The inapplicability of Chapter 9 makes orderly debt restructuring very difficult. Moreover, Puerto Rico is covered by the Patient Protection and Affordable Care Act and must pay accordingly, even though the island’s doctors are compensated at a lower rate than those on the mainland (and the Puerto Rican government must bear much of the cost).
对此美国政府也有责任。第9章的不适用导致有序的债务重组非常困难。此外，即使岛上的医生相比美国大陆需要补贴的费率更低（波多黎各政府必须承担大部分的成本)，波多黎各处于可承受医疗法案的覆盖之下并必须支付相应的费用，其他福利也是如此。