The Centre is looking to extend healthcare benefits under the Ayushman Bharat — Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) — to a wider section of population in order to cover the middle-income segment as well. According to sources, the Niti Aayog is looking into various models and the viability of such a move. It is understood to have sought data on various health insurance schemes being run by different ministries to understand how to expand the coverage of the flagship scheme on a viable basis.
Discussions are understood to have also taken place with insurance companies to understand their interest in such an expansion of the scheme as well as the need for any financial support. The scheme may be extended to another 100 million or more families at a nominal fee on the models of the flagship life and accident insurance schemes of the government. Insurance companies would be tapped for this model.
Currently, the AB-PMJAY offers `5-lakh-a-year free health cover to 107 million poor households. The households are identified based on select deprivation and occupational criteria in rural and urban areas, respectively, via the socio-economic caste census (SECC) 2011. Under the scheme, launched in September 2018, around 42 million beneficiaries have availed free hospitalisation benefits worth `48,500 crore till November 22, 2022.
“Healthcare is one of the main challenges before households that can make or break them. Keeping in mind the rising healthcare costs as well as the need for better healthcare for all segments of population, the Niti Aayog is working on how to expand the coverage of the scheme,” said two persons familiar with the development. The views of the finance ministry have also been taken on board on the issue.
The ministry of labour and employment has the Employees’ State Insurance Corporation that provides health insurance and medical facilities through its hospitals to formal sector workers up to a wage limit of `21,000 per month. It covers about 31 million insured persons. A number of state governments also run their own health insurance schemes.
While there have been discussions even in the past on extending the scheme to the missing middle class, the move assumes importance ahead of the General Elections 2024. Sources indicated an announcement on it could be made in the coming months.
“While the poor are already covered by the Ayushman Bharat scheme, the affluent can buy health insurance. However, many in the middle-income groups may not have any health cover or it may be inadequate. Healthcare costs can push them into poverty and that is why there is a need to cover them under the scheme,” said another source.
Previously, in a report in October 2021 on Health Insurance for India’s Missing Middle, Niti Aayog had flagged that 30% of the population or about 400 million individuals still lack any form of financial protection for health. The Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and state government extension schemes, provide comprehensive hospitalisation cover to the bottom 50% of the population – around 700 million individuals, it had noted.
It had highlighted the need for designing a low-cost comprehensive health insurance product for the missing middle class. One of its recommendations was also that the government can partially finance or provide health insurance. It can expand PMJAY coverage to the poorest segments of the missing middle population, or leverage PMJAY infrastructure to offer a voluntary contributory enrolment.
