Healthcare Crisis in CNMI Must Be Addressed

February 28, 2012

Healthcare is a universal or human right according to the United Nations Universal Declaration of Human Rights. This is the primary reason that the controversial Protection and Affordability Care Act pushed by the Obama Administration was signed into law.  It was a step toward the goal that every American, regardless of their financial state, could have access to quality healthcare.

The United States remains the only industrialized nation that does not guarantee health care as a right to its citizens. Should we even be surprised that we rank 26th among major, developed nations on life expectancy, and 31st on infant mortality? Rep. Bernie Sanders (D-VT) stated, "Until we put patients over profits, our system will not work for ordinary Americans."

While healthcare must be improved in every state, it has to be improved in the CNMI immediately.  The healthcare system in the CNMI is in a critically dangerous state that must not be ignored. The hospitals on all three islands are running on life support, trying to avoid bankruptcy. Vital personnel are not being paid or receiving benefits, vendors have stopped delivering supplies, necessary equipment cannot be replaced for lack of funds and numerous other problems threaten the facilities' ability to administer quality healthcare.

The Saipan Tribune reported that the Medically Indigent Assistance Plan of the CHC that was funded by the federal and local governments was shutdown last year sometime in July 2011. I am unsure how this would affect future federal funding or even what type of funding the program received. (Most likely the federal government is or will be investigating this.) This is just one more obstacle to medical care for the poor.

If a hospital in any state closed down due to bankruptcy it would be a blow to the community, but it would not bring about the utter disaster that the collapse of the healthcare system in the CNMI would bring. In any state in America those needing medical care can choose from dozens of hospitals and medical centers for treatment. Residents of the CNMI do not have that choice. While there are several clinics on Saipan, there is only one hospital on island. On Rota and Tinian the government-run healthcare centers are the only option for any medical care. The CNMI is isolated and far from any other medical facilities. If the CNMI's medical facilities cannot provide quality care, patients would have to fly to an off-island hospital. The urgency to fix the problems is obvious.

Another serious threat regarding healthcare in the CNMI is the proposed legislation that targets the poorest of the poor in the CNMI. The Fitial Administration and CNMI Legislature are pushing legislation that would force foreign workers to pay for their own healthcare and healthcare insurance. Since the average foreign worker makes only $5.05 an hour, it would be impossible for them to pay for rent, food, utilities and medical care on that poverty level salary.

Since foreign workers are not eligible for Medicare or any subsistence programs there could be a healthcare crisis of another kind if they had no access to affordable medical care. Those unable to afford medical treatment would not only find their health and lives at risks, but there would also be a strong possibility of infectious diseases spreading to the community.  In the 1990s when there were thousands of unemployed foreign workers, many the victims of illegal recruitment scams, there were untreated workers who were suffering from tuberculosis who posed a threat to the community at large. Is this what the legislators want to see happen?

Under the current system, the employers of foreign workers are responsible for paying for the medical care expenses of their employees. At least in theory.  Even with the law many just did not reimburse the CNMI hospitals for their workers' medical expenses or illegally deducted the costs from the employees' paychecks. I am sure that many foreign workers who will find themselves unable to afford medical care and discriminated against in federal offices will be soon leaving for more hospitable places.

Other hateful legislation being proposed in the CNMI would require that the employers of foreign workers become collection agencies for CHC, as they would have to garnish up to 25% of their employees' pay if they had outstanding bills with CHC. It also requires that the names of those owing bills to CHC be  published in the newspapers. Such a threat would also pose a danger to the state of health of the workers and the community as more foreign workers avoided seeking unaffordable medical treatment not wanting to see their salaries cut and names in print.

It has been two years since it was first revealed that nurses and other vital hospital employees were not being paid. Little was done to correct the problem, which has only gotten worse. The CNMI Government does not seem to have a comprehensive plan to revitalize the hospitals or to ensure quality healthcare for every person who works and lives in the CNMI. The leaders just move from one problem to another shifting what little funds exists to keep the schools open, the hospital open and trying to pay a flood of bills without raising needed revenue. They propose bills that could negatively impact the healthcare of the entire community. I do not see this crisis turning around without federal intervention.


the teacher said...

What happens when some of the 12k CWs need treatment? Are they insured and aren't employers required to offer coverage? It would be amazing to have guest workers here that are uninsured, meaning a citizen or company signed to employ a CW and they are uninsured. So the question is who pays?

The CW program has little or no provisions for health insurance, creating a situation of more workers without insurance than we have voters, a problem that must be addressed and a wink and nod won't get it. This coupled with a crashing retirement fund spells disaster for payments and collections for the hospital.

Anonymous said...

"The United States remains the only industrialized nation that does not guarantee health care"

You are absolutely mistaken. For starters Wendy China does NOT guarantee health care and it is not free to anyone. You pay cash or you die. Neither does the Philippines or Russia. The Philippines will place an armed guard at your door until payment is made. This happens at St. Lukes. No one in no one out. Patients have died like this. In fact come to think of it no industrialized nation guarantees health care to anyone. Some may offer a socialized version of "free" health care but there are absolutely NO gurantees of any patient care. Yes patients have died waiting for treatment in France, Germany and most socialist countries.

Wendy Doromal said...


China, Russia and the Philippines are not among the countries in the category of industrialized or developed nations. You know I am not sure of your point, but mine is that there needs to be a revamped healthcare citizens in the CNMI and US and that healthcare is a human right.

Anonymous said...

What happened to all of the Obama care that the Obama people heralded as a "life saver" for all? The best thing since the invention of the wheel. (plus the additional $5 trillion. plus debt in about three years of his term, and a plan to rise it another $1.5 trillion)

Anonymous said...

It does not matter if the Contract Workers have insurance or not. They don't pay their bills and are the largest debt holder for CHC. Refuse service to those having a debt. Do not release Birth Certificates until they pay up front.

Wendy Doromal said...

9:00 Unfortunately under CNMI LAW the EMPLOYERS, not the contract workers were responsible for all of the workers' medical bills. the EMPLOYERS, not the foreign workers owe the money. Please get the facts right!

It would be illegal to withhold a birth certificate, which is unrelated to a bill.