NEW DELHI : The National Health Authority (NHA) plans to extend health insurance cover under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (ABPM-JAY) to gig workers earning between ₹15,000 and ₹25,000 per month and other such groups, a top government official said.
At a recent meeting, the board members of NHA stressed the need to extend the health insurance cover to gig economy workers who have unstable incomes and often face financial ruin because of high out-of-pocket hospitalization costs.
NHA has sought quotations from some insurance companies to take the initiative forward, the official said, requesting anonymity.
ABPM-JAY, launched in September 2018, covers around 500 million poor beneficiaries (107.4 million families) based on the Socio-Economic Caste Census (SECC 2011) database. However, states implementing the scheme have expanded the beneficiary base to an additional 140 million families, covering around 700 million people. That leaves around 400 million Indians, or the so-called missing middle, without any form of financial protection for their health needs.
NITI Aayog defines the segment as the missing middle because they are not poor enough to be covered by government-subsidized insurance schemes and not wealthy enough to buy private insurance cover.
“NHA has been given the mandate to expand coverage under ABPM-JAY to sections of society, including the non-poor segment, which is commonly referred to as the missing middle on the basis of self-payment or payment by some organizations. For example, these groups can be street vendors identified under PM Svanidhi Yojana, smaller sugarcane farmers and their workers who are associated with sugarcane cooperatives, workers of All India Truck Drivers Association, etc.,” the official said.
Nearly 70% of India’s population is now estimated to be protected by some health insurance schemes, including those run by state governments, social insurance schemes and private insurance plans, a NITI Aayog report said.
This includes around 20% of the population, or 250 million people, who are covered through social health insurance, and private voluntary health insurance, the report said.
“To protect the ‘near-poor’ and the middle class from impoverishing health expenditure, existing government health insurance programs must be expanded. If needed, all sections which are currently not included may be provided with an 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 besides their regular employees. For instance, fast-moving consumer goods (FMCG) companies in India have approximately 150,000 salesmen and distributors who belong to the missing middle segment and can be given health cover in collaboration with the NHA.
Some of these organizations have requested NHA to include their associates under the health cover of ABPM-JAY coverage.
However, NHA is facing a technical challenge of adverse selection in ABPM-JAY.
Adverse selection in health insurance is the imbalance caused by the enrollment of more high-risk, sick policyholders than healthy policyholders.
The imbalance happens as sick people, who require more insurance, purchase more policies than healthy individuals, who need less coverage and may not buy a policy at all.
It is important to note that National Health Policy (2017) has highlighted the need for universal health coverage. Including the missing middle under Ayushman Bharat PM-JAY will be the last link to achieving universal health coverage.
“This must become a social movement as it will help to reduce the chances of adverse selection. This will strengthen the shoulders of the government to achieve the Sustainable Development Goal of Universal Health Coverage,” the official said, adding that NHA is creating an enabling environment for this initiative.
Queries emailed to the health ministry spokesperson on Sunday morning remained unanswered till the press time.