Two BJP-ruled states have expressed concerns over the implementation of the National Health Protection Mission. While the unscheduled Rs 22,000 crore farm loan waiver has left Maharashtra with no funds to join the NHPM, Rajasthan has cited logistical concerns in implementing the scheme.
At a recent meeting in Mumbai with officials of the Ayushman Bharat secretariat, Maharashtra health minister Deepak Sawant and Chief Secretary D K Jain conveyed to the Centre that the state is not financially capable of expanding its existing health insurance programme to that required for the NHPM.
Maharashtra has one of the widest health protection schemes — the Mahatma Jyotiba Phule Jan Arogya Yojana — which provides insurance cover up to Rs 2 lakh for 2.2 crore of the 2.5 crore families in the state.
The dilemma for Maharashtra is that it cannot leave current beneficiaries out of the NHPM if it adopts the Centre’s scheme. On the other hand, to extend Rs 5 lakh health cover to the beneficiaries will mean a huge financial commitment. The present scheme runs on an annual premium of Rs 700 per family. Even if the state implements the NHPM, the Centre will give 60 per cent of the premium for only 83 lakh families in the state that meet the criteria for inclusion in the NHPM as per data from the socio-economic caste census.
“It is as yet unclear how much money the state will require for expansion of the current health insurance scheme – there will be a backlash if current beneficiaries are left out. On the other hand, to more than double the entitlement for all of them with the Centre footing a small part of the bill is going to be very difficult,” said a Union Health Ministry official.
“The current premium is Rs 700, the premium for the Rs 5 lakh cover will have to be discovered through tender. The farm loan waiver has already left the state with huge financial constraints.”
Speaking to The Indian Express, Chief Secretary Jain said: “Yes we have some concerns but we are resolving these. We have had two rounds of discussions with the Central government. We were already looking at some cuts for existing schemes, especially infrastructure ones but the GST collections have been very good.”
“We have agreed to NHPM in principle. Our concerns now are how to apportion funds for the scheme. Presently, we are spending about Rs 1,500 crore on our scheme, Centre will give 400 crore. We may have to shell out another Rs 1,000 crore or so for NHPM.”
Problems in Rajasthan, officials said, is more about logistical concerns than financial. On Friday, Ayushman Bharat CEO Indu Bhushan met Vasundhara Raje to discuss the matter. Rajasthan’s Bhamashah Swasthya Bima Yojana provides cashless healthcare services to around 4.5 crore people with a maximum ceiling of Rs 3.30 lakh. Access is through a card, so the state is uncertain how to bring NHPM and BSBY on the same platform.
“They are not sure how to implement it, as they already have the ongoing scheme and a health card for access to the scheme,” said a government official. Under NHPM, an annual health cover of Rs 5 lakh will be provided to 10.74 crore families as per the “deprivations” listed in SECC data. “Moreover, Rajasthan’s contract with the insurance company goes on until the next year. So they are thinking of finding a way of how to converge the two schemes so that the ongoing scheme is not disturbed. An additional concern is that they are election-bound,” the official said.
So far, 25 states and union territories have signed MoUs with the Health Ministry to implement the scheme. The National Health Agency (NHA), the apex body for the implementation of the AB-NHPS, has launched a formal process to empanel public and private hospitals to achieve universal health coverage.
Odisha has already refused to implement the Centre’s proposed flagship health programme, saying it has a scheme called Biju Swasthya Kalyan Yojana with more beneficiaries compared to the AB-NHPM. The scheme was launched last month, stealing a march on the Centre even as preparations for AB-NHPM have reached the last leg ahead of a planned launch on Independence Day.
Two other Opposition-ruled states — Punjab and Delhi — are yet to come on board and approve the AB-NHPM. However, despite disagreements, the West Bengal government has agreed to adopt the scheme, the official said.