PM Modi is likely to announce the launch of Ayushman Bharat from the Red Fort on Independence Day (File)
Highlights
- Centre plans to ambitious insurance scheme this year
- 10 states, including BJP-run ones, yet to agree to conditions
- Many states argue that Modicare covers fewer people than already insured
The central government's plan to launch the world's largest government-funded healthcare programme - Ayushman Bharat, popularly referred to as "Modicare" is already facing obstacles. While the government had earlier said that the launch date would be October 2, on Gandhi Jayanti, it is now aiming to launch the scheme by August 15 as Prime Minister Narendra Modi is likely to make the grand announcement on Independence Day. However, 10 big states are yet to sign up for the ambitious scheme.
On February 1 this year, then Finance Minister Arun Jaitley, had announced the scheme which would provide a health insurance cover of Rs 5 lakh per family per year to 10 crore poor and vulnerable families.
States that haven't signed not only include non-BJP states like - Odisha, Punjab, Delhi, Karnataka, Telangana, Tamil Nadu and Kerala but also BJP-run states like Rajasthan, Maharashtra and Goa.
Seven out of these 10 states haven't signed the scheme yet as their existing state health insurance schemes cover a larger population than what is proposed under Ayushman Bharat. Six out of these seven are still in negotiation with the government so that their scheme can be integrated with Ayushman Bharat but Odisha has flatly refused to adopt Ayushman Bharat. Odisha's Chief Minister Naveen Patnaik also wrote a letter to Prime Minister Narendra Modi on June 16, informing him about the decision.
Several states have expressed reservations about the Ayushman Bharat scheme
According to Odisha's Health Minister, Pratap Jena, "For Ayushman Bharat, they are ready to take 61 lakh families of the state whereas in BSKY (Biju Swasthya Kalyan Yojana) we are ready to provide 70 lakh families the benefits. We are ready to provide Rs 5 lakh insurance cover to each family and in case of women it is Rs 7 lakh. Ayushman Bharat is only in planning mode and we are in an implementation mode."
For other states, covering the balance population will come at a hefty price tag as the centre has already made it clear that they will only pay its quota for those identified under the scheme. If the state wants to cover any population beyond that, it will have to bear the expenses on its own.
For instance, Rajasthan's current scheme Bhamashah Swasthya Bima Yojana (BSBY) provides an insurance of Rs 3 lakh per family per year to 90 lakh families while Modicare has only identified 60 lakh beneficiary families.
Rajasthan's Health Secretary Naveen Jain said, "As of now, we are continuing our scheme only since it is functioning well and covers higher population. It is very difficult to switch over quickly. The National Health Authority is aware of our concerns and we are examining all the options."
Similarly, Tamil Nadu's existing scheme Chief Minister's Comprehensive Health Insurance Scheme (CMCHIS) provides an insurance of Rs 1 lakh per family per year to 1.6 crore families while Modicare has only identified 78 lakh beneficiary families.
Tamil Nadu's Health Secretary Dr J Radhakrishnan said, "The packages and families that are not getting covered - how will we cover those? The core committees formed on the directions of the government have recommended that for the others also we can increase the coverage up to Rs 5 lakh. There will be additionalities borne out of those and we are working out with our law and consultative departments to solve that issue."
A rough calculation shows that in other states like Maharashtra, Punjab, Karnataka and Telangana, the gap between their schemes and Modicare comes to 2.4 crore families. While the state schemes in these four states would cover a total of 4 crore families, Modicare would cover only 1.6 crore families.
PM Modi has personally held meetings to review the progress of the Ayushman Bharat scheme.
Delhi does not have any existing insurance scheme but is unsatisfied with Ayushman Bharat's proposed target of 6 lakh families while Delhi has 50 lakh families with a total population of 2 crore. Delhi government is currently examining options to cover a larger population than the current target under Ayushman Bharat.
Two states-Kerala and Goa have agreed in principle but haven't signed the Memorandum of Understanding (MOU) yet due to procedural delays. Kerala would have more people covered under Ayushman Bharat than its existing scheme while Goa would have a deficit but Goa is not looking for going beyond the proposed target under Ayushman Bharat.
The union government claims it will be able to get these remaining states too on board in the upcoming days. Dr VK Paul, NITI Aayog member and incharge of Ayushman Bharat said, "The states that have not yet come on board - we are engaged with them. We know that there is only one state which has said no to joining NHPM. The others have indicated that they are thinking about it and examining. I have no doubt that practically all the states will be on board pretty soon. We are working to launch the mission at the earliest and our current internal deadline is August 15. But everything will happen, provided there is absolutely robust preparation at the state level. We will review this entire preparation state by state later this week and we would then be in a position to state the exact timeline or date of the launch."
The fact that the government is yet to take a final call on the launch date and may have to delay it is an indication that despite all its optimism it is well aware of the challenges ahead.