Guam’s healthcare safety net is once again the center of debate during the legislature’s evening session Tuesday, and this time its in the form of a proposed tax rebate for Medicaid providers. 

For the reported 30,000 Medicaid recipients on Guam, securing a doctor’s appointment can take weeks of waiting or end in going without care altogether. That’s the driving force behind Bill 118, which would give clinics a Business Privilege Tax rebate for Medicaid services provided – a move supporters say will help providers expand and see more Medicaid patients.

Bill author Senator Sabrina Salas Matanane says the current system forces providers to turn patients away, stating, “Providers who want to help often can’t afford to. The cost of doing business, the low reimbursement rates, the lack of support – it all adds up.”

She argues the rebate wouldn’t be giving away free money, but it would be an incentive for clinics to expand their operations to accept more medicaid patients with safeguards in place to monitor and prevent fraud.

But with the nation bracing for major federal cuts, Senator Chris Barnett points to the 117 clinics on-island and the 90 Philippine clinics that already accept Medicaid. “So what are we really talking about here? We’re talking about access to a tax break for the doctors that is going to erase $5.8 million of General Fund revenues," he shared.

It’s a question of priorities for our lawmakers: do they ease the weight on Medicaid providers’ shoulders, or preserve revenue for other critical needs?

For Senator Shawn Gumataotao, the choice is clear, as he noted, “We should try to realign tax policy where our people can benefit the most. A safety net that needs to be sure that there are no holes in it to the detriment of the most vulnerable.”

Vice Speaker Tony Ada adds that the federal government and the centers for Medicare and Medicaid services are already moving to close the Medicaid loophole, which has been utilized by some states and territories to inflate federal payments to states and territories, and free-up funds for non-medical purposes.

“One way or another, it’s going to come to an end. We do it on this floor or the federal government will do it," Ada said.

Co-sponsor Senator William Parkinson says the bill deserves a chance, but the legislature needs to plan for the loss, saying, “How are we going to offset these potential revenue losses? I don’t mind taking a chance here, but are we looking to make up that $6 million somewhere else or are we looking at cuts down the road?”

Senator Salas Matanane says cuts are inevitable and will be made to offset any loss. She closed the debate. 

“My senatorial colleague who claims to be the biggest advocate of the disenfranchised, the poor, the most vulnerable, is now claiming that doctors are going to get rich off a tax break," she stated. "This is the saddest part of their argument because the only thing on the other side are families with elderly members who have heart ailments or have debilitating diseases, or children with juvenile diabetes who can’t see a doctor because they were turned away.”

The bill was moved to the Third Reading File.