Congress Must Fully Fund Medicare, Medicaid, SSI, and SNAP for Territories

By Edoardo Ortiz (@edoardo_ortiz) and Giovanni Pagán Vélez (@giopaganvelez)

Congress is on track to reject President Biden’s proposal to treat U.S. territories like states when funding health and social programs. We find that an overwhelming majority of likely voters across partisan lines support Biden’s proposal. 

Fulfilling a campaign promise, President Biden included parity in funding for territories in his budget proposal.  Leaders from Congress and Puerto Rico’s government spent the past couple of months lobbying to keep this proposal in the budget, but the House recently decided to instead approve a 5-year continuation to the territories’ current Medicaid funding levels. This follows precedent. Congress had approved temporary extensions of Medicaid monies since the Affordable Care Act initially provided territories with more equitable funding through block grants. Since then, funding for Puerto Rico has followed a pattern. These temporary extensions run out and territories face steep funding cliffs. Congress then, neglecting to implement a permanent fix, simply legislates another funding extension. Moreover, current legislation imposes an arbitrary cap on medicaid funding for territories that is not commensurate with their healthcare needs. By eliminating Medicaid funding caps for Territories and aligning their matching rate with States, Biden’s proposal would have provided a permanent fix and eliminated the uncertainty territories face every time Medicaid extensions run out.

Access to Supplemental Security Income (SSI) in the territories sparks another debate entirely. This Social Security program “is designed to help aged, blind, and disabled people, who have little or no income” and “it provides cash to meet basic needs for food, clothing, and shelter.” Most territories don’t have access to it. This is despite the territories having the highest poverty rates of all U.S. jurisdictions (42 percent on average when weighted for population, well above 11 percent for the US. A 2020 federal court case, United States vs. Vaello-Madero, determined that denying SSI to Puerto Ricans was unconstitutional. However, the Department of Justice swiftly appealed this ruling and the Supreme Court is set to either affirm or reverse the decision. If they reverse it, extending SSI to Puerto Rico and the other territories will be in Congress’ hands.

All of this obscures the fact that, despite their government’s concerted efforts to prevent it, most Americans overwhelmingly support funding social programs for the territories like states.

When it comes to Medicaid and Medicare, 67 percent of Americans either strongly or somewhat support providing equal funding to the territories, with 50 percent of Republicans in favor.

 
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When we ask similar questions about SSI and SNAP we get remarkably similar results.

Not only are the margins of support wide, but they hold for Democrats, Independents, and Republicans. Fifty-two percent of Republicans support extending SSI to the territories.

 
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Finally, 65 percent of likely voters support expanding SNAP to U.S. territories, with 51 percent of Republicans supporting fully extending SNAP to U.S. territories.

 
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The U.S. government can legally continue to provide unequal funding to territories, precisely because they’re territories. While “territory” used to mean future state, legal changes have altered the meaning. Now “territory” means a place where the rules of equal treatment under the law don’t apply. This lets the federal government continue treating territories as separate and unequal when it comes to social program funding. Our polling finds that Americans of all political affiliations clearly disapprove, and support funding territories at the same levels as states.


Methodology

From July 28 to 30, 2021, Data for Progress conducted a survey of 1,184 likely voters nationally using web panel respondents. The sample was weighted to be representative of likely voters by age, gender, education, race, and voting history. The survey was conducted in English. The margin of error is ±3 percentage points.

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