FIVE TERRITORIES. MILLIONS OF PEOPLE. NO SECOND-CLASS SERVICES.

VAULT · SELF DETERMINATION

Published by Langhorne P. Breedlove

MONDAY, NOVEMBER 9, 2026 · 2:28 AM ET

Tags: U.S. Territories · Self-Determination · Medicaid · Infrastructure · Equal Services · Federalism

Dear fellow American proletariat: The United States can find an island on a map when it needs a naval facility, a trade route, or a strategically located airfield. Finding that same island when its residents need dependable electricity, comprehensive healthcare, safe drinking water, or a functioning federal benefit can become a more complicated expedition. We appear to have mastered the geography of power before the geography of responsibility.

This VAULT essay examines the five permanently inhabited U.S. territories—Puerto Rico, Guam, the United States Virgin Islands, the Commonwealth of the Northern Mariana Islands, and American Samoa. They are not five copies of the same jurisdiction. Their histories, populations, governments, tax systems, and federal relationships differ. What connects them is that they remain under U.S. sovereignty without statehood, and their residents encounter distinctive legal and practical barriers to certain public services (Sources 01, 02).

FIVE PLACES, FIVE HISTORIES

Puerto Rico and Guam came under U.S. sovereignty following the Spanish-American War in 1898. The United States purchased the Virgin Islands from Denmark in 1917. American Samoa's relationship developed through cessions around the turn of the twentieth century, and the Northern Mariana Islands negotiated their commonwealth covenant in the 1970s after the United States administered a United Nations trust territory (Sources 01, 03). Those histories explain why equalization cannot simply overwrite local constitutions, land rules, cultural institutions, or political choices.

Congress's Territorial Clause authorizes rules concerning federal territories, but each territory exercises forms of local self-government. The five elect nonvoting representatives to the U.S. House: Puerto Rico a Resident Commissioner and the others Delegates. They lack voting senators and cannot cast final House floor votes through those offices (Source 01). The residents' actual federal voting rights vary with residence and election law; this is a constitutional and statutory problem separate from the question of running a hospital.

Citizenship also requires precision. People born in Puerto Rico, Guam, the Northern Mariana Islands, and the U.S. Virgin Islands generally acquire U.S. citizenship under applicable law. People born in American Samoa generally are U.S. nationals rather than citizens at birth, absent another basis for citizenship (Source 01). This distinction has legal significance and is the subject of contested political views. A policy written in Washington should not casually declare what American Samoans must choose for their future.

THE POPULATIONS ARE NOT INTERCHANGEABLE

The 2020 census reported 3,285,874 residents in Puerto Rico; 153,836 in Guam; 87,146 in the U.S. Virgin Islands; 49,710 in American Samoa; and 47,329 in the Northern Mariana Islands (Source 02). These are dated census counts, not live 2026 estimates. They demonstrate why an equal per-territory grant and a population-based grant can produce radically different results.

A small island system may need a costly generator, seawater infrastructure, a specialist hospital referral network, and dependable air and sea connections even with relatively few residents. A larger territory may have greater scale but substantial debt, aging utilities, and rural or mountainous communities. Population alone is therefore not a sufficient measure of infrastructure need or fiscal capacity.

MEDICAID: EQUAL WORDS, DIFFERENT FUNDING RULES

The most concrete example lies in federal health financing. Unlike state Medicaid programs, which generally receive open-ended federal matching of qualifying expenditure, the territorial programs face annual federal funding allotments. Congress determines the caps and statutory matching arrangements (Source 04). An enhanced matching rate is not equivalent to unlimited federal support: once a territory reaches its applicable cap, it may face a very different financing problem from a state.

For FY2026, the statutory federal medical assistance percentage is 83% for American Samoa, Guam, the Northern Mariana Islands, and the U.S. Virgin Islands, and 76% for Puerto Rico, subject to the applicable allotments and program rules (Source 05). Those percentages describe federal matching of eligible expenditures up to the cap, not the share of every resident's medical bill that Washington automatically pays. Puerto Rico's statutory financing arrangements also contain important scheduled changes, so a ten-year proposal cannot simply project its FY2026 rate forever (Source 05).

A GAO review published in 2016 found major differences in covered Medicaid benefits among territories and relative to states: at the time, Guam offered all 17 specified mandatory benefits while American Samoa and Puerto Rico offered 10. Officials cited limited funding and healthcare infrastructure among the constraints (Source 06). Those findings establish historical disparity; they are not proof that the same exact coverage patterns persisted unchanged in November 2026.

ELECTRICITY, WATER, TRANSPORTATION & HOUSING

GAO's June 2025 territorial economic review found shared obstacles involving imported energy and goods, extreme-weather damage, population loss, restricted economic diversification, and pressure on public debt and pension obligations (Source 07). The report also documented starkly different local conditions. In Puerto Rico, utility disruptions remained significant following the 2017 hurricanes. GAO reported that electricity prices in January 2025 averaged approximately 29 cents per kilowatt-hour, around 80% higher than the mainland U.S. average for the same month (Source 07).

In the U.S. Virgin Islands, GAO cited approximately 42 cents per kilowatt-hour at the end of 2023, almost three times the contemporaneous national average, alongside aging infrastructure, billing problems, and outages (Source 07). Those prices are observations from different dates and places, not a November 2026 comparison. Reliable power is not merely a convenience: it affects refrigeration, hospitals, communications, water pumping, education, business continuity, and household costs.

Transportation and water projects likewise depend on geography and local operations. Federal infrastructure grants may be available to territories, but grant awards, required local matches, design capacity, procurement, workforce availability, environmental review, and actual disbursement can separate promised money from finished service. A 2025 GAO infrastructure review documented the distinction between appropriated, obligated, and expended grant funds across federal programs (Source 08). A ribbon-cutting ceremony is not a water-treatment operator.

WHOSE DECISION IS IT TO MODERNIZE?

The word 'modernization' can conceal paternalism if federal policymakers define it as making every territory imitate a mainland state. Puerto Rico's political-status debate includes statehood, independence, free association, and territorial arrangements; any change in territorial status requires congressional action, and the wishes of affected communities are central to the debate (Source 01). Other territories have distinct status questions, traditions, and self-government protections.

Essential-service reform does not require Congress to settle every status question first, but it cannot ignore the issue either. Local governments should determine their priorities through accountable institutions; federal authorities must honor applicable statutes, funding obligations, and constitutional constraints. A proposal that purports to equalize benefits while removing local control over culturally significant matters would present a different inequality under a more expensive name.

WHAT COULD EQUALIZATION ACTUALLY MEAN?

One approach would specify minimum service outcomes rather than mandate identical agencies: timely essential healthcare, dependable safe water, resilient electricity, accessible communications, safe schools, reasonable transportation, disability access, and competent disaster response. Congress could adjust territorial Medicaid caps and matching structures, fund workforce and infrastructure capacity, and authorize technical assistance while respecting each territory's legal and fiscal circumstances.

Another approach would address gaps program by program rather than establish one comprehensive standard. That may be easier to implement but could perpetuate fragmented eligibility and administrative burdens. The merits depend on evidence: service needs, local public finances, health capacity, existing federal commitments, workforce and operating costs, and the preferences of territorial residents. Uniform outcomes may require unequal allocations because circumstances are unequal.

THE ONE-YEAR & TEN-YEAR FISCAL TEST

A responsible ledger begins with a current-law baseline for each territory and for each program: Medicaid federal allotments, local matching, power and water grants, transportation, housing, schools, health facilities, disaster recovery, and public debt service. A tax-policy review by the Congressional Research Service explains that territorial revenue structures and their connections to federal tax law vary, making a single assumed tax base misleading (Source 09). Existing federal grants cannot be counted again as new spending, and federal transfers should not be mistaken for local economic gains without evidence.

Illustrative arithmetic—not an approved appropriation or needs assessment: suppose a first-year demonstration assigns each of the five territories $40 million in additional, locally directed essential-service grants and budgets $20 million for federal and territorial coordination, procurement support, evaluation, and safeguards. First-year gross new funding would be $220 million. If the grants continued at $40 million per territory per year for nine additional years, together with $15 million annual shared support after year one, the flat undiscounted ten-year total would be $2.155 billion: $220 million in year one plus nine years at $215 million. The assumed equal allocations are intentionally simple and almost certainly unsuitable as a final distribution formula.

The ten-year model must instead calculate annual needs by territory and service, beneficiary populations, local revenue capacity, federal matching formulas, operating and maintenance expense, workforce costs, inflation, borrowing and pension obligations, infrastructure depreciation, procurement and disaster risk, expected receipts or recoveries, and uncertainty. Any Medicaid cap reform needs an actuarial estimate of covered lives and utilization rather than treating higher matching percentages as sufficient evidence of cost. Social benefits from reliable infrastructure should not automatically be recorded as Treasury cash savings.

WHAT COULD GO WRONG?

An abrupt funding expansion could overwhelm small procurement offices and create waste, while a uniform federal formula might ignore actual island costs or local legal arrangements. Strict local matching could exclude jurisdictions with the greatest fiscal distress. A new centralized bureaucracy might duplicate existing territorial departments. Infrastructure grants without continuing maintenance can produce impressive facilities that deteriorate quickly.

Critics may question the federal cost, incentives for debt management, local accountability, and whether proposed standards exceed congressional authority or interfere with self-government. Supporters may emphasize comparable essential services, existing federal responsibilities, and the consequences of long-standing territorial disparities. These are meaningful tensions. Evaluation should include independently audited outcomes, transparent eligibility, territory-by-territory budgets, and the consent and participation of affected governments.

WHY IT MATTERS

The United States need not settle every constitutional question about territorial status to ask whether a family can get medical care, whether a school has reliable electricity, or whether safe water is available after a storm. Nor can it treat political self-determination as a ceremonial footnote to a federal construction contract.

Five territories are five communities with different governments, histories, and ambitions. The most basic obligation is to understand each one before spending money in its name. We should be capable of improving essential services without pretending sovereignty is irrelevant—and capable of respecting sovereignty without using it as an excuse for inadequate public services. That would be a considerably better use of American power than another map with five tiny labels and a very large strategic arrow.

RELATED JUSTICE MANDATES

Equal Essential Services in the Territories is the primary Racial Justice policy addressing service eligibility and funding. Puerto Rican Self-Determination concerns the island's distinct status options. Honor Freely Associated Pacific Agreements involves three independent sovereign countries—the Marshall Islands, Micronesia, and Palau—which are NOT among the five U.S. territories. Public Transportation for Everyone and Universal Comprehensive Healthcare raise connected delivery questions.

SOURCES & FURTHER READING

01 · Congressional Research Service — Statehood Process and Political Status of U.S. Territories: Brief Policy Background; updated June 6, 2024.

https://www.congress.gov/crs_external_products/IF/PDF/IF11792/IF11792.5.pdf

02 · Congressional Research Service — Federal Statistical Data for U.S. Territories: Issues and Resources, R48522; May 2, 2025.

https://www.everycrsreport.com/files/2025-05-02_R48522_25343732a1547265abd2c6ee4a5ebd43e454b133.html

03 · U.S. Government Accountability Office — U.S. Insular Areas: Multiple Factors Affect Federal Health Care Funding, GAO-06-75; 2005.

https://www.gao.gov/products/gao-06-75

04 · U.S. Government Accountability Office — Department of Health and Human Services: Fiscal Year 2022 Medicaid Allotment for Puerto Rico, B-333602; 2021.

https://www.gao.gov/products/b-333602

05 · Congressional Research Service — Medicaid Financing for the Territories, IF11012; updated June 22, 2023, with FY2023–FY2028 statutory schedule.

https://www.congress.gov/crs_external_products/IF/PDF/IF11012/IF11012.11.pdf

06 · U.S. Government Accountability Office — Medicaid and CHIP: Increased Funding in U.S. Territories Merits Improved Program Integrity Efforts, GAO-16-324; April 8, 2016.

https://www.gao.gov/products/gao-16-324

07 · U.S. Government Accountability Office — U.S. Territories: Public Debt and Economic Outlook—2025 Update, GAO-25-107560; June 30, 2025.

https://www.gao.gov/products/gao-25-107560

08 · U.S. Government Accountability Office — Infrastructure Grants: Status of Funding to Tribes, States, Localities, and Territories as of December 31, 2024, GAO-25-107243; April 29, 2025.

https://www.gao.gov/products/gao-25-107243

09 · Congressional Research Service — Tax Policy and U.S. Territories: Overview and Issues for Congress, R44651.

https://www.congress.gov/crs_external_products/R/PDF/R44651/R44651.3.pdf

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WE ARE ONE.  ·  E PLURIBUS UNUM.