Consequences of the Foreclosure of Puerto Rican Sovereignty: Congressional Doctrine and the Struggle for Health

This paper reflects on the historical claims of Puerto Ricans to health care as a human right, starting from the unilateral congressional amendment in 1952 of the Puerto Rican Constitution, which sought to guarantee health care as a civil right.  On the recent occasion of the passage of ‘Obamacare’ legislation in the United States, Speaker of the House Nancy Pelosi was quoted as saying that health care "is a right and not a privilege."  Ironically, the United States plans to apply this reform and distribute funds to its unincorporated territories (including Puerto Rico) according not to their need, but to their ambiguous and subjugated position within the US body politic. This means the US is continuing to rely on the congressional cap on federal funding for health care in Puerto Rico established in 1967. As recently as 2008 the Obama administration asserted that the congressional cap placed on federal funding for Puerto Rican public health is unfair to the 3.5 million US citizens who live on the island. Despite these assertions, there have been no changes to the congressional limitation on health care funding for Puerto Rico since its inception. Further, I argue that this structural insufficiency should properly be seen as one of the social effects of the US congressional doctrine of unincorporation. I argue that effective HIV prevention and equal access to treatment is structurally impossible in this context. This paper interrogates the consequences of federal inaction on the congressional health care cap for Puerto Rico.