Both Puerto Rico and Puerto Ricans are intertwined with the well-being of New York state and our nation. The complex relationship began with a payment to Spain in 1898 for a sum of $570 million in 2015 dollars. The island’s residents became U.S. citizens in 1917 and Puerto Rico became a commonwealth of the United States in 1952.

Now, over 116 years after the U.S. Congress ratified the Treaty of Paris, which handed over the once Spanish-controlled territory, the complex relationship between Puerto Rico and the United States continues. Facing a daunting set of economic problems, the island finds itself using more than 70 percent of its economic output to service a debt of over $72 billion. Simultaneously, migration to the U.S. mainland has accelerated, further shrinking its tax base.

Puerto Rico’s population has fallen 4.7 percent since 2010 to 3.5 million, a period when the overall U.S. population grew 3 percent. If current rates continue, Puerto Rico will lose over 250,000 residents this decade alone, and its population is set to decline to 3 million by 2050.

To put this problem in perspective, California has a population of 35 million and Puerto Rico has accumulated a debt nearly half as large as that state.

Combine this problem with years of low federal reimbursement rates for health care services to the island’s indigent population and we now have Puerto Ricans fleeing the island to obtain health care services on the mainland. New York state is home to 1 million Puerto Ricans and is a prime destination for Puerto Ricans seeking medical care in our hospital system. The impact and strain on New York’s health care system and funding mechanisms are and will continue to be significant unless the federal government moves to equalize its health care reimbursement rates for island residents.

In both Mississippi and Puerto Rico, over 52 percent of children are living in poverty, and the island has the highest overall poverty rate in the nation at 44.2 percent. Yet 83 percent of Mississippi’s health care costs for the indigent are covered by Washington, while Puerto Rico only receives 55 percent in assistance. This formula is leading to the closing of health care facilities and the rationing of health care.

The current debt crisis and health care quandary the island faces was enabled by policies originating in Washington. So it is clear that the solutions also rest with action by Washington.

However, like on so many other issues important to Americans, Washington has failed to act diligently and with resolve. Congress enabled this borrowing spree by granting Puerto Rico the unique power to issue bonds that are exempt from federal, state or local taxes. The island’s health care crisis was created by federal bureaucrats who decided to underfund the island’s health care system for decades. Puerto Rico has taken austerity measures to deal with the economic policies dictated by Washington, leading to mass protests and more pain for our fellow Americans.

As the members of the New York state Assembly’s Puerto Rican/Hispanic Task Force travel to the island for its 28th annual fall conference in early November, this situation is a priority issue which leads the list of important conversations we will be having on a wide range of topics that will have a direct impact on Puerto Rico, New York and our nation.

In our view, as the health and well-being of Puerto Rico goes, so goes the health and well-being of the mainland.

Assemblyman Marcos Crespo is chairman of the Puerto Rican/Hispanic Task Force.