House panel urges Modi govt to include elements from Obamacare in its health insurance scheme PMJAY

Apart from making it mandatory for employers to provide health insurance to each employee, Parliamentary panel also suggests increasing Centre's share of funds for PMJAY.

File photo of registration desk for E-card service of Ayushman Bharat Yojana at New Delhi Railway Station | Representational image | ANI

SUMI SUKANYA DUTTA, THE PRINT, 20 DECEMBER, 2023, NEW DELHI :  A parliamentary standing committee has suggested to  the government to include some provisions of the Affordable Care Act of the US, popularly known as Obamacare, in its flagship health insurance scheme, Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).

In its 151st report, which was tabled in the Rajya Sabha Tuesday, the parliamentary standing committee on health and family welfare suggested measures such as ‘employer mandate’ — making it must for an employer to provide health insurance to each employee.

Another suggestion is to expand the scope of the scheme to include some sections of children and senior citizens, who may not have health insurance and fall in the Above Poverty Line (APL) category.

Further, the panel suggested to the government to rely on tax incentives and disincentives to improve health insurance coverage among corporate employees.

Under AB-PMJAY, the government provides the benefit of cashless hospitalisation for secondary and tertiary care to nearly 10 crore families or 50 crore beneficiaries, identified on the basis of their socio-economic background.

The Affordable Care Act, formally known as the Patient Protection and Affordable Care Act (PPACA), was signed into law in 2010 by then US president Barack Obama. At the time, the legislation was seen as a landmark move, given that it proposed a radical overhaul of the health insurance sector and introduced provisions including one that prohibited insurers from denying coverage on account of preexisting conditions and another that paved the way for insurance cover for children who were not otherwise covered under an existing family plan.

In its report, the parliamentary panel also noted that many lower middle class Indians classified in the Above Poverty Line (APL) category, just above the poverty line, are not eligible for PMJAY.

Stating that such Indians are in dire need of this scheme, the panel said that a report by NITI Aayog, ‘Health Insurance for India’s Missing Middle’, also suggests that even after the implementation of the PMJAY, at least 30 percent of Indians (more than 40 crore) still lack any form of health cover.

Adverse health events can lead to financial hardship and even push them into poverty, said the report by the government’s premier policy think tank, adding that this group of Indians is characterised by informal employment, unstable incomes and a lack of social security.

“The committee believes that the government should consider expanding the base of beneficiaries to be covered under the PMJAY by including more categories in eligibility criteria,” the panel suggested in its report.

‘Insufficient funds’ for Ayushman Bharat

The report underlined that the central government has in the last five years (2018-19 to 2022-23) released Rs 17,000 crore towards PMJAY. Of this, Rs 6,180 crore was released in the previous financial year.

With the exception of the previous financial year, the utilisation of funds was lower compared to the amount allocated for the scheme in the Union Budget, the parliamentary panel said, adding that the government should take steps to ensure higher and more efficient utilisation of allocated funds.

It also observed that the average sum of Rs 6,000-7,000 crore allocated as the central government’s share of the scheme each year is “not sufficient” for 33 states and Union Territories, advising that the same be increased.

“For this purpose, other old/peripheral schemes of the government in the healthcare sector may be subsumed or integrated with PMJAY so that the unutilised funds, resources, and manpower involved in those schemes may be utilised for the efficient implementation of PMJAY,” said the report.

The panel also recommended that the National Health Authority  (NHA) and state health authorities ensure that hospitals follow all norms and safety measures, and that the physical verification process be carried out earnestly to ensure that only those hospitals that fulfil the requisite criteria are empanelled under the scheme.

The health ministry, said the panel, should ensure periodic social audits of the empanelled hospitals in coordination with NHA and state health authorities to weed out any malpractice. According to the report, this could go a long way in ensuring that hospitals adhere to benchmarks for discharging social responsibilities.

The parliamentary panel also emphasised the need to invest in and upgrade state-run health facilities across the country.

(Edited by Amrtansh Arora)