Puerto Rico is now the perfect place for people who think Obamacare is the worst thing since slavery, but would also like to be insured. Territories are now exempt from most of the requirements of Obamacare. Guam, the U.S. Virgin Islands, American Samoa and the Northern Mariana Islands have high uninsured rates, but Puerto Rico has a pretty good publicly funded health care system.
The Center for Medicaid and Medicare Services announced Wednesday that the five U.S. territories would mostly be exempt from Obamacare's requirements, according to Sarah Kliff at Vox. Like the 50 states, territories were required to offer insurance to everyone and use 80 percent of premiums on health care. Unlike the states, territories didn't have an individual mandate or subsidies to lure people into the exchanges. Obamacare's detractors were worried that young people would be turned off by high (but subsidized) premiums, and only old and sick people would sign up for the plans, driving premiums through the roof — aka a death spiral. Without a carrot (subsidies) and a stick (the mandate) to convince healthy people to enroll, that's what happened in the territories.
"HHS and the government itself describe health care reform as a three-legged stool where you have the mandate, the subsidies and the market reforms," John McDonald, director of the Virgin Islands' division of banking and insurance, told The Washington Post in December. "Well, what they've basically done is left us with a one-legged stool." In the Northern Marina Islands, the only insurer in the territory said it would stop offering its one plan in 2014.
In that sense, being exempt from most of the Obamacare provisions (plans in the territories can't drop coverage or have lifetime or annual spending limits) is a great thing. The only problem is the territories need Obamacare more than most states do. As the chart to the right shows, all the territories have incredibly high uninsured rates — except for Puerto Rico.
In 2012, Puerto Rico's uninsured rate was 10 percent, lower than all but three states and the District of Columbia. As Al Jazeera America explained in October, Puerto Rico has a "popular locally funded" health care system and its uninsured rate is much lower than the other territories. So if you want to escape the clutches of Obamacare but still have a decent health insurance system, move to Puerto Rico. Or Canada.