Five states unconvinced about PM Modi’s AB-PMJAY healthcare scheme

Prime Minister Narendra Modi has launched his government's ambitious healthcare scheme ‘Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY) on Sunday, September 23, but five states remained unconvinced. Telangana, Odisha, Kerala, Punjab and Delhi have said they will not implement the programme, citing better schemes in their own states, and lack of clarity on implementation of AB-PMJAY, dubbed the world's largest government-funded healthcare scheme by the Modi Government. The states also cautioned that similar initiatives had been bogged down by lack of infrastructure and state corruption.

Telangana chose not to implement the healthcare scheme, saying that the state’s own flagship healthcare scheme Aarogyasri covers 70% of the state's population while Ayushman Bharat will only benefit 80 lakh people. A Telangana official said the state’s model of health coverage is a robust programme. This drew criticism from local BJP leaders, who did not take kindly to the opposition to their programme.

According to news reports, Punjab's health minister Brahm Mohindra said, “This is not an insurance scheme, but an assurance scheme. There is no clarity on a number of points. We cannot accept the scheme in the present form.”

"The Centre will release 60% of the national ceiling rate determined by them. They have not yet shared with the state government what the rates will be. The state's liability remains open-ended as it will be driven by actual premium rates after the tendering process, while the Centre has its contribution fixed at 60 per cent. This is not acceptable to us," Mohindra pointed out.

Kerala Finance Minister Thomas Issac called the Centre’s healthcare scheme a ‘hoax’, in a an interview to the Indian Express. and questioned the “feasibility” of the Ayushman Bharat scheme. Issac questioned how the government would implement Ayushman Bharat. “The subsidy ceiling for the current Rashtriya Swasthya Bhima Yojana (RSBY) scheme of ₹30,000 benefit is ₹1,250. The subsidy for the Ayushman scheme, with benefit of ₹5 lakh, is ₹1,110. Is it possible to have such a jump in benefits for lower premium? Such a proposal can be made only on the premise that you don’t have to pay for it. This scheme, touted as world class, is a hoax,” he said.

According to Isaac, under the existing RSBY health insurance scheme, total claims in India have been ₹1.20 crore, of which ₹53 lakh is from Kerala. “Kerala with 3% of the population accounts for 42% of the claims. This means the programme is not functioning properly in the rest of the country,” said Isaac, reported the IE.

Issac further told IE that the Centre has been slashing healthcare system at the cost of institutional public health care system. “They are trying to make the state pay 40% of the payment. At this rate of ₹5 lakh benefit, total premium cost for the state is going to be ₹,000-6,000. If we are not allowed to customise it, it will break the state’s health care system,” he said.

Odisha Chief Minister Naveen Patnaik rejected the central scheme stating that it has introduced a better programme, Biju Swasthya Kalyan Yojana, in the state. Patnaik said the state’s healthcare scheme covers many more people than Ayushman Bharat and provides ₹7 lakh to women as opposed to the central programme’s ₹5 lakh.

This, however, drew criticism from PM Narendra Modi. “Everyone is aware of the importance of Ayushman Bharat scheme, but Naveen Babu does not understand. Odisha government should come forward and join the programme,” Modi said. Countering this, Patnaik suggested that PM Modi focus his energies on curbing the rising prices of fuel in the country instead of picking on a state that already has a good healthcare programme.

The Captain Amarinder Singh government in Punjab has also refused to implement the scheme because the Centre has not made it clear who will pay the ceiling-excess rates for the various components of the scheme.

Delhi’s Aam Aadmi Party-led government refused to be a part of the Ayushman Bharat scheme stating that Ayushman Bharat's proposed target of 6 lakh families is just 3% of its 2-crore population.

“The Centre’s health insurance scheme will exclude a majority of Delhi’s population who need it. The Delhi government will work towards implementing its own health insurance scheme,” said Dr Kirti Bhushan, director general of health services, Delhi government.

Interestingly, there were reports that BJP-ruled states, Maharashtra and Rajasthan, had expressed unwillingness to implement the scheme as similar projects were being run in the state for a larger population. While Rajasthan has had the Bhamashah Swasthya Bima Yojana since 2015, Maharashtra has had the Mahatma Jyotiba Phule Jan Arogya Yojana since 2012.

There were news reports also suggesting that the Prime Minister's photograph on the Ayushman Bharat card will result in the ruling BJP getting undue publicity in the run-up to the multiple assembly elections, quickly followed by the next Lok Sabha elections.

With inputs from IANS, PTI