Roadblocks to Universal Health Care System for Puerto Rico: The Role of US Federal Government

The World Health Organization (WHO) and General Comment No.14: The Right to the Highest Attainable Standard of Health from the United Nations Committee on Economic, Social and Cultural Rights (CESCR) have recognized the importance that all countries guarantee an accessible, universal, affordable and good quality health care system to implement the right to health. The United States has taken a different approach to secure these guarantees, that is, through regulation of the health industry, with the implementation of the Patient Protection Affordable Care Act (PPACA). Puerto Rico, as an unincorporated territory of the US and Latino community, is very unique, since the US Federal Government has determined that even though Puerto Ricans are US citizens, federal dispositions regarding PPACA can apply differently to Puerto Rico in comparison to other states. For example, the possibility of implementing an universal health care system under section 1332 (waiver for state innovation) of PPACA as a form of implementing the right to health as interpreted by the WHO and CESCR, as well as other dispositions (guaranteed availability, community rating, single risk pool, essential health benefits) have been excluded through federal administrative interpretations. This research reviews federal administrative opinions of the US Department of Health and Human Services and federal jurisprudence, and examines the principal arguments on which this unequal treatment rests. It analyzes from a critical sociological perspective whose interests these actions benefit. This investigation demonstrates the Puerto Rican population’s need for more transparent and direct democratic processes to obtain its health care rights.