NEW DELHI : The National Health Authority (NHA) plans to extend health insurance coverage under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (ABPM-JAY) to gig workers earning between ₹15,000 and ₹25,000 a month and other such groups, a senior government official said.
At a recent meeting, NHA board members stressed the need to extend health insurance coverage to gig economy workers who have unstable incomes and often face ruin. financially due to high hospitalization costs.
The NHA has requested quotes from some insurance companies to move the initiative forward, the official said, speaking on condition of anonymity.
ABPM-JAY, launched in September 2018, covers approximately 500 million poor beneficiaries (107.4 million families) based on the Socio-Economic Caste Census (SECC 2011) database. However, states implementing the program have expanded the beneficiary base to an additional 140 million families, covering approximately 700 million people. This leaves an estimated 400 million Indians, or the so-called missing middle, without any form of financial protection for their healthcare needs.
NITI Aayog defines the segment as the missing link because they are not poor enough to be covered by government subsidized insurance schemes and not rich enough to purchase private insurance.
“The NHA has been given the mandate to expand ABPM-JAY coverage to sections of society, including the non-poor segment, which is commonly referred to as the missing middle on the basis of self-pay or payment by some organizations. For example, these groups can be street vendors identified under Prime Minister Svanidhi Yojana, small scale sugarcane growers and their workers associated with sugarcane cooperatives, All India Truck Drivers Association workers, etc. “said the official.
It is estimated that nearly 70% of India’s population is now covered by some health insurance schemes, including those run by state governments, social insurance schemes and private insurance schemes, according to a report by NITI Aayog.
This includes about 20% of the population, or 250 million people, who are covered by social health insurance and private voluntary health insurance, according to the report.
“To protect the ‘near-poor’ and the middle class from impoverished health care spending, existing government health insurance programs must be expanded. If required, all sections that are currently not included can be given the opportunity to become beneficiaries of government schemes through income-graded premiums,” said Dr. K. Srinath Reddy, President, Public Health Foundation of India (PHFI).
Many organizations have associates and partners in addition to their regular employees. For example, the Fast Moving Consumer Goods (FMCG) companies in India have around 150,000 salespeople and distributors who belong to the missing middle segment and are eligible for health coverage in conjunction with the NHA.
Some of these organizations have asked the NHA to include their associates under the health coverage of ABPM-JAY coverage.
However, NHA faces a technical adverse selection challenge in ABPM-JAY.
Adverse selection in health insurance is the imbalance caused by the underwriting of a greater number of high-risk sick policyholders than of healthy policyholders.
The imbalance occurs when sick people, who need more insurance, buy more policies than healthy people, who need less coverage and may not buy a policy at all.
It is important to note that the National Health Policy (2017) highlighted the need for universal health coverage. Including the missing link under Ayushman Bharat PM-JAY will be the final link towards achieving universal health coverage.
“It must become a social movement because it will help reduce the risks of adverse selection. This will strengthen the government’s shoulders to achieve the Sustainable Development Goal of universal health coverage,” the official said, adding that the NHA is creating an enabling environment for this initiative.
Questions emailed to the Department of Health spokesperson on Sunday morning went unanswered until press time.