Puerto Rico’s illness is a chronic condition. The unemployment rate, poverty rate and median household income have always been far worse than any state’s. The main cause is inequality. Residents cannot vote for president or senators, and have one nonvoting delegate in the House. It is disheartening to see many self-styled progressives, who otherwise speak eloquently about the importance of voting rights, go silent on this subject when it comes to Puerto Rico.

Congress routinely treats Puerto Rico and the other territories worse than it does the states. Consider Medicaid, which provides health insurance for the poor. Federal funding for a state Medicaid program is open-ended, but capped for Puerto Rico. The $1 billion in annual Medicaid funding that Puerto Rico receives from Washington is about 20 percent of the $5 billion received by similar-size Oregon. Puerto Rico is also treated unequally under Medicare, even though my constituents pay the same federal payroll taxes that fund much of this program. The Affordable Care Act — Obamacare — has been the subject of partisan debate, but the law’s rarely mentioned defect is that the territories are barred from most of its new programs and protections.

The list goes on. Puerto Rico is excluded from the Supplemental Security Income program that aids the most vulnerable Americans. It does not participate in the federal nutrition program, instead receiving a block grant that shortchanges it by $450 million a year. Puerto Rico is partly excluded from the child tax credit and fully from the earned-income tax credit, which encourages low-income individuals to seek employment. Unlike a state, Puerto Rico cannot authorize its public enterprises to seek relief under Chapter 9 of the federal bankruptcy code, which impedes its recovery.

The argument that such treatment is justified because Congress does not require Puerto Rico residents to pay federal income taxes on local earnings is weak. Nearly half of all stateside households do not earn enough to owe income taxes, but are still treated equally. Moreover, because of federal tax credits, a working-class family of four in the States is likely to have greater take-home pay than an identical family in Puerto Rico.

It is little wonder, then, that Puerto Rico is in recession, has excessive debt and is bleeding population. Unequal treatment at the federal level, combined with mismanagement at the local level, has a debilitating effect on the island’s economy. To compensate for the lack of federal support, the Puerto Rico government has borrowed heavily. And when my constituents move to the States, they are entitled to vote for their national leaders and to equal treatment under federal law. So naturally they leave.