Trump cuts affect Guam

Trump cuts to affect Guam

The full potential impact of President Trump’s proposed federal spending cuts isn’t clear yet, but early estimates show Guam’s federally funded safety-net programs for people who can’t pay for their own health care or food would suffer if the plan becomes law.

The Department of Public Health and Social Services prepared initial projections based on a 10 to 30 percent reduction scenario stemming from Trump’s budget cut proposals for next fiscal year.

“If Mr. Trump’s budget were to pass unscathed, we would be devastated,” said Director James Gillan of the Department of Public Health and Social Services.

Trump’s budget proposal requests a 10 percent increase in military spending next fiscal year alone, by $54 billion, but proposes cuts to Public Health services, education and other vital services.

Based on Public Health’s projection, at a 30 percent budget cut for various programs, the department would have to suspend hiring or let go of certain employees paid for with federal funds. The total number of impacted jobs isn’t known, but several jobs in each of the department’s federally funded programs could be in jeopardy, according to the department’s initial review.

Services such as lab testing, immunizations, and prevention of tuberculosis and mosquito-borne illnesses would have to be reduced or canceled as well, according to the department’s projections.

Some of Public Health’s estimated cuts, based on a 30 percent reduction, include:

• $12 million, from Medicaid;

• $4.2 million from the Medically Indigent Program;

• $2.4 million from the Temporary Assistance for Needy Families; and

• $1.2 million in administrative costs alone, not including the benefits that households receive under the Supplemental Nutrition and Assistance Program office costs.

The president is expected to propose cutting as much as 25 percent of funding for SNAP, commonly called the food stamps program, over 10 years, The Washington Post reported.

Nearly a third of Guam’s residents are on food stamps – 55,983 last fiscal year, but the amount has decreased from $113 million in fiscal 2014 to $106.8 million last year, Public Health has previously stated.

Gillan also showed a detailed analysis by the Association of State and Territorial Health Officials that lists nearly three pages of affected programs addressing respiratory diseases, birth defects and developmental disabilities, among other services.

Titled “A New Foundation for American Greatness,” Trump’s budget proposal would cut Medicaid funding by more than $12 million, reducing the approved fiscal 2018 funds for the program from $40.6 million to just $28.4 million.

At that rate, it’s projected that Guam medical providers’ participation from the program would decline. This was an issue raised during the department’s legislative budget hearing earlier this month.

Budgeting cautiously

The Trump budget cuts proposal should prompt GovGuam to be cautious with planning for how to spend money next financial year, which starts in October, said Speaker Benjamin Cruz.

“At this point, we have literally no idea how much support the Trump budget proposal has in either the House or the Senate,” Cruz said. “With so much uncertainty at play, GovGuam must act cautiously throughout the fiscal year 2018 budget process.”

Guam Delegate Madeleine Bordallo’s office yesterday said Trump also proposes to cut $3 million from annual Compact-impact funding, which helps Guam pay for services to immigrants from the Federated States of Micronesia, Palau and the Marshall Islands.

“President Trump’s budget proposal makes his administration’s priorities clear and will significantly harm the middle class and those who most need help,” she said.

Gillan hasn’t lost hope.

“I am hopeful that Gov. (Eddie) Calvo’s solid relationship with the president will help leverage help for the territories,” Gillan said.


Addressing the hospital crisis

Image result for guam memorial hospital

By Juan Flores

What if … our community insisted on and ensured that all residents receive 21st-century essential health care from our public hospital and Public Health clinics?

How can the governor, the senators and even the courts work on prioritizing resources so the compromises at the health facilities don’t lead to losing lives? What assurances can we get from our leaders that the “right to life” will be honored in determining how resources will be allocated, especially the time and energy it will take to address financial and procurement challenges?

We need to hear that someone is losing sleep over the issues at the Guam Memorial Hospital. We know that revenues from insurance companies, Medicare/Medicaid and direct payments are not meeting the demands for equipment, supplies and professional services that will have an impact on providing the right amount of care. If that continues to be true, what should be done? One approach is to run to the Legislature to secure more funding. That does not seem to be effective when allocations for tax dollars always lead to facing insufficient funds for “what we need” versus “what we would like to have.” Adequate health care is clearly a “need” rather than a “want.”

What other avenues can be taken to identify adequate funding, prioritize expenditures and provide the critical services, considering the expectations of the professionals at the hospital? How are the greatest financial, legal and health professional minds being brought to a table to map out an effective plan? We may all have faith that this is already taking place, but we’re not hearing about it. If any one of us finds ourselves or our loved ones at the hospital, will we be convinced that we will get the best possible care and ensure the likelihood we will be able to leave the hospital a little better than when we entered? We seem to be assured of the best care from the nurses, doctors and other staff members. We just keep hearing from them that they don’t always have the tools and supplies to do their best.

Our island community seems to face crises well when we put our hearts and minds to it. That has been true in the aftermath of natural disasters or impending events like FestPac. What’s happening at the hospital is a crisis. We will have confidence in what our leaders are doing if we know there is a viable plan. We also need to know that elements of the plan are being followed and that incremental successes have been achieved. We need to know that the sacrifices in some areas in our community are worth recognizing and living with for the sake of supporting the efforts for adequate health care at the hospital. As we have done in the past, we have to rally members of the community to stand behind our leaders, however they are to be identified and recognized, and make a hospital worthy of our community a reality.


Health Care Services A Big For Puerto Ricans in Current Economy


As the Puerto Rican government wades deeper into negotiations with some creditors in Washington for substantial financial relief, one thing is certain – millions of Americans who live in the U.S. commonwealth are bracing for more spending cuts. And many of them are already hurting when it comes to getting health care and other basic services across the board. Danica Coto, a reporter with the Associated Press, has been closely monitoring the direct impact on Puerto Rico’s residents. She joins us now from San Juan, Puerto Rico, by Skype.

Danica, welcome.

DANICA COTO: Thank you for having me.

SINGH: How bad are things now across Puerto Rico?

COTO: Well, I think most people would agree that it’s the worst it’s ever been. The island has been mired in a decade-long recession. People here have been hit with an increase in taxes, higher utility rates, an unemployment rate that is twice that of the U.S. mainland. And now the island is getting ready to restructure a portion of its $73 billion public debt. The situation has worsened to the point where nearly half a million people have left for the U.S. mainland since 2005.

SINGH: Talk to us a little bit about what you’re hearing on the ground from people who are especially worried about the impact on health care services.

COTO: That’s still a very big concern among Puerto Ricans here. The health situation is such, here, that in the past decade, the number of doctors has dropped from 14,000 to 9,000. They can wait up to a year to receive medical care for special conditions. And those who have money and can afford it, go to the U.S. mainland to get treated. Now, Puerto Rico pays the same amount in Medicaid taxes as U.S. states. The only problem is it receives less funding in return.

So the island expects to exhaust about $6.4 billion worth of supplemental Medicaid funding by the end of this year. And both the governor and the federal control board that is overseeing the island’s finances have warned that if they do not receive additional money for that purpose that hundreds of thousands of Medicaid recipients will be dropped from the plan. And officials note that nearly half of Puerto Rico’s population is on Medicaid, and they say that a total $900 million is needed to keep the health system alive.

SINGH: Could you just explain – if I were living in Puerto Rico and I wanted to go to the hospital or just to the doctor’s office, what am I likely to encounter?

COTO: Well, it’s all different types of scenario depending on where you live. If you live outside of the capital San Juan, I mean, many people travel to the capital, as it is, because they can’t find those services – basic services that they need. I think the most acute problem lies with specialists. The island of 3.5 million people at this point has only about two pediatric urologists, one orthopedists, specializing in ankle and feet, and one pediatric cardiologist and about a handful of geneticists and endocrinologists.

SINGH: Danica, when we spoke with the governor, he talked about a lot of reforms that he planned to pursue. He expressed a great sense of optimism that even though there are going to be austerity measures adopted, spending cuts will have to happen. But he expressed optimism that the reforms that were going to take place were going to be really helpful in the coming years. Do you sense Puerto Ricans feeling the same way?

COTO: I think people are very, very upset. More than 30 or 40,000 people marched against, you know, the federal control board, who’s overseeing the island’s finances, that recently approved a fiscal plan that outlines, you know, these measures that the governor has been touting. Everybody or most everybody understands that there’s a need for change.

But the anger here is toward previous administrations that have built this debt up over decades and decades. And now many feel that they are paying for this. And obviously, they don’t like it. There’s been marches. There’s more marches planned. And I think Puerto Ricans here have hit their limit for changes.

SINGH: That’s Danica Coto speaking with us via Skype. She’s a Caribbean-based reporter with the Associated Press. Thank you for speaking with us.

COTO: Thank you very much for having me. Transcript provided by NPR, Copyright NPR.


Bordallo warns new bill would cripple health care

The American Health Care Act of 2017 was passed Friday by House Republicans in a vote of 217 to 213. The bill seeks to repeal the Affordable Care Act, cutting Medicaid spending and changing the incentive structure to reduce government subsidies.

Guam Delegate Madeleine Bordallo believes the bill passed by the House Republican leadership will “cripple health care” around the country and force millions of Americans to lose coverage.

Bordallo said the bill does nothing to address the unique health challenges in the territories, and does not include important provisions that would make health care more affordable and accessible.

“I believe that we must find ways to remove the disparity between the 50 states and the territories in Medicaid and bring down insurance costs,” Bordallo said in a statement yesterday.

The Guamd delegate said she would continue to advocate for the elimination of Guam’s Medicaid cap and providing Medicaid eligibility to Compact of Free Association migrants, and will encourage her colleagues in the Senate to oppose the bill.

American Samoa

American Samoa forced to hire nurses off island.

The chief executive Taufetee John Faumuina said the number of local nurses cannot meet the growing numbers of ill people in the territory.

He said the hospital won’t function without nurses and thanked all those in the nursing profession for their service.

Mr Taufetee said the deteriorating health of the local population has made him lean on his counterpart, the Director of Health to step up preventive health care.

Continue Reading Here

American Samoa · Puerto Rico · Uncategorized · Virgin Islands

The American Health Care Act-Blog

I’ve been active on social media, and many are asking how does AHCA affect the US territories. So far, I just found a “summary” that was published by The Henry J. Kaiser Family. I will be digging more to find the text so I can hopefully make it easier to understand. So far, I don’t see anything on how this will work in US territories, There are no specificity to it in regards to US territories. But it already looks similar to what the ACA amendment that was in place. For those who don’t know I will try to clear this up:

Medicaid Overview:

The Medicaid program in American Samoa differs from Medicaid programs operating in each of the 50 states and the District of Columbia. Some of the key differences are:

  • American Samoa became a territory in 1900 and its Medicaid program was established in 1983. It is a 100% fee-for-service delivery system with one hospital servicing the territory. There are no deductibles or co-payments under the American Samoa Medicaid program however there are some fees charged by the hospital located in American Samoa. The territory does not administer a Medicare Part D Plan, instead the Medicaid program receives an additional grant through the Enhanced Allotment Plan (EAP) which must be utilized solely for the distribution of Part D medications to dual-eligibles.
  • American Samoa operates its Medicaid program under a broad waiver granted under the authority of Section 1902(j) of the Social Security Act.  This provision allows the Secretary to waive or modify any requirement of Title XIX, in regards to American Samoa’s Medicaid program, with the exception of three: the territory must adhere to the cap set under Section 1108 of the Act; the territory must adhere to the statutory Federal Medical Assistance Percentage (FMAP); Federal medical assistance payments may only be made for amounts expended for care and services described in a numbered paragraph of section 1905(a).
  • Through Section 1108 of the Social Security Act (SSA), each territory is provided base funding to serve their Medicaid populations. For the period of July 1, 2011 through September 30, 2019, Section 2005 of the Affordable Care Act provided an additional $181,307,628 in Medicaid funding to American Samoa.
  • Unlike the 50 states and the District of Columbia, where the federal government will match all Medicaid expenditures at the appropriate federal matching assistance percentage (FMAP) rate for that state, in American Samoa, the FMAP is applied until the Medicaid ceiling funds and the Affordable Care Act available funds are exhausted. The statutory FMAP local matching rate increased from 50%/ 50% to 55% federal /45% local, effective July 1, 2011. From January 1, 2014 to December 31, 2015 there is a temporary 2.2% FMAP increase for all Medicaid enrollees, bringing American Samoa’s FMAP to 57.2%.

Medicaid-Marketplace Overview

American Samoa was awarded $16,510,330 million for its Medicaid program in lieu of establishing a health marketplace. American Samoa must exhaust its Affordable Care Act (Section 2005) allotment prior to using these funds.

Medicaid and CHIP Standard Monthly Income Eligibility Levels

Eligibility in American Samoa differs from eligibility in the states. American Samoa does not have a TANF or SSI program and does not determine eligibility on an individual basis. Rather, the territory uses a system of presumed eligibility. Each year the percentage of the population below 200% of the poverty level is estimated and, after CMS approval of the estimate, CMS pays expenditures for Medicaid based on that percentage.

Monthly Medicaid and CHIP Enrollment Data

As of January 2015, 40,515 people are enrolled in the Medicaid and CHIP program in American Samoa.

Medicaid and CHIP Applications

  • Currently, American Samoa has no online Medicaid/CHIP application.

Medicaid and CHIP State Plan Amendments

The state Medicaid and CHIP plans spell out how each state has chosen to design its program within the broad requirements for federal funding. As always, states amend their Medicaid and CHIP state plans in order to inform CMS of programmatic and financing changes and to secure legal authority for those changes. The Affordable Care Act included many new opportunities for states to augment and improve their Medicaid and CHIP programs. As a result there has been a great deal of state plan amendment activity over the past several years in the areas of eligibility, benefits design and financing, as well as new approaches to providing health homes, long-term services and supports, and enrollment strategies like hospital presumptive eligibility. See below for a state-specific list of approved Medicaid and CHIP SPAs.

The AHCA states that there will be an allotment. The Summary specifically states that : “Convert Medicaid funding to a per capita allotment and limit growth..”

I don’t know who this will affect Guam, the Mariana Islands, Virgin Islands or Puerto Rico. I have had more luck being able to dig more information of the clinics in American Samoa and the services provided. I’ve read about American Samoa offering a women’s clinic with free services ( pap smear, HPV test, etc. ) I don’t know if the AHCA will allow funding for this clinic to continue to offer these services for free.

I will be taking the new few days, or maybe all this week to read through the text of the AHCA.

Here are the links if you are interested to dig deeper!

AHCA Summary by Kaiser Family

Congress Text- AHCA


American Samoa hospital workers without pay.

There’s disappointment, anger and frustration among employees of American Samoa’s LBJ Hospital after they discovered their pay was not in their bank accounts.

LBJ employees normally receive their pay-cheques by direct deposit on the Friday preceding payday .

But last week employees who went to withdraw money found their pay wasn’t available.

They were told their direct deposit would will be in their accounts today.

There’s disappointment, anger and frustration among employees of American Samoa’s LBJ Hospital after they discovered their pay was not in their bank accounts.

LBJ employees normally receive their pay-cheques by direct deposit on the Friday preceding payday .

But last week employees who went to withdraw money found their pay wasn’t available.

They were told their direct deposit would will be in their accounts today.

Click Here to continue reading the story.