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  5. Puerto Rico

Puerto Rico

The Commonwealth of Puerto Rico is an unincorporated U.S. territory in the northeast Caribbean Sea.

Like the residents of the other Island Areas, Puerto Ricans lack full voting representation in Congress. They typically do not pay federal taxes on income earned on the island, they do not have the same eligibility for some federal programs as those in the states, and they cannot vote in presidential elections, although they may vote in party primaries.

Culturally, Puerto Rico closely resembles Latin America, including a predominately Spanish-speaking population.

Government

The U.S. president is considered head of state, while the governor of Puerto Rico is the head of government.

Healthcare and Facilities

The public institutions of the health sector in Puerto Rico are part of the “umbrella” Department of Health. It consists of the Department of Health, the Substance Abuse and Mental Health Services Administration, the Puerto Rico Medical Services Administration (which provides health services and education and conducts research), the Cardiovascular Center of Puerto Rico and the Caribbean, and the Correctional Health Program.

Puerto Rico operates a Medicaid program to support care for low-income residents. Territorial Medicaid programs are underfunded relative to the states. Unlike state Medicaid programs, territorial Medicaid programs have (1) a cap on total federal contributions and (2) a federal funding match set by law rather than based on per-capita incomes. Unlike the other territories, in which the match rates are permanently set at 83%, Puerto Rico’s federal funding match is 76% and only guaranteed through 2027, after which point it could revert to an even lower match rate of 55%. Learn more about the need for equitable Medicaid funding for the territories via ASTHO's Permanent, Sustainable Medicaid Funding for U.S. Territories Policy Statement.

Key Priorities

In the 2016 ASTHO Profile report, Puerto Rico Department of Health highlighted these priorities:

  • Improve resource acquisition and management to optimize health impact.
  • Strengthen the infrastructure to support sustainable collaboration.
  • Institutionalize the use of health information technology.

Disease Burden

Like the Pacific jurisdictions, Puerto Rico works to address a significant noncommunicable and communicable disease burden. The top causes of death in 2019 were:

  • Ischemic heart disease
  • Stroke
  • Diabetes
  • Chronic kidney disease
  • Alzheimer’s disease