrero said the cap on federal Medicaid dollars “presents an additional burden on the adequate delivery of efficient health services in that the constrained budget limits the ability of the commonwealth’s Medicaid office to better explore opportunities to innovate in the delivery of services to increase efficiency, lower Medicaid expenditures, and improve patient outcomes.”

He said these concerns are not new to the federal government, nor are they unreasonable.

“In the December 2016 report by the Bipartisan Congressional Task Force on Economic Growth in Puerto Rico, which oversaw the Puerto Rican government debt crisis, the task force recommended that ‘Puerto Rico and the other territories be treated in a more equitable and sustainable manner under the Medicaid program.’ ”

Gov. Ralph Torres agrees with the recommendations of the Task Force, his chief of staff said.

“But beyond access to coverage and financing health services, the CNMI’s health care system is facing challenges in connection with obtaining a sufficient labor force.

“Currently, our hospital is operating with a shortage of nurses. Our public health officials have stated that our nurses are greatly outnumbered by patients due in large part to the current constraints of our transitional immigration worker program authorized by U.S. Public Law 110-229, which have limited our hospital’s capacity to hire additional nurses and other health care professionals. We continue to reach out to members of Congress and folks within the administration about these concerns.

“The labor force issues we are experiencing which are highlighted by the shortage of skilled nurses in the Northern Mariana Islands is, in fact, broad reaching…. Despite diligent efforts to maintain their status, we stand to lose 39 nurses from our only hospital by October, unless swift action is taken. Such a loss would gravely impact our ability to provide essential medical services on Saipan and makes the task of meeting CMS provider standards even more challenging.”

At the height of the CNMI’s economic decline in 2009, Deleon Guerrero said, the commonwealth suffered a reduction in GDP by 17.5 percent and the following year saw a 35 percent increase in its debt per capita.

“The burdens…we pass along to the next generation are tied closely to the state of the economy.

“Yet we are on the verge of achieving the goal that we all share at this table.”

However, Deleon Guerrero added, “we cannot grow to provide jobs for our people, to upgrade the delivery of our healthcare services, or to avoid the government indebtedness that weighs so heavily on populations around our nation that can least afford it if we do not realize that the CNMI and the rest of the territories face unique problems that require a unique consideration.”

The CNMI, he said, “does not have the available U.S. labor force to fuel a growing economy that can succeed on its own. As much as we would like it to be so, the numbers are just not there, and the CNMI does not have reasonable access to proven federal programs such as the Earned Income Tax Credit, that has proven itself to be one of the most effective policies within the federal government to alleviate poverty and incentivize workforce participation.”

Moreover, the CNMI “is in the midst of a healthcare crisis as the rates of noncommunicable diseases literally cripple our people, and fracture the foundations of our community as lives are taken before their time.”

Deleon Guerrero said the people of the Northern Mariana Islands “are proud Americans, who send our sons and daughters to fight in our armed forces in disproportionate numbers.”

But “broad federal action without adequate representation to advocate for our citizens on issues as important as healthcare and our economic viability often times encumber territories like the CNMI with programs that do not take into account our unique circumstances.”

Still, he said, “I am encouraged that this working group and the agencies here today are of the belief that the insular areas’ best days are ahead. I want to thank you all again for listening to our concerns, and I commend this working group’s efforts to deal with those concerns.”

Marianas Variety
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