If the Delhi government is staying away from Ayushman Bharat, someone forgot to tell Parveen Shah. “My parents have asked me to find out more about the scheme,” says the 34-year-old migrant worker, who does household work at apartments in Mumbai suburbs. She is just another member of India’s millions of people trying to find her way in a country of 133.92 crores, but her story gets to the conundrum faced by policymakers attempting to implement a policy in the world’s seventh largest economy.

PM has been writing personal letters to beneficiaries like Parveen allegedly at the cost of Rs 400 crore.

A Big Promise?

Without a doubt, Ayushman Bharat is one of the most significant healthcare projects of the Modi government, and many private players have bet big on the scheme to connect to more patients.

Interestingly, one of the most prominent topics discussed on social media even before the budget was the health of Finance Minister Arun Jaitley. He left for the United States before the crucial budget session. Despite concerns about his health, sources maintained that he had gone for a regular health checkup. So it was interim Finance Minister Piyush Goyal, who launched the brahmastra. The Budget saw the Centre increase funds for Ayushman Bharat to Rs 6,400 crore (US$895.6 million). This marks an increase of four crore rupees from last year’s budget for the scheme – and a 167 per cent rise in the allocation.

Add to that, Rs 156 crore from the Rashtriya Swasthya Bima Yojana (RSBY), a health insurance scheme implemented by the Manmohan Singh government ten years ago. Ayushman Bharat is expected to replace RSBY.

Signs of Stress

However, even with the 167 per cent increase in mind, the funding for Modicare will potentially fall short of the necessary budget needed to implement the scheme entirely. A source quoted in The Economic Times said Rs 7,400 crore would be the budget required for Modicare for the upcoming fiscal year – short of what the Centre has allocated. Rs 10,000 crore may be needed the year after.

How Ayushman Bharat got a silent boost in the budget

Bright Spots

The budget speech was, in fact, the longest budget speech on the record because a good part of highlighted the achievements of the government and its vision for the next ten years. In the run-up to the elections, most of the details about the scheme can be found in the speeches of ministers. Union Minister Ashwini Kumar Choubey pointed out at the 6th meeting of the National Health Mission Steering Group that around 8,000 health and wellness centres have become operational in 35 states and union territories under the government’s flagship Ayushman Bharat scheme. Also, the health ministry has high goals. It has set a target to transform nearly 1.5 lakh primary health centres and sub-centres as health and wellness centres by 2022 to provide comprehensive and quality primary care close to the community.

PMJAY app launched

Another significant development was the launch of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) mobile app, which was downloaded more than 10,460 times during its testing phase in the last few days. The app, offers users easy access to information on the scheme, besides allowing them to check eligibility, find hospitals nearby, and receive help. The app is available on Google Play Store for Android users. It was introduced four months ago along with the scheme and has an average rating of 4.6.

Uber, Swiggy, Zomato, Oyo to tie up with Ayushman Bharat

Equally impressive were the tie-ups of government with private companies like Uber, Swiggy, Zomato and Oyo.The government body entrusted with the implementation of the national health protection scheme – Ayushman Bharat is partnering with cab-hailing company Uber to promote it along with reaching out to the 5 lakh Uber drivers, many of whom are eligible for the scheme but haven’t received their golden cards meant for such beneficiaries of the programme, The Indian Express reported. NHA is also looking to tie up with other such businesses including Swiggy, Zomato, Airbnb and Oyo to publicise Ayushman Bharat and have access to their staff — the delivery boys and the cleaning staff.

Amit Shah vs Naveen Patnaik

Keeping hype aside, implementing the scheme will be a massive task for the government. The developments of this month reflect this reality. The most important one is BJP chief, Amit Shah’s comment on Naveen Patnaik for not implementing schemes by the central government. "If you want, you can remove our names from the scheme but why are you troubling the poor people of Odisha?" he said. He further said that the Odisha CM had not implemented the Ayushman Bharat Yojana in the state as he fears that it will increase PM Modi's popularity,” said Shah at the valedictory session of the national convention of the BJP's ST Morcha.

Meanwhile, Deccan Herald reported that Chief Minister H D Kumaraswamy said that the Union government had presented a ‘Dhoka’ (deceptive) budget and the state government is thinking of re-introducing the Yeshasvini health scheme.“While the state has earmarked Rs 700 crore for the health sector, the Centre has provided only Rs 200 crore under Ayushman Bharat. Following the health schemes by the Union government, the state had removed schemes, like Yeshasvini. Now, the state government is thinking to reintroduce Yashasvini for secondary treatment. It will be announced in the upcoming budget,” Kumaraswamy said.

Roll out fraught with delays in some states

While Meghalaya and Puducherry had signed the MoU way back in June, Kerala and Punjab had signed the MoU in end-October. Rajasthan, which had approved the MoU in October, is yet to start the roll-out. Though West Bengal has decided to opt out, it may not be easy as the Centre has paid up to ₹175 crore to the State for the scheme. Chief Minister Mamta Banerjee had declared that the State wants to withdraw from the plan.

Finance Minister, Thomas Isaac came out against the scheme. "Even before the state decided on the modalities of implementing the scheme in the state, the centre has directly started selecting beneficiaries of the scheme from the state,” he said. “They have started sending letters to the beneficiaries in the state through Speed Post. The cards are being sent by Ayushman Bharat Directorate, saying that you have been selected as a beneficiary under the scheme, which is shameful. The state has reached an agreement with the centre to launch the scheme only from April 1st here. Then how can the Centre directly select a beneficiary without the consent of the state,” Isaac said his Facebook post.

During his speech at the BJP National Council meeting held in Delhi in January, Amit Shah said the 2019 elections would be like the battle of Panipat. By the look of things, Panipat will be the Indian healthcare sector.

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