A day after West Bengal withdrew its participation in prime minister's big ticket health insurance scheme, also known as Modicare, the Centre has responded by accusing the state of stating “incorrect facts” and violating the terms of the agreement between the two.
The controversy began after the Mamata Banerjee-ruled state withdrew itself from Pradhan Mantri Jan Arogya Yojana (PMJAY) on January 10. According to the state, the bone of contention was a letter sent to the beneficiaries in West Bengal (as is the case across the country), signed by Prime Minister Narendra Modi and bearing the name of the scheme as PMJAY. This was done without consultation with the state, and without the knowledge of the state officials, Rajiva Sinha, additional chief secretary, state health department, said in his letter to the Union health secretary on January 10.
In the letter, Sinha also stated that according to the terms of the agreement between the two, the name of the state's existing, “successful” health insurance scheme—Swasthyasathi—had to be retained, and the family card with that name would be used for the beneficiaries. The delivery of the letter with the scheme's name as 'PMJAY' violated this understanding between the state and the Centre, and caused “unnecessary confusion” at the state level, the letter said. Since health is a state subject, the Centre was bound to consult with the states before taking such a decision (sending out the letters), Sinha said in his letter.
However, in its response, a copy of which is with THE WEEK, the Centre stated that the letters that were sent directly to people were an “integral”part of the beneficiary identification guidelines, given that Ayushman Bharat was an entitlement based scheme. The letter design followed a “standard template” and was in keeping with the “national character” of the scheme. The response from Dr Indu Bhushan, chief executive officer, National Health Authority (NHA), also states that the terms of the agreement state that the information, education and communication activities had to be done according to the NHA guidelines. Since the letter sent to beneficiaries was part of an activity to generate awareness for the scheme, it was well within the said terms, the Centre argued.
According to the terms of the agreement, the state has to mention the scheme name as 'Ayushman Bharat-Swasthyasaathi' in all the communication activities. However, the state has not done it on their website—the name Ayushman Bharat does not appear on the official site, the NHA letter stated. Also, the state has been providing “incorrect facts” and it was in fact the state that had violated the terms of the agreement, Bhushan said.
For instance, the website said the entire premium for the scheme would be borne by the state government, making no mention of the Centre's contribution (60 per cent), Bhushan pointed out. “With Rashtriya Swasthya Bima Yojana (RSBY)—the national health insurance scheme launched in 2008—too, the smart card issued by the state (West Bengal) mentioned RSBY as a national scheme, with the card being a property of the government of India. Under RSBY too, the state had been contributing 40 per cent of the funds," he said, implying that the state had not objected at that time.
For Ayushman Bharat-Swasthyasaathi scheme, the Centre had already given Rs 175 crore, and the scheme would allow West Bengal to provide Rs 5 lakh health insurance to 1.1 crore poor. This was double the number of families getting benefit under the state-only scheme, Bhushan said. “Withdrawal of the state from PMJAY would discontinue the benefits for more than 1.1 crore poor families,” he said, adding that the state ought to reconsider its decision.
“The scheme (Ayushman Bharat-Swasthyasaathi) was doing reasonably well in West Bengal. However, of late, the state stopped sharing (relevant) data with us,” said Dr Dinesh Arora, deputy CEO, Ayushman Bharat-PMJAY. “We are now waiting for their response,” he said.