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Charlotte Amalie
Sunday, March 26, 2023


The Medical Faculty Foundation has identified four elements critical to the development of the Virgin Islands health care sector. They are the establishment of a world-caliber medical college, exporting health care expertise by attracting medical tourism, delivering existing health insurance dollars to our providers, and eliminating the unreasonably low Medicaid compensation cap Congress imposed upon the Virgin Islands.
During 2003 our hospitals spent over $30 million on uncompensated care. The purpose of the Medicaid program is to provide health coverage to the medically indigent. Nevertheless, while states are given prospectively relatively unconstrained Medicaid funding, the territory has an unreasonably low cap.
As a practical matter, the federal cap on Medicaid results in our receiving just under $450 per Medicaid client per year, which compares very poorly to the continental average of over $4,000 during that same year.
The foundation believes that the good work being done by Roy L. Schneider Hospital's chief executive officer, Rodney Miller, and its chief operating officer, Amos Carty, particularly in securing Joint Commission on Accreditation of Healthcare accreditation, would be far easier if the Medicaid compensation rate were corrected.
The economic impact of denying basic U.S. Medicaid standards denies Virgin Islanders tens of millions of dollars annually. This adverse impact is amortized across our entire population. It appears to represent our single largest missing but necessary source of annual health dollars.
We believe that the core Medicaid problem is quite ordinary and fundamental. Can the United States, in laws promulgated through Congress, unilaterally maintain a second-class sort of citizenship for Americans in the territories? The Honorable Judge Thomas K. Moore (in Ballentine v. United States) reminded us that "the nature and extent of the citizenship of residents of the Virgin Islands has been controlled up to now by a thoroughly ossified set of cases marked by the intrinsically racist imperialism of a previous era of the United States." He continued that those "who may not realize the extent to which the current status of the Virgin Islands depends upon an entirely repugnant view of the people who inhabited the Virgin Islands at the time of their acquisition are invited to read the Insular Cases."
The foundation believes that Judge Moore is entirely correct. The time to deliver the medical protective safety net of entitlements to citizens of the territories and citizens of the states equally has long since arrived. Notably, the V.I. Legislature recently urged Congress to lift our Medicaid cap and to increase average Medicaid expenditure. Similarly, Delegate Donna M. Christensen introduced a well-crafted bill in Congress to accomplish that goal. To our knowledge, it has not yet emerged from committee.
Creating a world-caliber health-care sector requires strong cooperative effort between federal and territorial governments, our educational and health-care institutions and people, and the private sector. Unequal and unreasonable Medicaid compensation to the Virgin Islands is founded in part upon a discriminatory series of cases and ideas which should be overturned. We in the Virgin Islands must expand the total health dollars delivered to the Schneider and Juan F. Luis Hospitals (and providers) by intentional and systematic attention to the four critical development efforts, starting with the largest.

Editor's note: Bruce R. Tizes is managing partner and co-founder of Galt Capital, a St. Thomas-based firm which manages investments for select clients which have included individuals, foundations and trusts, endowments, corporations and family offices. He holds doctor of medicine and law degrees and has been an active investor for more than 20 years. He chairs the Medical Faculty Foundation, which last August was granted a charter by Gov. Charles W. Turnbull to establish a private medical school in the St. Thomas-St. John district.
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