Ayushman Bharat: Modi govt ignored recommendations of Gadkari-led panel to benefit private insurers

The Narendra Modi government ignored recommendations of a high-powered panel, led by Union Minister Nitin Gadkari, in order to benefit private insurance companies involved in the implementation of Ayushman Bharat.

The high-powered panel, comprising Gadkari, Union Health Minister JP Nadda, Union Agriculture Minister Radha Mohan Singh and Union Minister for Railways Piyush Goyal, had recommended that the flagship scheme of the Modi government, Ayushman Bharat, should either be implemented through assurance model or through only public sector insurance companies. But the government had not only involved private players, but also gave them preference over the public sector companies, setting aside the recommendations of the Gadkari-led panel.

Curiously, the panel was set up by the government itself to finalise the Request for Proposal (RFP) for the selection of implementation agencies for Ayushman Bharat.

Documents, having minutes of the meeting of the Gadkari-led panel, accessed by the NH reveal that the panel had recommended, among other things:

• That, first preference will be given to the assurance model.
• That, if any state wants to implement the scheme through insurance companies, it will have to limit the bidding among public sector companies only.
• That, if any state wants to implement the scheme through private sector companies, it will have to carry out open tender with both pubic and private sector companies first, and it will have to divide the state into almost equal zones with respect to the target families.
• In case of open tendering, the lowest bidder will be the winner. However, public sector companies will be given the option of matching the private company, in case any private company offers the lowest bid.

Clearly, the Gadkari-led panel had pitched hard in favour of the public sector companies (in the implementation of the Ayushman Bharat) but the government eventually opted for private insurance companies, allegedly under pressure from the lobby of private insurance companies.

“Bureaucrats sitting at the helm of the policy-making played the role of the catalyst, steering the scheme in favour of private companies,” said sources, on the condition of anonymity.

As a result, states were not told about the order of the priority suggested by the Nitin Gadkari-led panel.

Toeing the line of the Modi government, Ministry of Health also did not publish model tender document, limited to public sector insurers only, on the website, which is mandatory, as per the rules.

When contacted by NH, CEO of the Ayushman Bharat, Indu Bhushan, accepted that the “government emphasises on promoting private sector (in the implementation of the Ayushman Bharat),” even as he denied sharing any information about the outcome of the ministerial discussion.

Interestingly, in the next line of his reply, Bhushan contradicts himself by saying that, as the CEO of the Ayushman Bharat, he had “truthfully” implemented the decision of the Gadkari-led panel, “both in letter and spirit.”

It remains to be answered, however, if recommendations of the Gadkari-led panel were implemented then, how come private insurance companies were involved in the process?

As per sources, ground for the entry of the private insurance companies in the implementation of Ayushman Bharat was laid down in a meeting, chaired by PM, to monitor the progress of the scheme.

Held on May 7, 2017, the meeting had in attendance Niti Ayog CEO Amitabh Kant and CEO Ayushman Bharat, Indu Bhushan, along with the Deputy Chief Executive Officer of the Ayushman Bharat, Dinesh Arora. In the meeting, Dinesh Arora, who is a 2002 batch Kerala-cadre officer, delivered a presentation about the implementation of Ayushman Bharat.

Sources told NH that Arora, by citing wrong facts and fudged data, tried to steer the scheme in favour of private players.

For instance, citing the example of Uttarakhand, Arora said during his presentation that National Insurance, a public sector insurance company, had quoted Rs 1,197 as premium in 2016 to secure the bid, while the truth is that NI had only quoted Rs 399.

Similarly, quoting Maharashtra, Arora said during the presentation that the public sector insurance companies had increased the premium to Rs 1,571 but he deliberately hid the information that the new package had added services also.

When contacted, Arora diverted this correspondent to Bhushan, saying “his CEO is the competent authority to answer.”

Obliging his deputy, Bhushan replied: “The presentation was based on actual facts and figures after due verification. We dare not present wrong information to the PM.”

Citing “code of conduct” in response to the question as to what was discussed in the meeting chaired by the PM, Bhushan said that “privileged information” could not be shared.

According to sources, the India head of German development aid firm GIZ, Nishant Jain, who is considered very close to Dinesh Arora, was the man behind all kind of manipulation. He is also learnt to have helped Arora in his presentation. Important to mention, Jain had been ousted from the ministry for allegedly trying to influence policy decision in the past by Modi government itself.

However, Bhushan denied being “under the influence of any individual.”

Explaining Jain’s involvement with the policy-making, Bhushan went on to say: “We want private sector to play an important role in our scheme and want to use their energy, resources and skills. This philosophy is not dictated by any individual but our own analysis, and the government’s emphasis on promoting the private sector.”