Last week the Union cabinet signed off on Ayushman Bharat National Health Protection Mission (AB-NHPM), the ambitious social welfare programme announced in the Union budget for 2018-19. It set the stage for the rollout of the scheme that has come to be dubbed “Modicare" (like the medical plan for the poorest in the US came to be called Obamacare) and is estimated to cost anywhere upwards of Rs12,000 crore annually. At the minimum, this scheme aims to provide healthcare to 500 million poor and vulnerable people by funding their secondary and tertiary healthcare costs—for beneficiaries it will be a cashless and paperless transaction.
Undoubtedly this is the most ambitious social welfare programme being attempted by the Prime Minister Narendra Modi-led National Democratic Alliance (NDA). It is something that is long overdue—to be sure, versions of it already exist at the state level and even the Union government—and one that the Union government can’t afford to botch up in implementation.
Given that nearly one in two Indians (including the neo-middle class) are just one illness away from slipping into poverty—a problem that has become more acute with the rapid spread of non-communicable diseases (NCDs) like cancer across demographic groups—such a programme is a necessity not an option. The national health atlas, the first of its kind, released earlier this year in a frightening revelation showed a structural shift in the disease burden: six out of 10 Indians now die due to non-communicable diseases (NCDs), even while child and maternal malnutrition continue to cause premature deaths killing an estimated six million children before they are five years old, and tuberculosis continues to be a threat. Addressing the health risks therefore is a precondition for this segment of the population to realize their aspirations in a rapidly transforming India.
Like the rural employment programme, or the Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS), put in place by the Congress-led United Progressive Alliance (UPA), this too is an entitlement programme—probably the first on this scale from the NDA, which has so far preferred empowerment over entitlement by providing an ecosystem that allows for a level playing field. Seen this way it also signals a recalibration of the NDA’s thinking on development policy; but together they strengthen the social safety net for rural India.
However, it also raises the political stakes for Modi, given that there is little over a year to go for the 2019 general election and there are key state elections due later in the year. There are legitimate concerns on the ability of the NDA to successfully rollout a scheme so large in scope in this period without being overwhelmed by the rigours of the election cycle. Their track record in implementing ambitious programmes, like it happened with the demonetisation of high value currency notes in 2016, only creates more doubts. (To be fair though, they are handicapped by a broken and severely compromised public service delivery system.)
Especially since this the new health initiative is designed in a very complex manner (like the other big idea floated in the budget: extending minimum support price to all crops), is staggering in scale and entails active participation from the states. The fact that the BJP is in power in 21 states should ensure that petty political rivalries in opposition-ruled states do not bury the programme (and the flip side is that the BJP has very few excuses to justify a flop show).
On the other hand, if the NDA is successful in implementing the programme then the BJP is bound to reap political dividends. The launch of Ujjwala, the programme to universalize cooking gas, electricity and housing for all and Swachh Bharat Mission, or clean India campaign, have already enabled the BJP to make deep inroads into the traditional vote bank of the Congress: the poor. A successful rollout of Modicare will only accelerate this creeping acquisition of the Congress vote base.
It is clear then that while indeed Modicare is a social cause, the associated political stakes too are equally compelling.
Anil Padmanabhan is executive editor of Mint and writes every week on the intersection of politics and economics.
His Twitter handle is @capitalcalculus. Respond to this column at email@example.com.