Been there

FUNDING the medical referral program has always been a controversial issue because the CNMI government has other ongoing (and ever mounting) obligations and is, usually, not collecting enough revenue.

But House Bill 22-77, which aims to “reform” the medical referral program, may make it  more contentious.

The bill’s key provision states that once the appropriated funding for the program has been “exhausted” then medical referral services will cease — “until additional funding is identified by the governor and appropriated by the legislature from the general revenues of the CNMI.”

So what will happen to the patients who must be referred to off-island hospitals if there is no more funding for the program?

What will be the reaction of off-island hospitals and/or other vendors if they learn that they may have to wait longer before they can receive payments from the CNMI government?

(Headline news from the year 2000: “Hawaii Hospitals Tell CNMI: No More Medical Referrals.” The hospitals were demanding payments. Ten years later, it was reported that “Travel Agencies Stop Tickets For Medical Referral Patients” due to the CNMI government’s “nonpayment of arrears.”)

So let’s say H.B. 22-77 becomes law and the governor, the House and the Senate are still figuring out where to find the extra funding needed for medical referrals. Would CHCC end up paying for the unappropriated expenses? (Which is what CHCC says shouldn’t happen because the government already owes CHCC a lot of money for other unfunded services it provides the public.)

In April 1995, the governor informed lawmakers that the medical referral program might be “terminated” unless lawmakers appropriated additional funding. Variety reported that the program “has perennially been a problem…as it has constantly overrun its budget for the last several years. It has also accounted for most of the government’s spending deficit in fiscal year 1994.”

We’re talking about the 1990s, when the local economy was doing so much better compared to what it is today.

In any case, the then-governor told lawmakers that they must pass, as soon as possible, a supplemental budget to fund medical referrals and the student financial aid program. According to lawmakers, however, the governor should identify the funding sources. Perhaps, they said, the governor should cut spending “in other areas.”

Ping meet Pong. Pong, Ping.

In May 1995, the governor shut down the (unfunded) medical referral program and blamed lawmakers for not passing a new funding measure. Lawmakers responded by passing a bill…that would allow the governor to reprogram funds for medical referrals and scholarships.

For the past several years, that is how, more or less, the medical referral program is usually funded. The programs asks for an $18 million budget, but the central government appropriates only about $2 million. The program ends up spending $18 million, and the governor reprograms funds. Lawmakers then complain about the governor’s reprogramming powers. Lather, rinse, repeat.

No one, to be sure, is “against” the medical referral program. The “problem” then and now is how to fund it. As currently drafted, H.B. 22-77 will likely trigger a political brawl on Capital Hill, and medical referral patients and their families will not find it amusing.

“The Legislature cannot and should not be treated with ‘kids gloves’ by either the media or the public,” the then-governor said over 26 years ago. “Not one legislator has the right to sit back and deflect all the blame to the administration for the Legislature’s failure in the budgeting process…. I would think that if medical referral was a ‘real’ priority of the Legislature (as opposed to a political priority), the Legislature would have prioritized [it]….”

One of the headlines on Variety’s front-page, June 1995:

“Despondent Mom Seeks Referral for Sick Baby”

A Rota mother, Variety reported “is seeking help from the government to be able to get medical referral for her two-month-old daughter who is…suffering from a serious disease.” The baby could not be treated on island. “But she could not be referred off-island either due to the current freeze on medical referrals.” The mother and daughter had health insurance, but not enough money to pay for the airfare to Honolulu, Hawaii where specialists could provide the baby with  critically needed care and treatment.

“I just want to tell the governor and our legislators to stop fighting and think about the people too,” the sobbing mother told Variety. “My baby is suffering and I don’t know what to do. Please stop the politics and help us.”

Done that

THE House health committee should conduct more public hearings on H.B. 22-77. If the bill reaches the Senate, it should hold public hearings as well. The administration, for its part, should make its own assessment.

Legislation, however well intentioned, does not always produce the desired results. More often than not, it can make things worse.

Meanwhile, if the administration and lawmakers believe that the medical referral program is important, then they should adequately fund it.


Zaldy Dandan is the recipient of the Best Editorial Writer Award of the Society of Professional Journalists, and the CNMI Humanities Award for Outstanding Contributions to Journalism. His three books are available on

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