Touted as the world’s largest health insurance scheme, the Indian government’s Ayushman Bharat programme was never going to be easy to implement. The team tasked with its roll out knew this when it was first announced in February 2018. How would the Centre convince states, especially those which already had similar schemes in place, to come on board? After all, why should a state that is already successfully running a health insurance scheme adopt the Centre’s more elaborate version?

The Centre’s answer to this was simple. Flexibility. It gave states the option of deciding how to execute the programme. Rajasthan, for instance, had a very similar scheme—Bhamashah Yojana. In effect since 2014, it offered a coverage of Rs 3.3 lakh ($4,514) across over 1400 medical procedures. The scheme already covers most of the state’s poor. Understandably, Rajasthan was reluctant to sign on for the Centre’s scheme. And while Ayushman Bharat is yet to be launched in the state, Rajasthan finally signed the Memorandum of Understanding (MoU) for the scheme thanks to the favourable terms on the table.

“The MoU gives complete freedom to the state to decide execution and merging the schemes. It just mentions that 5.97 million beneficiaries must be covered. We already have 9.2 million people covered. There would obviously be overlap in beneficiaries of the two schemes,” said Ashish Modi, Joint CEO, Rajasthan State Health Assurance Agency.

Most other states have also agreed to either launch Ayushman Bharat as a fresh scheme or make it work with their existing schemes the way Rajasthan intends to. Since the scheme was launched, Tamil Nadu has announced that it would merge the existing Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS), which covers 13.4 million families for Rs 1 lakh ($1,368) annually, with Ayushman Bharat. Similarly, West Bengal negotiated a merger on the condition that the merged scheme continues to be called Swasthya Sathi. This, despite the number of beneficiaries under the scheme increasing twelve-fold. From 4.7 million to 60 million.

As of now, only two states have rejected the scheme outright—Odisha and Delhi. Telangana, meanwhile, has chosen to abstain for the time being. Despite these holdouts though, the effect of Ayushman Bharat could still be massive. 500 million vulnerable people will stand to benefit from it, according to a press statement issued by the Ministry of Health and Family Welfare. Once it is implemented, says a consultant with the Ayushman Bharat scheme, about 40% of these 500 million will get health insurance for the very first time. For the remaining 60%, the scheme will push their coverage from as little as Rs 20,000 ($273) to Rs 5 lakh ($6,840), while also covering more medical treatments.

AUTHOR

Ruhi Kandhari

Ruhi writes on the impact of healthcare policies, trends in the healthcare sector and developments on the implementation of Electronic Health Records in India. She has an M. Sc. in Development Studies from the London School of Economics.

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