A slugfest is currently on between Prime Minister Narendra Modi and Opposition leaders Mamata Banerjee and Arvind Kejriwal regarding the lack of implementation of the Centre’s Ayushman Bharat – PM Jan Arogya Yojana in West Bengal and Delhi, respectively. While the chief minister of Bengal and the former Delhi CM claim that their state health care schemes are better, Modi’s contention is that they have not implemented the scheme in their “political interests”.
However, several non-BJP states — mostly in the south — have adopted the scheme ever since it was rolled out in 2019, and largely benefitted from it. Reportedly, patients suffering from kidney ailments and need regular dialysis are its biggest users, along with those who need treatment for heart diseases, infectious diseases, and general surgery.
But before we go into all that, here’s a little on what the Ayushman Bharat scheme is about and why Delhi and Bengal are loath to implement it.
Also read: Explainer: Ayushman Bharat scheme to cover all seniors over 70; read more here
What is AB-PMJAY?
The AB-PMJAY is the Centre’s flagship health assurance scheme launched in 2018 to provide an annual health cover of Rs 5 lakh per family for secondary and tertiary care hospitalisation to the poor and vulnerable.
With a target of providing health care to 10 crore families, it is one of the world’s largest health assurance schemes. Modi said on Tuesday (October 29) that nearly four crore poor people have benefitted from AB-PMJAY.
For most states, the Centre pays 60 per cent of the cost, while the state pays the remaining 40 per cent. For the northeastern and Himalayan states, the Centre pays 90 per cent, while the state pays 10 per cent.
However, there is a lack of clarity over the eligibility criteria of the scheme. On Tuesday, the scheme was expanded to cover citizens aged 70 years and above, regardless of income. But for those younger than 70, the scheme lays down certain preconditions.
Applicants must belong to either of the categories of Scheduled Caste or Scheduled Tribe or Lower Income Group or Economically Weaker Sections. In rural areas, the eligibility criteria also include preconditions such as lack of housing and other deprivations.
Bengal and Delhi’s argument
Both the TMC in Bengal and the AAP in Delhi have raised arguments about the eligibility factor and the complex terms and conditions.
The Bengal government, in fact, introduced the Swasthya Sathi scheme two years before the PM-JAY, in 2016, which, it argues, is an all-inclusive scheme that covers every member of every family. It has over 2.4 crore families as beneficiaries. Despite implementing the PM-JAY initially, the Bengal government decided to withdraw from the scheme in 2019.
Similarly, AAP chief Kejriwal has pointed out that many people in the national capital receive free medical treatment through the Delhi government’s healthcare scheme, under which every person living in Delhi gets complete treatment free of cost.
Also read: AAP blasts Modi over Ayushman Bharat scheme, dubs it a ‘scam’
How other states have benefitted from PM-JAY
All other states and Union territories have adopted the PM-JAY scheme in the past six years. And interestingly, three of the top four states that have recorded the highest number of hospitalisations under the scheme are not ruled by the BJP. These are Tamil Nadu, Kerala, and Karnataka. Here is a gist of how various states have benefitted from the PM-JAY scheme:
Tamil Nadu: On top of the list of is the DMK-ruled Tamil Nadu, which has reported over 90 lakh admissions under PM-JAY since the scheme was adopted in 2019. Admissions in Tamil Nadu comprise about a sixth of all made under the scheme countrywide, numbering about 6.86 crore. Over 179,003 hospitalisations were recorded for every 100,000 people enrolled in Tamil Nadu in 2023.
Tamil Nadu is also one of four states that have implemented the PM-JAY scheme through public-sector insurance companies. States can adopt the trust mode, insurance mode, or a combination of both, termed the hybrid mode, to implement the scheme. By February this year, 82 lakh Ayushman cards had been created by Tamil Nadu.
Karnataka: Ruled by the Congress since May 2023, Karnataka comes in second place, with 66 lakh hospital admissions under the scheme. Last year, Karnataka was in fourth place, with 41,089 hospitalisations for every 100,000 cards issued. Karnataka had created 1.5 crore Ayushman cards by February this year.
Rajasthan: Currently ruled by the BJP, Rajasthan was under Congress rule until last year. It has seen 57.4 lakh admissions since 2019 and comes third in utilisation. In terms of the number of hospitalisations (52,168) for every 100,000 cards issued, too, it was in third position last year. Rajasthan had created 2 crore cards by February.
Barring Rajasthan, the NDA-ruled Andhra Pradesh, Gujarat and Chhattisgarh also have decent utilisation rates.
Kerala: The Left-ruled Kerala currently has the fourth highest utilisation rate, with nearly 55 lakh hospital admissions since 2019. Last year, the state had the second highest PM-JAY utilisation rate, with 74,280 hospitalisations for every 100,000 cards issued. Kerala had created 75 lakh cards by February this year.
Telangana: Despite having its own Aarogyasri scheme, the Congress-run Telangana government has converged it with Ayushman Bharat. Telangana covers 80 per cent of its population, irrespective of age limit, under this merged health scheme. Around 90 lakh families — or 2.84 crore individuals — benefit from this merged scheme. All BPL families have health cards based on their food security profile. So far, 82 lakh cards have been issued by Telangana.
Trouble in Punjab
However, the AAP-ruled Punjab has failed to use the scheme effectively. Ever since the PM-JAY was launched in 2019, the scheme has been mired in controversies in the AAP-ruled Punjab. Private hospitals in the state have suspended treatment to patients under the scheme on and off over non-payment of bills worth crores. The agreement under the scheme says the treatment costs have to be reimbursed to hospitals within 14 days of submission of bills.
Punjab uses the ‘trust’ mode to handle the scheme. While the state has been blaming the Centre of delaying the payments of its 60 per cent share, it has also been blaming hospitals for inflating the bills. The Centre claims the Punjab government has mismanaged the funds.
Also read: Delhi BJP MPs file writ petition against AAP for not implementing Ayushman Bharat scheme
Low utilisation by NDA-ruled states
Interestingly, the rate of utilisation by states ruled by the BJP or its NDA allies is comparatively lower. These include bigger states such as Uttar Pradesh, Bihar, and Maharashtra.
UP has reported about 28 lakh admissions so far, which means only about 8,000 hospitalisations for every 100,000 people enrolled. Interestingly, UP has so far created the highest number of Ayushman cards — 4.91 crore. It has also adopted a trust model, where a dedicated trust or society is set up to manage the scheme.
Bihar, currently ruled by the NDA, also has one of the lowest utilisations of the PM-JAY scheme, with total hospitalisations numbering only about 7.7 lakh since 2019. The number of cards created by Bihar is also low — around 87 lakhs.
Odisha, ruled by the BJD until earlier this year, had not adopted the PM-JAY scheme until the BJP government came to power. It has now joined the scheme after discontinuing the Biju Swasthya Kalyan Yojana health cards introduced by the Naveen Patnaik government.
Among the other big BJP-ruled states, Assam had the lowest utilisation of PM-JAY, with 5,292 hospitalisations for every 100,000 beneficiaries last year even though it issued more than 1 crore cards. Madhya Pradesh and Maharashtra stand at number two and three positions for the number of cards generated — 3.78 crore and 2.39 crore — respectively. However, both have a dismal utilisation rate, with slightly more than 8,000 hospitalisations per 1 lakh beneficiaries.
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