LAKSHMI SINGH, HOST:
As the Puerto Rican government wades deeper into negotiations with some creditors in Washington for substantial financial relief, one thing is certain - millions of Americans who live in the U.S. commonwealth are bracing for more spending cuts. And many of them are already hurting when it comes to getting health care and other basic services across the board. Danica Coto, a reporter with the Associated Press, has been closely monitoring the direct impact on Puerto Rico's residents. She joins us now from San Juan, Puerto Rico, by Skype.
Danica, welcome.
DANICA COTO: Thank you for having me.
SINGH: How bad are things now across Puerto Rico?
COTO: Well, I think most people would agree that it's the worst it's ever been. The island has been mired in a decade-long recession. People here have been hit with an increase in taxes, higher utility rates, an unemployment rate that is twice that of the U.S. mainland. And now the island is getting ready to restructure a portion of its $73 billion public debt. The situation has worsened to the point where nearly half a million people have left for the U.S. mainland since 2005.
SINGH: Talk to us a little bit about what you're hearing on the ground from people who are especially worried about the impact on health care services.
COTO: That's still a very big concern among Puerto Ricans here. The health situation is such, here, that in the past decade, the number of doctors has dropped from 14,000 to 9,000. They can wait up to a year to receive medical care for special conditions. And those who have money and can afford it, go to the U.S. mainland to get treated. Now, Puerto Rico pays the same amount in Medicaid taxes as U.S. states. The only problem is it receives less funding in return.
So the island expects to exhaust about $6.4 billion worth of supplemental Medicaid funding by the end of this year. And both the governor and the federal control board that is overseeing the island's finances have warned that if they do not receive additional money for that purpose that hundreds of thousands of Medicaid recipients will be dropped from the plan. And officials note that nearly half of Puerto Rico's population is on Medicaid, and they say that a total $900 million is needed to keep the health system alive.
SINGH: Could you just explain - if I were living in Puerto Rico and I wanted to go to the hospital or just to the doctor's office, what am I likely to encounter?
COTO: Well, it's all different types of scenario depending on where you live. If you live outside of the capital San Juan, I mean, many people travel to the capital, as it is, because they can't find those services - basic services that they need. I think the most acute problem lies with specialists. The island of 3.5 million people at this point has only about two pediatric urologists, one orthopedists, specializing in ankle and feet, and one pediatric cardiologist and about a handful of geneticists and endocrinologists.
SINGH: Danica, when we spoke with the governor, he talked about a lot of reforms that he planned to pursue. He expressed a great sense of optimism that even though there are going to be austerity measures adopted, spending cuts will have to happen. But he expressed optimism that the reforms that were going to take place were going to be really helpful in the coming years. Do you sense Puerto Ricans feeling the same way?
COTO: I think people are very, very upset. More than 30 or 40,000 people marched against, you know, the federal control board, who's overseeing the island's finances, that recently approved a fiscal plan that outlines, you know, these measures that the governor has been touting. Everybody or most everybody understands that there's a need for change.
But the anger here is toward previous administrations that have built this debt up over decades and decades. And now many feel that they are paying for this. And obviously, they don't like it. There's been marches. There's more marches planned. And I think Puerto Ricans here have hit their limit for changes.
SINGH: That's Danica Coto speaking with us via Skype. She's a Caribbean-based reporter with the Associated Press. Thank you for speaking with us.
COTO: Thank you very much for having me. Transcript provided by NPR, Copyright NPR.