Budget 2018’s biggest bonanza was an ambitious health care project that the Modi government announced for the poor. The launch of the National Protection Health Scheme was quick to draw the attention and immediately being compared to former US President Barack Obama’s Patient Protection and Affordable Care - also known as Obamacare - which promised affordable health coverage to all Americans. But how similar are these two healthcare missions of the two of the world's biggest democracies?
Even though it might be too early to launch forth into comparisons before waiting for some more clarity to emerge on the architecture of the Ayushman Bharat scheme, some obvious similarities and differences are clearly seen.
Initial estimates have pegged the cost of the project at Rs 4,000 crore and targeted to cover 10 crore households. It is going to be a Centre-state joint participation where the Centre has confirmed to cough up Rs 2,0000 crore and is hoping that the states will supplement the rest. The whole scheme is open to scaling up if and when the government decides to turn the programme into a universal healthcare scheme with benefits given to all citizens in the country. According to some in the know, the government plans to eventually do turn the programme to universal healthcare and aim to cover all the 24.49 crore households in India in the next three years. In 2010, Obama had pegged the whole cost at $ 940 billion over 10 years but two years later the Congressional Budget Office came out with an estimated cost of $1.76 trillion.
While Obamacare was also largely aimed at the poor, it also benefited middle-class Americans, but Modicare is specifically targeted at India's poor for the time. Obamacare made it mandatory for every citizen to buy insurance cover and offered government subsidy on the premiums. There have been criticisms over the recent increase in premiums and continuous debate over whether it should be scrapped, including President Trump's efforts to repeal the Act.
In sheer numbers the scheme is likely to cover, Modicare is going to cover a much larger population compared to Obamacare. A total of 10 crore families have been identified on the basis of the lowest earning 10 crore poor, BPL and APL families as per the Socio-Economic & Caste Census of 2011 to be brought under the cover of Modicare. In fact, Finance Minister Arun Jaitley in his budget speech announced that 50 crore people were to ultimately benefit from the scheme. However, Obamacare till 2016 had brought around 2 crore 40 lakh citizens under the insurance protection scheme.
In India, the government is going to invite bids from the insurance companies to cover these 10 crore families. These insurance companies, in turn, will tie up with healthcare chains where the insured will be treated. The poor will not be expected to pay for the insurance as the government has promised to provide a cover of up to Rs 5 lakh per family for secondary and tertiary care hospitalisation.
Compared to the Rs 5 lakh limit under Modicare, there are no such limits or cap under Obamacare for essential health benefits. The US government pays a subsidy in the premium to those whose income fall between the 100-4—per cent poverty line. The US Affordable Care Act also ensures that in case of chronic illness, policyholders get health cover even if they have run out of coverage.
As far as spending on health care is concerned there is no comparison between the US and India by miles. The United States spends around 18 per cent of its GDP on healthcare, India’s public health budget is currently 1.15 per cent of GDP and it hopes to raise to 2.5 per cent of GDP by 2025. Surely a long way to go to come anywhere near the Obamacare’s huge outreach.