Dear Editor,

As we celebrate the one year anniversary of the Supreme Court’s decision that upheld the Affordable Care Act (ACA), better known to some as Obamacare, it is important for me to reiterate that this landmark law is a giant step forward for all Americans, including those of us in the U.S. Virgin Islands and all of the off-shore territories. 

I am proud to have worked on such landmark legislation that many consider on par with the laws that created Medicare, Medicaid and Social Security. Certainly ACA has experienced the same opposition that came from some quarters in the wake of its passage.

While the offshore territories will benefit from their overall inclusion in the law, we will still have to fight to receive parity in some key provisions.

My territorial colleagues and I, after many meetings and arguments put forth in Caucus meetings, and with the support of the Black, Hispanic, Asian and Progressive Caucuses convinced the Democratic leadership to craft a bill with strong territorial provisions which passed the House.  In the Senate bill which became law, many provisions were changed and weakened, but overall, we still have received significant benefits that took a lot of work to achieve, and it was up to me as Chair of the Congressional Black Caucus Health Braintrust, a member of the Tri-Caucus and a member of the House Committee on Energy and Commerce which oversees health to lead the effort. 

While the House bill provided over $10 billion in new Medicaid funding for the territories, the Senate intended to continue only the 30% increase gained through the American Recovery and Reinvestment Act.  The White House’s original proposal was worse, with only an additional 5%, but I was able to rally the Black, Hispanic, Asian and Progressive Caucuses and after several tough face to face meetings with the Senate leadership and the President himself, we were finally able to come close to the original figure.  In the end, because of the ACA, instead of $16 million, the U.S. Virgin Islands has had access to over $40 million for the last two fiscal years and will have access to more in the future. It is up to the Virgin Islands, just as it is for the States, to implement the law we passed, but for reasons that are not entirely clear, the U.S. Virgin Islands is the only territory not to have drawn down on this funding.

Medicaid dollars must be matched by the state or territory.  In the House, I was able to get a match comparable to the highest in a state at around 75% federal requirement. The Senate and the White House were initially not willing to change it at all.  In the end, we were able to get a 55 federal/45 local match.  While the Center for Medicaid and Medicare Services informed the U.S. Virgin Islands administration that utilizing all funding spent on health would likely meet the match in whole or in part, it is important to point out here, that we are currently working to restore the 75% match and support for that is increasing.

We got $4 billion for the territorial exchanges in the House bill, but neither the Senate bill nor the White House proposal even included us in an exchange. In those meetings, we could not convince them to give us $4 billion, but we were able to move them from zero to $1 billion. 

We also were included in the pre-existing disease insurance program for adults in the House, but could not get it no matter how hard we fought for it from the White House and the Senate.  We also tried but did not get early retiree insurance.  Both closed prematurely due to cost overruns and are no longer available.

We were able to get the consumer protections extended to the territories, although they were initially only included in the House passed bill.  Later, we worked with Secretary Sebelius to make it clear that we were included as implementation began. These consumer protections mean, for example, that young people can stay on their parents insurance to age 26,  that children with pre-existing diseases like asthma, diabetes and sickle cell cannot be denied coverage and there are no lifetime limits.

In addition to the consumer protections and the major increase in Medicaid which will allow us to provide health coverage to more low income individuals and expand services, Virgin Islands residents have and will benefit from health care reform in the following ways:

•        Our Community health centers have received approximately $1.6 million in grants.

•        We have additional National Health Corps physicians because of the ACA increase.

•        The Virgin Islands received a $1 million grant to explore expanding insurance coverage and setting up of an exchange.

•        We received $.5 million for a visiting nurse program.

•        Any of our seniors or persons with disabilities who fell into the Medicare prescription donut hole received a $250 rebate.

•        Over 50% of our Medicare beneficiaries received preventive services without a co-pay and some begin taking advantage of the free (no co-pay) annual exam for the first time.

•        In addition, because the ACA limited how much insurance companies could spend on overhead, over $1.6 million dollars was rebated to Virgin Islanders, at an average of close to $500 per person.

Ultimately, it is up to the Virgin Islands government to decide whether or not the Virgin Islands will have an exchange given the reduction in funds in the Senate version, which became law.  The almost $25 million can go to expand Medicaid further, or as the Government House consultants have suggested, the territory can seek to use it to provide coverage for the uninsured who do not qualify for Medicaid. If indeed the level of funding or other legitimate reasons preclude us from setting up an exchange either alone or with one of the eligible 18 states or D.C., I would gladly support that position.

I hope this helps to clarify the many questions that Virgin Islanders have about how ACA will affect them.  As the implementation phase continues, there are still issues that need to be resolved in both the states and territories.  However, there is no question that we in the Virgin Islands are in a far better position than we were prior to it becoming law.


Donna M. Christensen

V.I. Delegate to Congress