The implementation of the Affordable Care Act (ACA) continues to move forward rapidly, with 7.1 million people signing up by April 1, 2014 through the exchanges created through the law. This is happening despite the fact that certain elements of the ACA lack a degree of clarity, especially related to how the law will affect American territories like the U.S. Virgin Islands, Puerto Rico, Guam and the Northern Mariana Islands.
One issue of note is the appearance that the ACA treats territories differently and unequally, putting governments such as the U.S. Virgin Islands in a difficult situation when it comes to dealing with large numbers of uninsured residents.
While some critics have argued that the only certainty is that territories are not able to participate in federal exchanges, the reality is that the ACA bill does address territories specifically. The two pages dedicated to the territories effectively state that they have one of two options: implement their own exchange or boost overall funding for Medicaid. While this has little effect in Puerto Rico, which has relatively low rates of uninsured people, it directly impacts the U.S. Virgin Islands and other insular territories.
The U.S. Virgin Islands has a higher rate of uninsured than the average in the United States. In response to the vague language within the ACA bill, the Governor of the Virgin Islands, John P. de Jongh, has created a task force to determine the costs associated with creating an exchange. The task force concluded that it would cost $251 million to implement and subsidize an exchange for five years, something many critics consider an impossible option. Medicaid funding also would not address the overall uninsured rate, so the second option seems unrealistic to many, as well.
The ambiguity of the text concerning the territories and the ACA also leaves much of the implementation up to the U.S. Department of Health and Human Services. Representatives from the U.S. Virgin Islands are attempting to work with the federal agency to determine a suitable solution to this problem. And with some critics saying that residents of the Virgin Islands are being treated as “second-class citizens,” there’s a lot riding on these efforts.
It’s important for residents throughout the U.S. Virgin Islands to remain updated on progress with the ACA related to our territory. If you have more detailed questions, consider working with an experienced attorney for guidance.
BoltNagi is a well-established and respected government relations law firm serving clients throughout the U.S. Virgin Islands.