On Thursday, West Bengal Chief Minister Mamata Banerjee announced that her state is withdrawing from Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY). Delhi, Telangana and Odisha have stayed out of the programme, while reports have suggested that Congress-ruled states such as Karnataka may follow suit. A look at why the Centre’s flagship health programme is raising political hackles:
Why has West Bengal exited?
The dispute is over branding. The letter sent to beneficiaries has photos of Prime Minister Narendra Modi; the West Bengal government feels that given the 60:40 partnership in the scheme, the state government should get similar space on documents. Then there is the name of the scheme itself. In a letter dated January 10, in which it informed the Centre about its withdrawal, the West Bengal government chose to call the scheme Jan Arogya Yojana rather than Pradhan Mantri Jan Arogya Yojana. Additional Chief Secretary Rajiva Sinha wrote: “… The MoU of JAY signed between Government of West Bengal and Government of India clearly stipulated that since West Bengal already had a well-established scheme Swasthyasathi, the state government would like to retain the name Swasthyasathi in the scheme… To our surprise the entitlement letter/card issued by your Ministry mentions the name of the scheme as PMJAY which is not only a violation of the stipulations of the said MoU but has created confusion at the grassroots level.”
Launched in 2016, West Bengal’s Swasthyasathi provides a basic health cover for secondary and tertiary care up to Rs 5 lakh per annum per family, the same as PMJAY. So far, around 1 crore people have been enrolled under the central scheme in West Bengal while the state scheme already had 40 lakh beneficiaries. Rs 176.56 crore has been released to the state.
For PMJAY, the pullout is a setback because it affects the national portability of the scheme. Kolkata being the preferred destination for many people from the Northeast and from states such as Bihar, officials fear it could impact more people than just the beneficiaries in West Bengal.
Why have three other states stayed out?
Each has a different reason. In Odisha, Chief Minister Naveen Patnaik stole a march over the Centre when, about 40 days before the launch of PMJAY in September 2018, his government announced the launch of Biju Swasthya Kalyan Yojana (BSKY) named after former Chief Minister Biju Patnaik. BSKY will give an insurance cover up to Rs 5 lakh per eligible family and Rs 7 lakh for treatment of female members. A letter from the CM to every beneficiary family also lists other state schemes such as Niramaya (free medicines), Nidan (free diagnostics), and Sahay (dialysis and chemotherapy in all districts).
Delhi, like West Bengal, has an issue with the name of the scheme. On August 23, Dr R N Das, Additional Director in the Directorate General of Health Services, wrote to implementing agency NHA (National Health Agency) Deputy CEO Dr Dinesh Arora: “Hon’ble Minister of Health, Government of NCT of Delhi has approved the entering of MoU with the National Health Agency. However, he has also minuted that name of the scheme will be Mukhya Mantri Aam Aad(m)i Swasthya Bima Yojana Ayushman Bharat for implementation in Delhi.” Negotiations stumbled when the NHA replied: “Since this is a national scheme with national character, it’s critical that the name of the scheme starts with AYUSHMAN BHARAT. This will also help us in operationalising portability and easy identification of beneficiaries. The state government can have any suffix after the AYUSHMAN BHARAT.” Neither side has budged from its position and NHA has since started empanelling Delhi hospitals on its own rather than through the State Health Agency as has been done in all other states. Delhi, incidentally, has been mulling its own health insurance programme for some time now.
Telangana has kept the NHA guessing. Officials have met Chief Minister K Chandrasekhar Rao in Delhi but have not managed to convince him. Sources say another meeting in Hyderabad is possible, but a decision one way or the other may have to wait until after the elections.
Starting from undivided Andhra Pradesh, Telangana has one of the oldest functioning tertiary care health schemes in the country. A community health insurance scheme, Arogyashri provides financial protection to families living below the poverty line up to Rs 2 lakh in a year for the treatment of serious ailments requiring hospitalisation and surgery. Altogether 949 treatments are covered. According to a 2017-18 report, there are 77.19 lakh beneficiary cards with 330 empanelled hospitals.
What’s next in West Bengal’s case?
In a letter dated January 11, Ayushman Bharat CEO Dr Indu Bhusan has urged the state government to reconsider its position. The letter says: “… Ayushman Bharat family letter is neither a beneficiary card nor an entitlement card. The said letter is only one of the modes of spreading awareness among eligible families… The distribution of the letter is an integral part of the beneficiary identification guidelines (available in the public domain) given that Ayushman Bharat is an entitlement based scheme.” The CEO’s letter makes it clear that the family letter is non-negotiable.