NEW DELHI -- The world's largest government-funded health insurance program covering 500 million poor people -- equivalent to the population of the European Union -- has been rolled out in India, despite the refusal of five local states to partake.
Ahead of general elections due by the middle of next year, Prime Minister Narendra Modi launched the service called Ayushman Bharat -- popularly known as Modicare -- on Sunday in the eastern city of Ranchi, saying it would provide free medical treatment of up to 500,000 rupees ($6,800) annually to each of the families identified as beneficiaries. The rollout was brought forward by two days.
The central and state governments will shoulder those fees at a ratios of 60% to 40%. This service will insure 40% of India's population of over 1.25 billion, or 100 million households.
The insurance will cover 1,300 illnesses, including cancer and heart disease. More than 13,000 hospitals across the country have already signed up to the program, Modi said.
"Beneficiaries are not required to register for the scheme," the prime minister said, adding they would be provided with a health card that will give them access to all the services provided.
Calling it "a game-changer," Modi said the program targets the poorest. "The number of beneficiaries of this scheme is roughly equal to the population of the European Union, or the population of America, Canada and Mexico, taken together," he pointed out.
However, five of 36 Indian states have opted out of Modicare. These are Delhi, Kerala, Odisha, Punjab and Telangana that are all ruled by different opposition parties. They claimed that their existing regional health care programs served the public better than Modicare, which some of them said was "flawed" and even "a hoax." These states have aired their reservations since the idea of Modicare was mooted but the government had hoped to win them over.
There was no sign of that this week. Delhi Chief Minister Arvind Kejriwal claimed in a tweet that Modicare was simply a public relations exercise that will prove to be an empty promise.
Separately, he shared a statement issued by his Aam Aadmi Party that said the Ayushman Bharat program only covers hospital stays and not outpatient care.
"The Modi government plans to climb the ladder of health care without laying a foundation; which is one of the reasons why the AAP terms the scheme as 'flawed.' Without a strong foundation, it is destined to fall."
Thomas Isaac, finance minister of Kerala state ruled by the Communist Party of India (Marxist), told The Indian Express newspaper that Modicare was "a big hoax."
"They are trying to make the state pay 40% of the payment... If we are not allowed to customize it, it will break the state's health care system. It's so ridiculous," he said.
Until now, Indians have had to pay for health care themselves, a reason that many families have been made destitute. About 70% of total health spending is paid for by Indians in a country where public expenditure in the sector is just 1% of gross domestic product. The government wants to raise that ratio to 2.5% by 2025.
According to the Times of India newspaper, in less than 24 hours of the launch of Modicare, more than 1,000 people have taken advantage of the benefits across the country.
Ahead of the launch, the World Health Organization voiced its approval. Director General Tedros Adhanom Ghebreyesus tweeted on Sept. 6: "Very impressed with India's initiative on Ayushman Bharat or universal health coverage! Thank you prime minister. Great commitment!"
For Modi, the success of this initiative will also be crucial -- it can be used as a flagship achievement to woo voters as he seeks a second five-year term in the 2019 polls.
"Welfare policies do impact the prospects of the ruling party" to some extent, said Sanjay Kumar, director of the New Delhi-based Centre for the Study of Developing Societies. "Yes, this scheme is going to benefit BJP [or Bharatiya Janata Party, Modi's party]."