New Delhi: Nearly two months after announcing “the world’s largest healthcare programme” in February with scant details, the government appears to have finalised the basic contours of its new health insurance scheme.
On March 21, the union cabinet approved the Ayushmann Bharat National Health Protection Mission (NHPM), the central government’s new health insurance programme. It plans to offer a coverage of Rs 5 lakh to 10 crore (100 million) of India’s poorest families. The central and state governments have been expected to pay the full premium on this insurance.
“For 2017-2018 and 2018-2019, we have kept Rs 10,000 crore for this. We have to work for and go forward in that direction,” J.P. Nadda, the health minister, said on March 22.
About 1,347 “packages” are being considered for insurance, which will cover diseases and claims.
Importantly, preexisting health ailments as well as cancer treatment will be covered under this scheme. Aadhaar will not be mandatory but will be encouraged. There will also be a transport allowance per hospitalisation and patients are expected to be able to avail this coverage in any part of India.
These details come nearly two months after the government first announced the insurance scheme. As The Wire had reported at the time, the health ministry had not been in the know about the details of the scheme. Instead, NITI Aayog had taken the lead.
The Rs-10,000-crore allocation is a large increase from the Rs 2,000 crore assigned to the NHPM in this year’s budget. Many had questioned if Rs 2,000 crore would suffice to insure 10 crore families, in all expected to be around 50 crore people.
However, Rs 10,000 crore is not for the insurance coverage itself. It is to fund a host of backend processes that the government has started to develop, including IT systems and the database of those who are eligible.
The value of the insurance premium has also not yet been finalised as negotiations are still underway with various state governments as well as with insurance companies. The Centre and states are expected to contribute to this in a 60-40 split. The government plans on taking the next few months to develop packages and assign rates. This is to control costs and avoid a situation where package costs become inflated by hospitals to benefit insurance company collections.
The 10 crore families will be those listed in the government’s Socio Economic Caste Census (SECC), which is different from the poverty-line estimation of beneficiaries. In the SECC, beneficiaries will be included in the scheme based on whether they have rooms with kucha walls or roofs, whether they have adult members, whether it is a female-headed household, whether there are able-bodied family members, and whether the household is landless and engaged in manual labour.
Some rural families are automatically included, such as those involved in manual scavenging, primitive tribal groups and legally released bonded labourers.
Role of state governments a challenge
The central government could face some resistance from states like Tamil Nadu and West Bengal, which have already criticised the government’s scheme and said that their governments run their own schemes.
Writing in The Wire, Derek O’Brien, a parliamentarian of the Trinamool Congress, had recounted the previous announcement of a health insurance scheme by the current government. This had been in the 2016-2017 budget speech. O’Brien wrote:
The scheme was announced with much fanfare but never quite materialised. State governments were particularly disappointed. They were asked to slow down enrolments under the Rashtriya Swasthya Bima Yojana (RSBY), because this new scheme was supposed to replace the RSBY. Soon, when the BJP-led government realised it had not done the groundwork for the ambitious new scheme, it quietly asked state governments to resume enrolling families for the RSBY.
Nadda had said that the NHPM would in fact strengthen the spirit of “cooperative federalism” and that the mission could easily be “merged with the ongoing health protection or insurance schemes in various ministries and governments.” This is exactly what states like West Bengal have already resisted.
The central government has said that state governments will be allowed to expand the NHPM “both horizontally and vertically. States will be free to choose the modalities for implementation. They can implement through insurance company or directly through Trust, Society or a mixed model.” To be able to implement the scheme, the states will need to have a dedicated ‘State Health Agency’.