Challenges in the U.S. Territories: COVID-19 and the Medicaid Financing Cliff
Issue Brief
Puerto Rico data are available for 2019. U.S. Virgin Islands data are available for 2016.
National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), How CDC Prevents Chronic Diseases and Promotes Health for US Territories and Affiliated Pacific Islands (Atlanta, GA: Centers for Disease Control, April 2019), https://www.cdc.gov/chronicdisease/resources/publications/factsheets/island-health.htm
Ibid.
U.S. Army Corps of Engineers, Facilities Condition Assessment Guam Memorial Hospital (Washington, D.C.: U.S. Army Corps of Engineers, April 2020), https://www.doi.gov/sites/doi.gov/files/uploads/oia-guam-memorial-hospital-facility-assessment.pdf
U.S. Department of the Interior, Office of the Inspector General, Insular Area Health Care: “At the Crossroads of a Total Breakdown” (Washington D.C.: U.S. Department of the Interior, Office of the Inspector General, September 2008), https://www.doioig.gov/sites/doioig.gov/files/2008-G-0040.pdf
U.S. Department of the Interior, Office of the Inspector General, Insular Area Health Care: “At the Crossroads of a Total Breakdown” (Washington D.C.: U.S. Department of the Interior, Office of the Inspector General, September 2008), https://www.doioig.gov/sites/doioig.gov/files/2008-G-0040.pdf
Averting A Crisis: Protecting Access To Health Care In The U.S. Territories, 117th Cong. (2021) (testimony of Congressman Gregorio Kilili Camacho Sablan).
Peter Georgiev and Adiel Kaplan, “American Samoa’s coronavirus conundrum: No Way to test,” NBC News (May 2020), https://www.nbcnews.com/health/health-care/american-samoa-s-coronavirus-conundrum-no-way-test-n1167776
Ibid.
Dánica Coto, “Missteps mar Puerto Rico’s response to coronavirus,” AP News (April 2020), https://apnews.com/article/e5ba6c2639ee52dad5e367d2228ac764
Patricia Mazzei, “Puerto Rico Lags Behind Everywhere Else in U.S. in Virus Testing,” The New York Times (August 2020), https://www.nytimes.com/2020/04/21/us/puerto-rico-coronavirus.html
Haidee Eugenio Gilbert, “Lack of nurses could slow community testing as COVID cases rise again,” The Guam Daily Post (August 2020), https://www.postguam.com/news/local/lack-of-nurses-could-slow-community-testing-as-covid-cases-rise-again/article_6a7808b8-d79d-11ea-9cd1-370bce05a80d.html
Emily Palmer, “Moored in a Fragile Paradise,” The New York Times (April 2020), https://www.nytimes.com/2020/04/17/travel/coronavirus-stjohn-caribbean.html
Michael Walsh and Elsie Lange, “How the tiny Pacific island of Guam became one of America’s coronavirus hotspots,” ABC News Australia (September 2020), https://www.abc.net.au/news/2020-09-11/guam-hospitals-under-pressure-after-coronavirus-outbreak/12637704
Nicole Acevedo, “FEMA acknowledges Puerto Rico lacks rebuilt homes and a hospital to survive COVID-19,” NBC News (July 2020), https://www.nbcnews.com/news/latino/fema-acknowledges-puerto-rico-lacks-rebuilt-homes-hospital-survive-covid-n1234810
Michael Walsh and Elsie Lange, “How the tiny Pacific island of Guam became one of America’s coronavirus hotspots,” ABC News Australia (September 2020), https://www.abc.net.au/news/2020-09-11/guam-hospitals-under-pressure-after-coronavirus-outbreak/12637704
U.S. Department of the Interior, The Trump Administration is Supporting the People of the U.S. Virgin Islands (Washington, D.C.: U.S. Department of the Interior, 2020), https://www.doi.gov/sites/doi.gov/files/uploads/oia-covid19-wh-fact-sheet-usvi.pdf
U.S. Department of the Interior, Commonwealth of the Northern Mariana Islands Uses Interior CARES Act Funding to Strengthen COVID-19 Emergency Preparedness and Response Capabilities (Washington, D.C.: U.S. Department of the Interior, July 2020), https://www.doi.gov/oia/press/commonwealth-northern-mariana-islands-uses-interior-cares-act-funding-strengthen-covid-19
Data are a KFF analysis of Johns Hopkins University Centers for Civic Impact for the Coronavirus Resource Center (CRC), https://github.com/govex/COVID-19/tree/master/data_tables/vaccine_data.
Average daily number of cases are calculated as the average cases per million as a seven-day rolling average. For this analysis, the daily change in cases per million residents is averaged for the previous seven days. All data were pulled on May 12th, 2021.
Edmy Ayala and Patricia Mazzei, “Puerto Rico Orders Coronavirus Lockdown. Violators Could Be Fined,” The New York Times (March 2020), https://www.nytimes.com/2020/03/15/us/coronavirus-puerto-rico.html
Yanira Hernández Cabiya, “Dramatic economic reopening after 88-day lockdown,” Caribbean Business (June 2020), https://caribbeanbusiness.com/52221-2/
Associated Press, “Puerto Rico will close schools amid COVID surge,” NBC News (April 2021), https://www.nbcnews.com/news/latino/puerto-rico-will-close-schools-covid-surge-rcna632
Edmy Ayala and Patricia Mazzei, “Puerto Rico Just Had Its ‘Worst Moment’ for Covid-19,” The New York Times (April 2020), https://www.nytimes.com/2021/04/23/us/coronavirus-puerto-rico.html
United States Virgin Islands, COVID-19 – Path to a New Normal (United States Virgin Islands, March 2021), https://www.vi.gov/covid/phases/
National Governors Association, Coronavirus State Actions (Washington D.C.: National Governors Association, July 2020), https://www.nga.org/coronavirus-state-actions-all/
Reopening efforts were analyzed on May 12th, 2021. At that time, USVI had not made any changes from its previous “Safer at Home” phase.
Simon Romero, “A Place in the U.S. With No Covid-19? Look at American Samoa,” The New York Times (May 2020), https://www.nytimes.com/2020/05/06/us/coronavirus-american-samoa.html
Associated Press, “American Samoa Repatriation Program Detects 5 Virus Cases,” U.S. News (January 2021), https://www.usnews.com/news/best-states/hawaii/articles/2021-01-28/american-samoa-repatriation-program-detects-5-virus-cases
Rates were compared using “Total Doses Delivered Rate per 100,000” and data were analyzed on March 26th, 2021 and May 4th, 2021. See: Center for Disease Control, COVID Data Tracker (Centers for Disease Control, March 2021), https://covid.cdc.gov/covid-data-tracker/#vaccinations
Steve Limtiaco, “CNMI outpaces United States in COVID-19 vaccine rollout,” Pacific Daily News (January 2021), https://www.guampdn.com/story/news/2021/01/06/cnmi-covid-19-vaccine-rollout-best-us-cdc/6574087002/
RNZ (Radio New Zealand), “Close to 24,00 Covid-19 vaccines rolled out in American Samoa,” RNZ (March 2021), https://www.rnz.co.nz/international/pacific-news/437798/close-to-24-000-covid-19-vaccines-rolled-out-in-american-samoa
Manatt Health, The American Rescue Plan: An Overview of Medicaid Provisions and State/Local Relief (Manatt Health, March 2020), https://www.shvs.org/wp-content/uploads/2021/03/FINAL-ARP-Medicaid-and-State_Local-Relief-Deck.pdf
Ibid.