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NEW DELHI: People on social media had begun to call the healthcare insurance plan announced yesterday in the Budget ‘Modicare’ – on the lines of ‘Obamacare’ – long before the finance minister did, but when Arun Jaitley on Doordarshan referred it to as ‘Modicare’, he made sure that’s what it would come to be called henceforth.
“I don’t know if ‘Obamacare’ was successful or not, but people will one day say ‘Modicare’ has been successful,” said Jaitley to Doordarshan News in an interview, after presenting the Union Budget 2018.
The Union finance minister was probably being disingenuous when he said he didn’t know about the fate of Obamacare, which was praised and reviled in equal measure. Still, Obama’s now-discontinued legacy was indeed a step in the direction of universal healthcare, much like this government’s ambition for the “world’s largest government funded health care programme”
Here’s a look at Jaitley’s top proposals – short of functioning detail – and how they compare to Obamacare:
‘Healthcare for all’
The National Health Protection Scheme, dubbed not ‘Modicare’ but ‘NaMocare’ by BJP president Amit Shah, will be a government-funded health care programme. It’s aimed at providing health insurance cover of up to Rs 5 lakh per family per year to 10 crore poor families. That accounts for roughly 40 per cent of the country’s population. This scheme addresses secondary and tertiary care hospitalisation and covers both “prevention and health promotion”, Jaitley said.
Obamacare, or the Affordable Care Act, was enacted in 2010 to ensure that all Americans – the well-off as well as middle and low income families – have access to affordable health insurance. It offered consumers discounts – which they called ‘tax credits’ – on government-sponsored health insurance plans, albeit with certain caveats. It also expanded the Medicaid assistance program to include more people who could not afford to pay for health care.
Follow the money
Keeping the new healthcare scheme in mind, this year’s total budgetary allocation to the Health Ministry is Rs 52,800 crore, an 11.5 per cent rise over the Rs 47,353 crore allocated last fiscal.
But the National Health Mission – the flagship scheme – has actually seen a decrease in allocation. While Rs 30801.56 crore was spent on NHM in 2017-18, this year’s allocation is Rs 30129.61 crore.
The government has committed Rs 2,000 crore to the Rashtriya Swasthya Bima Yojna through which money for the National Health Protection Scheme will be initially routed. In addition, an allocation of Rs 9,752.82 crore has been made to the National Rural Health Mission. The flexible pool for non-communicable diseases, injury and trauma has been granted Rs 1,004.67 crore.
One of the main reasons Obamacare was controversial was the ‘Individual Mandate’, a provision that allowed the government to raise funds by penalising people who didn’t have health insurance. Other modes of revenue generation for the healthcare policy included cuts in government funding, increasing taxes on high-income individuals and a variety of annual fees and surcharges.
As for finance minister Jaitley, he’s confident the government will be able to support the insurance scheme. For one, he says reintroduction of long term capital gains tax will being in revenue for it.
‘Modicare’ plans to cover 50 crore beneficiaries in its push for Universal Health Coverage. As part of the ‘Ayushman Bharat’ programme, Rs 1,200 crore has been allocated for the National Health Policy, under which 1.5 lakh health and wellness centres will bring health care system closer to the homes of people.
A total of 24 new government medical colleges have also been announced, with a view to fulfill the government’s vision of “swasth Bharat, samriddha Bharat” (healthy India, prosperous India).
Still, a former consultant to Union health minister Dr Sunil Nandraj pointed out to TOI that the Rs 2,000 crore.allocation for the insurance scheme is just not enough.
“This is far from adequate to cover the health premium for 10 crore families,” he said. Dr Abhay Shukla, national convener of Jan Swasthya Abhiyan, said, “If the allocation is meant for 50 crore people, then the premium works out to Rs 40 for each.”
Under Obamacare, it was mandatory for health care plans to cover 10 basic categories of medical services, including trips to the hospital, prescription drugs, and mental health care. It incentivized buying health insurance for low or middle income individuals by providing ‘health insurance subsidies’. It is estimated that around 23 million Americans gained health insurance coverage through Obamacare.
But perhaps the biggest USP of Obamacare was that insurance companies could not turn down, or overcharge, people with pre-existing medical conditions.
‘Overblown expectations’, says Opposition
No sooner was ‘Modicare’ announced that opposition parties began picking holes in the government’s budgetary promise, with Congress equating it to a typical “jumla”, or “hollow promise”, by PM Modi.
“The promise of Rs 5 lakh per family for secondary and tertiary healthcare is a big ‘jumla’. The target group is 10 crore families. There is, as yet, no scheme,” said Congress leader P Chidambaram.
The former finance minister said that assuming each family will avail Rs 50,000, the amount required per year will be Rs 5 lakh crore, which far exceeds the total budgetary allocation to the Health Ministry for the next fiscal year.
Obamacare, too, had faced much opprobrium, with one Republican lawmaker memorably calling it “the most dangerous piece of legislation ever passed.” The GOP made more than 60 unsuccessful attempts to defeat it in Congress, stemming from its distaste for the policy due to ideological, economic and historical reasons.
During his electoral campaign, US President Donald Trump vowed to repeal Obamacare, and partially achieved this goal when the US Senate scrapped the individual mandate, as part of a sweeping tax reform bill last December.