Unlimited medical perks for MLAs? The ₹38 crore question facing Kerala government

Kerala’s second Pinarayi government spent Rs 8.42 crore on the medical treatment for sitting MLAs and their dependants. In the last five years between April 1, 2021, and April 30, 2026, the government also spent Rs 30.23 crore on the medical treatment for former MLAs and their dependents.

These details were disclosed in response to an RTI application filed by activist Raju Vazhakkala. As of March 31, 2026, 310 sitting and former MLAs were alive in the state.

“During the previous government's tenure, it had also emerged that more than ₹2.5 crore was spent on the medical treatment of 27 individuals, including the Chief Minister, ministers, the Leader of the Opposition, and others who held Cabinet rank. All these expenses were met from public tax revenues,” noted Vazhakkala. “Currently, MLAs and former MLAs are entitled to reimbursement of medical expenses without any prescribed upper limit.”

The Kerala Legislative Assembly (Medical Facilities) Rules, 1994, entitle MLAs and their dependants to free treatment in government hospitals and full reimbursement of medical expenses. They are also eligible for treatment in private hospitals at government expense, while treatment outside Kerala is covered if certified as medically necessary by an authorised medical authority. The rules also permit treatment abroad for an MLA or spouse, subject to medical certification and the Speaker's approval.

Economist and social observer Jose Sebastian argues that the scheme needs an overhaul. "There should be a limit on this. Frankly, there is no justification for spending public money in this manner," he says. "Instead of unlimited reimbursement, there should be a cap on how much the government can spend on an individual's treatment each year. Just as we expect integrity from public representatives, society should also begin discussing whether physical fitness ought to be an important consideration for those seeking public office."

Pointing out that even millionaire politicians receive substantial medical reimbursements, Sebastian says the government should also place a statutory cap on the total expenditure incurred on ministers, including such benefits, as a proportion of its annual revenue. "Once such limits are legally enforced, governments will not spend indiscriminately. If the expenditure exceeds the prescribed limit, the individual concerned should bear the excess from their own pocket. After all, these people are not poor. Most of them pay income tax and possess substantial personal assets. Why should they alone enjoy a level of protection that an ordinary citizen does not receive?" he asks.

Economist and former chairperson of Kerala Public Expenditure Review Committee, Mary George, argues that MLAs and ministers should be brought under a health insurance scheme instead of enjoying an open-ended reimbursement system. "Kerala already has MediSep and other health insurance programmes, so there is little justification for a separate reimbursement mechanism for elected representatives," she says.

She argues that the expenditure is particularly difficult to justify at a time when Kerala's public healthcare system continues to face severe financial strain. "In recent years, hospitals empanelled under the Karunya Arogya Suraksha Padhathi (KASP) have repeatedly complained of delayed reimbursements, with some even threatening to withdraw from the scheme. The Kerala Medical Services Corporation has also struggled to clear suppliers' dues, while government hospitals have grappled with infrastructure failures and shortages of basic surgical equipment. Yet, at the same time, the government has been spending crores on generous medical benefits for elected representatives and their dependants," she says.

Despite its impressive health indicators, Kerala has one of the highest levels of out-of-pocket healthcare spending in India, driven by its heavy reliance on private healthcare, an ageing population with a high disease burden, and the high cost of hospitalisation.

Pramod Kumar, former senior policy adviser with UNDP Asia-Pacific, argues that the debate should not be about creating yet another insurance scheme but about implementing universal health coverage (UHC). "Ahead of the 12th Five-Year Plan, the Planning Commission under Prime Minister Manmohan Singh constituted a High-Level Expert Group headed by Dr K. Srinath Reddy. Its recommendation was unambiguous: India should pursue universal health coverage, not an insurance-based model," he says.

Kumar contends that insurance primarily benefits private providers, whereas UHC requires strengthening the public health system so that it becomes the first point of care for everyone. "Government hospitals should be equipped and expanded to provide almost all treatments. Only highly specialised procedures that cannot be performed in the public system should be referred to private hospitals. If government hospitals are considered good enough for ordinary citizens, they should also be good enough for MLAs and their dependents. If elected representatives still choose private or overseas treatment, they should bear the cost themselves. After all, they are not people without income," he says.