Online Program

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

Wednesday, November 4, 2015

Nylca Munoz, JD, MPH, DrPHc, School of Public Health, University of Puerto Rico, San Juan, PR
Luis Alberto Aviles, PhD, MPH, University of Puerto Rico School of Public Health, San Juan, PR
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.

Learning Areas:

Advocacy for health and health education
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy

Learning Objectives:
Identify main justifications of US Federal Government and court decisions for a differential treatment to Puerto Rico in the implementation of an universal health care system and key dispositions of the Affordable Care Act; Discuss the implications for the people of Puerto Rico of this disparate treatment. Analyze the importance of implementing alternative direct democratic processes to achieve right to health in the island.

Keyword(s): Health Disparities/Inequities, Public Policy

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an attorney and doctoral student in Public Health with specialty in social determinants of health. My areas of research and interests are structural determinants of health; that is the role of government and market in population health outcomes.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.