After tens of thousands rallied in San Juan asking for parity in Medicare funding for Puerto Rico, the fight has moved to Washington, D.C., as headlines on the island have shifted from the health care issue to the chaotic fiscal situation of the Government Development Bank. But that has not slowed local government officials and representatives from the health sector from their efforts as they continue to meet with federal officials and legislators to discuss the matter.

The Puerto Rico Healthcare Crisis Coalition, represented by its chairman Dennis Rivera and member Terry Bishop, and Ricardo Rivera-Cardona, executive director of the Puerto Rico Health Insurance Administration, will officially present their position on the proposed Medicare funding cuts of 11 percent for the island.

“There are also meetings taking place with our lobbyists to develop different strategies to work with Republican and Democrat legislators, because we understand that to achieve parity, we need action from Congress, since Puerto Rico is a territory,” said Dr. José Joaquín Vargas, president of the Independent Practice Association of Puerto Rico.

Vargas said the coalition is also evaluating the possibility of suing the federal government because of the unequal treatment of Puerto Rico and to ask that the island be exempt from the Health Insurance Tax, included in the Affordable Care Act, which would impact local health insurance companies.

Puerto Rico pays the same Medicare taxes as the states but receives 40 percent less in reimbursement, and about 70 percent less in Medicaid reimbursement, according to figures provided by the Healthcare Crisis Coalition, a group of patient advocates, doctors, hospitals, insurers, activists, labor unions and business leaders.

Puerto Rico’s health care system will lose $500 million across the board if Washington doesn’t restore the funding, including $150 million to hospitals and $65 million to pharmaceutical companies, the group says.

“If this matter is not resolved, we will face a chaotic situation and our patients will continue to leave the island, which would represent less funds for our health care system and would lead us down an abyss from which we won’t be able to escape,” Vargas said. “We have to be vigorous in this fight and we can’t continue to let others make decisions that affect us without our input.

“Just because we’re a territory, it doesn’t mean we as American citizens don’t have the same rights as the rest of the states,” he added. “People are leaving, families are being torn apart and we can’t stand still with our arms crossed while this crisis takes hold.”

Sources said another alternative Puerto Rico is evaluating is asking President Barack Obama to set aside funds for this issue from his proposed $25 billion omnibus spending package.

“But that would be a more difficult proposition,” said one source close to the negotiations with the federal government.

The coalition is also organizing a march Dec. 2 in Washington, D.C., and New York Gov. Andrew Cuomo is organizing a summit to discuss the issue, but a specific date is yet to be set.

“We’re very grateful in Puerto Rico for all the support we have received from the people and the officials in New York,” Vargas said. “We’re aware they’re giving 100 percent of their effort for us and we hope they continue contacting their senators and representatives to help us get out of this situation. If not, we’ll see them soon in New York, but as our next-door neighbors.”