Puerto Rico was devastated by Hurricane Maria last month. During a debt crisis, they also faced Zika virus last year. It became clear during that public health emergency that Puerto Rico’s Medicaid block grant was insufficient and did not have enough flexibility to help address the crisis. Now it is worse.

“Treating the health needs of people displaced by the storm and keeping chronically ill people alive in a health system that is seriously damaged and in many places operating without power is an obvious and immense challenge. Hospitals and clinics will need to rebuild. Were it not for the block grant, the Medicaid program could help cover those expenses. But in Puerto Rico, every dollar spent re-activating a surgery ward or buying a generator comes at a cost of money for prescription drugs or doctor visits. Americans living in Puerto Rico are unfortunately likely to find their health system further degraded from its already difficult condition.”

• Vikki Wachino and Tim Gronniger, Health Affairs