VIDEO: Mandate Applies to Guam, But Guam Can Not Afford Health Exchange


Guam – In the wake of last week’s ruling from the U.S. Supreme Court, Tax Commissioner Art Ilagen says the individual mandate applies to Guam meaning everyone will have to get insurance. NetCare Administrator Jerry Crisostimo agrees and so does Public Health Director James Gillan.


But the Health Insurance exchange aimed at providing a wide range of affordable plans, is optional. And GovGuam will have to decide whether to adopt it or not. But, Public Health Director Gillan, and others, warn we can not afford the exchange which Ilagan has said may cost GovGuam $70 million dollars annually.


When Congress passed the Affordable Health Care Act, Public Health Director James Gillan says “the territories were an after-thought.”

For example, Gillan points out that states who opt-in for the additional medicaid benefits will get 100% reimbursement from Medicaid for 3 years and then 90% after that. But if Guam opts-in, it would have to come up with matching funds in order to get a lump sum payment of just over $200 million through 2019. 

Gillan says one way they’re trying to match the additional funds Medicaid is by moving some island residents off of the Medically Indigent Program [MIP] which is paid for entirely by Guam taxpayers, and into Medicaid which the Feds pay for. That could free up some GovGuam funds currently used for the MIP program and allow us to qualify for the the matching Medicaid money.

Meanwhile, the question of the individual mandate seems to be settled with the Supreme Court’s decision that its a tax.

Gillan agrees with Insurance Commissioner Art Ilagan and NetCare Administrator Jerry Crisostimo that because Guam mirrors the IRS Code, the individual mandate, requiring everyone to get coverage, does apply to Guam.

But that creates another problem.

The Health Insurance Exchange provision in ObamaCare is designed to provide a wide range of insurance plans from both on-island and off-island providers allowing Guam residents the broadest possible choice to find an affordable plan that suits their needs.

But there is a reimbursement component in the Health Exchange option that would require GovGuam to re-imburse individual subscribers, and that is what Insurance Commission Ilagan warned could cost us $70-million a year.  Gillian agrees with Ilagan, GovGuam can not afford it.

The bottom line maybe that everyone on Guam will have to get health insurance, but they won’t have the advantage of shopping for the lowest cost plan that the Health Exchange is meant to offer.