'Ayushman Bharat' launched: Why these 5 states have rejected PM Modi's mega healthcare scheme

Prime Minister Narendra Modi on Sunday launched the Pradhan Mantri Jan Arogya Yojana-Ayushman Bharat from Ranchi in Jharkhand and termed it a "game-changer initiative to serve the poor.

The Central scheme, which was renamed the Pradhan Mantri Jan Arogya Abhiyan (PMJAY), aims to provide a coverage of Rs five lakh per family annually, for secondary and tertiary care hospitalisation. Over 10.74 crore vulnerable entitled families (approximately 50 crore beneficiaries) will be eligible for these benefits.

Eligible people can avail the benefits in the government and listed private hospitals. 

The scheme is the world's largest fully government-funded health insurance programme.

"PMJAY-Ayushman Bharat is the biggest government-sponsored healthcare scheme in the world. The number of beneficiaries is almost equal to the population of Canada, Mexico and the US taken together," Modi said.

The health scheme will set an example for countries across the world, Modi said.

Five states - Telangana, Odisha, Delhi, Kerala and Punjab - have, however, stayed out of the ambitious healthcare scheme. They have said they will not implement the programme until their concerns are addressed since they have better health assurance schemes.

Here are the reasons given by the five states on why they have stayed out of 'Ayushman Bharat':

Telangana

Telangana has not joined the Ayushman Bharat 'as of now' and would continue to implement its health scheme, official sources said.

One of the reasons for not joining it, for the time being, was because the state's Aarogyasri scheme covers nearly 80 lakh families, official sources said.

"We already have the Aarogyasri scheme. As of now, Telangana is not participating in the (central government's) scheme," they told PTI.

Asked when the Centre's flagship Ayushman Bharat health insurance scheme would be implemented in Telangana, the official said "as of now Aarogyasri scheme will continue," adding Telangana's health coverage model is a robust programme.

Odisha

At a rally in Odisha on Saturday, PM Modi had criticised Odisha Chief Minister Naveen Patnaik for not joining the Centre' s Ayushman Bharat scheme.

Odisha Health minister Pratap Jena announced in June that the state would not join the AB-NHPS as the state's demands are not met by the Centre.

While the Centre agreed to include only 61 lakh families in AB-NHPS, Odisha's requirement was 70 lakh families, Jena had said, adding that the state government, therefore, announced Biju Swastha Kalyan Yojana to provide health assurance to its people.

Later, Chief Minister Naveen Patnaik said that the state is willing to join the Ayushman Bharat if its concerns are addressed.

"...We will still be willing to consider joining AB-NHPS in due course if the concerns of the state are addressed adequately," Patnaik wrote to Prime Minister Narendra Modi.

While noting that announcement of the Ayushman Bharat -National Health Protection Scheme (AB-NHPS) was a welcome step, Patnaik said the dependence of the scheme on SECC (Soci-Economic Caste Census-2011) data will be a serious handicap in achieving the goal of near universal coverage.

"As you will agree, the SECC survey done on the criteria fixed by the UPA government has grave lacunae and many genuine poor have been left out," Patnaik said in the letter.

Kerala

Rejecting the Ayushman Bharat scheme, Kerala Finance Minister Thomas Isaac had called the programme 'a big hoax.' In an interview to The Indian Express, Isaac had said that under the existing health insurance scheme, Rashtriya Swasthya Bhima Yojana, total claims in India have been Rs. 1.20 crore, of which Rs 53 lakh is from Kerala. 

“The subsidy ceiling for the current RSBY scheme of Rs 30,000 benefit is Rs 1,250. The subsidy for the Ayushman scheme, with benefit of Rs 5 lakh, is Rs 1,110. Is it possible to have such a jump in benefits for lower premium?” he asked.

He questioned how the government would implement Ayushmann Bharat at such a big scale. 

Arguing that health is a state subject, he said that the states should be allowed to customise the programmes in health according to the respective state’s needs.

"Let us debate about Ayushmann Bharat. The argument that larger the no. of beneficiaries, lower would be the premium is irrelevant. Each state is going to independently tender for beneficiaries as per central norms, just as in RSBY. Therefore tender coverage is not going to be higher," he later tweeted. 

Delhi

Delhi chose to not join the Ayushman Bharat scheme as Arvind Kejriwal government expressed dissatisfaction with the proposed target of 6 lakh families. Delhi has nearly 50 families with 2 crore population. 

Kejriwal had claimed that Ayushman Bharat is a public relation exercise which will prove to be another "jumla" (rhetoric). The AAP termed the scheme "another white elephant in the making" and alleged that it covers only six lakh out of 50 lakh families in Delhi.

Punjab

The Amarinder Singh government in Punjab had expressed reservations over the flow of funds and the low of number families covered under the Ayushman Bharat scheme. 

While Punjab government’s Bhagat Puran Singh Sehat Bima Yojna (BPSSBY) scheme covers 29.3 lakh Below Poverty Line (BPL) families, the Centre had procured offered to cover 14.96-lakh families in Punjab under the Ayushman Bharat. 

However, the key difference between the two schemes is the amount of health insurance cover. While BPSSBY provides a cover of only Rs 50,000, Ayushman Bharat provides a cover of 10 times.  

“We have some reservations. Punjab government is running some health insurance schemes. We are yet to study the convergence of existing schemes with this one. We also have issues about 60:40 ratio of funding by Centre,” Punjab health and family welfare minister Brahm Mohindra said in May.  

The state government later agreed to join the scheme. It, however, requested the Centre to bring the cost sharing to 75:25 from earlier 60:40.