Punjab’s Dissenting Diagnosis

Are there any specific objections?

As per the Ayushman Bharat scheme, the Centre has announced it will pay 60 per cent of grant as premium, and the states will chip in with the balance 40 per cent. As per Punjab government, the point of deliberation is that Government of India will release 60 per cent of the national ceiling rate to be determined by the Centre at a later stage. The actual premium rate, on the other hand, will be determined through an open tendering process in every state. Punjab’s contention is that it does not know what the insurance companies would be quoting as premium price. Consequently, GOI’s contribution may drop to less than 60 per cent. The state would then have to pay more than its share on account of excess premium over and above the national ceiling limit. The state’s liability is thus open-ended.

Punjab also wants clarity on who will bear the administrative cost of hiring Ayushman Mitras. These assistants would be needed to be appointed in all empanelled hospitals in Punjab.

Thirdly, according to the government, the Centre has shared a preliminary model tender document. There is no detailing of several provisions. Every state, it says, is distinct in endemicity, incidence and prevalence of diseases. So, all states cannot be bound to a uniform health policy.

Is there an element of political resistance in these objections?

Punjab is a Congress-ruled state. Health Minister Brahm Mohindra says it’s not about politics. Instead, he cites the Congress’s own manifesto promising a “Universal Health Insurance Scheme” for all 60 lakh families in the state.

However, the state does not have the money to implement its promise, and is reluctant to partner a central scheme of Rs 5 lakh per annum cover, powered by the Modi government. The state government says it only opposes the scheme as it would cover only 14.5 lakh families listed as underprivileged under the Socio Economic Caste Census (SECC) of 2011.

Moreover, Punjab runs an insurance scheme of Rs 50,000 each for 29.50 lakh Blue Card holding families, who are beneficiaries of Atta Dal scheme. Also, it has an insurance scheme for farmers under which an insurance cover of Rs 2 lakh is give to each farmer’s family for major ailments. Mohindra says the central scheme will need to be dovetailed with its plan for universal health insurance and other health insurance schemes so that there is a uniformity.

“We are not averse to the MoU. The issue raised need to be addressed. There is no political agenda. Our own health insurance schemes are being deliberated upon. We just want that maximum people in the state get benefit for the health insurance, which is a state subject. The day Centre addresses our issues, we will sign the MoU,” said Mohindra.

When does Punjab think it will be able to roll out its Universal Health Scheme?

Not immediately. The state still has to work out the details — the premium, total insurance cover and its monetary obligations. Punjab is burdened under a debt of over Rs 2 lakh crore. Also, the government rolled out a debt waiver of Rs 10,000 crore to farmers which has burnt another hole in its pocket. The Social Security Cess being levied may be used for providing the health insurance cover.

What next?

Union Health Minister J P Nadda has invited Mohindra for a meeting so that he can address all the concerns of Punjab. The state is likely to go ahead with the meeting that is yet to be scheduled.