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Parliamentary Panel recommends Centre to include provisions from Obamacare into Ayushman Bharat
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Gireesh Babu, New Delhi
January 02 , 2024
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A Parliamentary Panel has recommended that the Centre may consider inclusion of some of the provisions of the US government's much deliberated Affordable Care Act, known as Obamacare, in India's flagship health assurance scheme Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).
The Department-related Parliamentary Standing Committee on Health and Family Welfare in its 151st report on implementation of Ayushman Bharat, after analysing the healthcare and health insurance schemes in various countries including US, Thailand, China, and some of the Latin American nations, observed that the implementation of Obamacare has led to significant reduction in the uninsured and improved access to essential healthcare services for millions of Americans.
It aims for widespread coverage, affordability, and quality care. Specific health schemes like Medicare, Medicaid have been subsumed in Obamacare. As of 2021, around 91.7 per cent of the population is covered through public and private health insurance.
"The Committee is of the view that the Government may consider some of the provisions of the Affordable Care Act of the United States for inclusion in Ayushman Bharat," said the Panel.
"By including some sections of the persons falling in APL category, the provisions for 'employer mandate' to provide health insurance to the employee and his family, subsuming of specific schemes for children and senior citizens, tax incentives and disincentives to corporate regarding healthcare are some of the measures worth including in the Ayushman Bharat Scheme and PMJAY," it added.
Implemented in 2014, Obamacare, through a host of comprehensive healthcare reforms, covered about fifty percent of the uncovered population by 2016. The Employer mandate in Obamacare requires large employers to provide health insurance to employees or face penalties. This provision was, however, eliminated in 2019.
Preventive Services such as vaccinations and screening are covered without cost sharing which promote early detection and disease control, observed the Panel. The law also focuses on improving healthcare cost through organizations like Accountable Care organisation and provides for bundled payments for certain healthcare packages. It also emphasises health information technology to enhance coordination among health care providers and improve patients’ outcomes.
On December 20, the US officials said that more than 15.3 million people have signed up for Health Insurance Marketplace plans in states that use HealthCare.gov, with a 33% increase compared to this time last year, said the US officials.
The US Department of Health and Human Services added that the ACA marketplace enrollment is at "a record-breaking pace" and the projections are that over 19 million consumers will enroll into the programme in 2024 through the ACA marketplaces, over seven million more than when President Joe Biden took office.
The Parliamentary Panel also noted that the experiences of Thailand, China, and Latin American countries demonstrate the difficulty of increasing health coverage in the informal/unorganised sector. Thailand made good progress in UHC by fully subsidising the informal sector, while China has partially subsidised that segment.
However, China’s experience also indicates the possibility of sustained coverage through a contributory and voluntary scheme. The experiences from Latin America highlight that adverse selection and inadequate risk-pooling is a pressing challenge for voluntary contributory schemes targeted towards the informal sector.
"The adverse selection due to opting out of high-income people reduces cross-subsidisation, leading to high premiums and inequality in access to healthcare," observed the panel.
AB PM-JAY, according to the Ministry of Health and Family Welfare, is the largest publicly funded health assurance scheme in the world which provides health cover of Rs. 5 lakh per family per year for secondary and tertiary care hospitalization.
Currently, 55 crore individuals corresponding to 12 crore families are covered under the scheme. Many States/UTs implementing AB PM-JAY have further expanded the beneficiary base, at their own cost, says the Ministry.
As of December 20, 2023, approximately 28.45 crore Ayushman Cards have been created since the inception of the scheme, out of which, approximately 9.38 crore Ayushman Cards have been created during the current year 2023 (Jan -Dec 2023).
A total of 6.11 crore hospital admissions amounting to Rs. 78,188 crore have been authorized under the scheme, of which 1.7 crore hospitals admissions worth over Rs. 25,000 crore have been authorized during the year 2023 (Jan-Dec 2023). A total of 26,901 hospitals including 11,813 private hospitals have been empanelled under AB PM-JAY to provide healthcare services to scheme beneficiaries.
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