What Health Reform Means to the American Territories

There are about four million citizens living in the U.S. territories, yet they’re seldom considered in the calculus of national policy decisions. That blind spot is especially prominent in health-policy decisions, as the territories are uniquely dependent on federal programs and don’t have the same kind of latitude or flexibility as states to respond to the needs of citizens—who tend to be both poorer and sicker than their mainland counterparts.

When health-policy issues in the territories have made national news, they’ve almost exclusively , by far the largest territory, and one currently facing public-health and solvency crises. But there are four other permanently inhabited territories, each with distinct governments and health-care needs. One of those territories is the U.S. Virgin Islands, where the territorial government has been working to solve health-care budgetary issues by and eligibility, and by challenging some