[Guest post by Molly Redden]

For Rick Santorum, there’s one benefit of being the underdog: Mitt Romney’s flip-flops and establishment ties are so numerous and distracting that his own contradictions and Washington connections often go unremarked upon.

These contradictions are on full display in Puerto Rico, which has 23 delegates to offer and is the site of the GOP’s next primary on Sunday. As Politico reports, Rick Santorum is hopping around the island, posing as its one-time, sort-of Senator—a legislator who “felt a responsibility” to the vote-less territory, to the extent that the denizens of his home state mocked him as “Senador Puertorriqueño.”

Let’s get one thing out of the way: Barring this week’s coverage, a Nexis search for “Senador Puertorriqueño” and “Santorum” turned up zilch. But the former legislator does have numerous ties to the island. Chief among these are his efforts, from 2003 to 2005, to secure millions in Medicare dollars for Puerto Rican hospitals. His cooperation with Luis Fortuño, then the resident commissioner of Puerto Rico and now its governor, was at the center of a Wednesday town hall for Puerto Rican voters.

So what's the catch?

Elsewhere on the campaign trail, Santorum has strongly repudiated the very efforts he’s touting to Puerto Ricans. Santorum was among the earliest and most eager backers of Rep. Paul Ryan’s Medicare reform plan, which had the potential to roll back exactly the kind of gains Santorum once claimed to have championed for elderly Puerto Ricans. Of Congress’s enormous overhaul of Medicare in 2003, Santorum has told CNN, “I held my nose” when voting in favor of it. He even went so far to call his vote for the bill a mistake on Fox News. Of course, not only did Santorum vote for the Medicare overhaul and push for its passage, the initial amendment that he attached to on behalf of Puerto Rican hospitals could have cost up to $400 million over a period of 10 years, according to the CBO. So there’s that.

His contradictory boastfulness aside, Santorum’s lobbying on behalf of Puerto Rican hospitals smacks of some serious Beltway cynicism. As The New York Times pointed out earlier this year, a hospital management firm, United Health Services, based in the senator’s home state of Pennsylvania, owned several hospitals in Puerto Rico and stood to gain millions from his efforts. After being voted out of Congress, Santorum went on an unusually hot streak of picking up work with clients whose interests he’d represented in the Senate. The Times speculates that his Puerto Rican Medicare efforts led to what was likely his most lucrative post-Senate gig—a position with United Health Services.

Separately, Will Bunch of The American Prospect found that Santorum’s Puerto Rico riders dovetailed nicely with his uncanny ability to fundraise. After successfully securing more reimbursement money for Puerto Rico in 2003, his leadership PAC received $45,865 from Puerto Rican donors, more than some of the largest donations that he received from individual companies throughout his time in Congress.

So, yes—Rick Santorum did push for Medicare reform on behalf of Puerto Rico. For all the reasons you’d think that a small-government conservative might break with his ostensible values. The real question is whether he’d stick up for the island’s elderly patients again, which he seems to be implying in his town hall and media appearances there. But if his recent statements—to CNN, to Fox News, and to voters stateside in general—are any indication, this time the incentives don't line up in the island’s favor. 

Molly Redden is a reporter-researcher at The New Republic.