CM Atishi tells officials to find a way to adopt Ayushman Bharat scheme, continue state’s own free healthcare model

As per the scheme, low-income families are offered cashless hospitalisation coverage of up to Rs 5 lakh per family, per year. Earlier this year, the scheme was expanded to offer universal coverage up to Rs 5 lakh all people aged over 70.  In October, Prime Minister Narendra Modi had said that he was prevented from serving the older people of these two states as they were not adopting the scheme owing to “politics”.

Responding to a question, Atishi said the Delhi government was ready to implement the scheme but there were “contradictions and problems” in implementation.  “These problems arise because the Delhi government is already providing comprehensive free medical facilities in its hospitals. The exclusions under Ayushman Bharat do not align with this system. The government does not want to take away free medical care from anyone. Therefore, directions have been issued to the Health Department to devise a mechanism that ensures no one in Delhi is deprived of the free healthcare services they currently receive while also incorporating the benefits of Ayushman Bharat,” she said.

The High Court made its observations while hearing the plea by the seven BJP MPs from Delhi against the “arbitrary” decision to not adopt the scheme. The party has also made the exclusion a part of its election campaign, where it has promised that if voted into power, the scheme will be the first one to be implemented.

Speaking about the contradictions, Atishi said, “For example, if you visit any hospital run by the Delhi government, all treatment is provided free of cost. Consultations, medicines, pre-surgical and post-surgical care, hospitalisation, rooms, and food — everything is offered without any charge. This applies to every patient without exception. On the other hand, Ayushman Bharat has a limited number of categories. If you are a rag picker, cobbler, or belong to one of the 10–12 specific categories, you are eligible for health insurance under Ayushman Bharat.”

She added, “Moreover, Ayushman Bharat has several exclusions. For instance, if a person owns a refrigerator, they are not eligible for insurance under the scheme. Similarly, if someone owns a two-wheeler, three-wheeler, or four-wheeler, they cannot benefit from it. Those with a ‘pakka’ house are also excluded from taking advantage of Ayushman Bharat.”

Under the Delhi government’s own schemes, if waiting time for tests and surgeries is too long the patients can go to private hospitals and laboratories, with the government footing the bill. It also has a scheme for accident victims, where they can be taken to any private hospital and treated for free.  As per data shared by the Delhi government, in 2023-24, 2.42 lakh people availed the free diagnostic test facility; 7,036 got surgeries done at private hospitals for free and 7,314 were treated at private hospitals under the accident victim scheme.

Atishi also questioned the capping of the insurance amount at Rs 5 lakh. “If a family member falls ill and incurs medical expenses of Rs 10 lakh, they will have to pay Rs 5 lakh from their pocket. Moreover, if another family member falls ill afterward, they cannot claim any further benefits under Ayushman Bharat. In contrast, the Delhi government hospitals currently provide treatment for free regardless of the cost, whether it is Rs 5 lakh, Rs 10 lakh, or even Rs 50 lakh.,” she said.

Earlier in the day, the High Court had issued notice to the government and its health department in a PIL seeking implementation of Ayushman Bharat scheme under the PMJAY in the Capital.

The PIL has been moved by the seven sitting BJP MPs of Delhi, including MP and senior advocate Bansuri Swaraj who argued the matter before the court of Chief Justice Manmohan and Justice Manmeet Pritam Singh Arora, Thursday.  The petitioners sought the court’s direction to the Delhi government, the Lieutenant Governor, and the Union health ministry to take all necessary steps to ensure that the residents of Delhi are provided access to healthcare under the scheme.

inputs from Sohini Ghosh