Prime Minister Narendra Modi recently extended the Ayushman Bharat Health Insurance scheme to all citizens aged 70 years and above. However, the response to an RTI inquiry shows that states like Kerala are already facing disproportionate financial stress under the PM-JAY scheme.
Cost of implementation of PM-JAY schemes are supposed to be shared between the Union and state governments. Kerala signed an agreement with National Health Authority on October 31, 2018, and constituted State Health Agency (SHA) for implementing the scheme in the state as Karunya Arogya Suraksha Padhathi (KASP).
Subsequently, the project was started in Kerala on April 1, 2019. The RTI documents in possession of activist Raju Vazhakkala shows that since then, the hospitals in Kerala have incurred expenses to the tune of Rs 4,709.3 crore under the scheme. Notably, out of this amount to be paid to the hospitals, the Centre's contribution is just Rs 777.9 crore, and the state's is Rs 3,919.5 crore. As of August 31, 2024, the total pending arrears to be given to hospitals is Rs 1,681.5 crore, with the Centre's share being around Rs 75 crore.
Kerala is currently providing coverage under the KASP to close to 42 lakh economically and socially backward families. However, experts note that the Centre's norms consider only close to 24 lakh families as below poverty line. Notably, the Centre is sharing the burden of PM-JAY only in case of these 24 lakh families. In case of the rest of the beneficiaries, state is managing 100 per cent of the amount.
Now, the insurance for the elderly will be added to this. According to Census 2011, the proportion of elderly in Kerala is 12.7 per cent as against 8.0 per cent at the all-India level. The corresponding figures in 1961 was 5.1 per cent and 5.6 per cent, respectively. By 2036, the state is expected to have 23 per cent of its population under the elderly category.