Parl Panel Suggests Inclusion of US’ Obamacare Provisions into Ayushman Bharat Scheme

The panel emphasised that preventive services such as vaccinations and screenings covered without cost sharing in Obamacare promoted early detection and disease control.

A Parliamentary Panel has proposed the inclusion of specific provisions from the United States Affordable Care Act, widely known as Obamacare, in India's flagship AB-PMJAY (Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana) initiative.

The Department-related Parliamentary Standing Committee on Health and Family Welfare, in its 151st report on the implementation of Ayushman Bharat, highlighted the success of Obamacare in reducing the uninsured population and improving access to essential healthcare services.

The committee analysed healthcare and health insurance schemes globally, including those in the US, Thailand, China, and Latin American nations.

Obamacare, implemented in 2014, achieved comprehensive healthcare reforms that covered approximately 50% of the previously uninsured population by 2016. The Employer mandate in Obamacare, requiring large employers to provide health insurance to employees or face penalties, is one of the provisions recommended for inclusion in Ayushman Bharat.

The panel suggested that the Indian government consider incorporating aspects such as preventive services, tax incentives, and disincentives to corporates regarding healthcare, subsuming specific schemes for children and senior citizens, and the 'employer mandate' into Ayushman Bharat.

While the 'employer mandate' was eliminated in 2019, the panel believes that specific measures from Obamacare could enhance Ayushman Bharat's scope and effectiveness.

The Affordable Care Act in the US achieved widespread coverage, affordability, and quality care. Specific health schemes such as Medicare and Medicaid were subsumed under Obamacare, resulting in around 91.7% of the US population being covered through public and private health insurance as of 2021.

The panel emphasised that preventive services such as vaccinations and screenings covered without cost sharing in Obamacare promoted early detection and disease control.

The law also focused on improving healthcare costs through initiatives including Accountable Care Organisations and bundled payments for specific healthcare packages. Another notable feature was emphasising health information technology to enhance coordination among healthcare providers and improve patient outcomes.

The experiences of other countries, including Thailand, China, and Latin American nations, were also examined. Thailand's progress in achieving Universal Health Coverage (UHC) by fully subsidising the informal sector, China's experience with a contributory and voluntary scheme, and the challenges faced by voluntary contributory schemes in Latin American countries were highlighted by the panel.

Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), considered the world's largest publicly funded health assurance scheme, provides health coverage of INR 5 Lakh per family per year for secondary and tertiary care hospitalisation.

Currently, 55 Cr individuals, corresponding to 12 Cr families, are covered under the scheme. According to the Ministry of Health and Family Welfare, many States/UTs implementing AB PM-JAY have expanded the beneficiary base at their own cost.

As of December 20, 2023, around 28.45 Cr Ayushman Cards have been created, with approximately 9.38 Cr Ayushman Cards generated during the current year. A total of 6.11 Cr hospital admissions, amounting to INR 78,188 Cr, have been authorised under the scheme.

In 2023 alone, 1.7 Cr hospital admissions worth over INR 25,000 Cr have been authorised. The scheme has empowered 26,901 hospitals, including 11,813 private hospitals, to provide healthcare services to beneficiaries under AB PM-JAY.