Rs 400 crore unpaid Ayushman Bharat dues: IMA Haryana threatens strike

The Haryana branch of the IMA (Indian Medical Association) has issued an ultimatum to halt services under the Ayushman Bharat Jan Arogya Yojana (AB-PMJAY) from 3 February over non-payment of dues by the central government mission. The possibility directly threatens healthcare access for millions of underprivileged beneficiaries in the state.

“Dues amounting to Rs 400 crore for the last three months are pending. This is in addition to several earlier dues that remain unpaid,” said president of the IMA's Haryana branch, Dr Mahaveer P. Jain, in an interview with CNBC-TV18.

Nearly 600 out of 1,300 hospitals empanelled under the AB-PMJAY scheme in Haryana are private hospitals. If they refuse to admit patients or provide treatment under the Ayushman Bharat initiative unless their pending dues are cleared, a serious disruption in healthcare delivery may be expected.

The worst impacted, as always, would be the patients with the least means to pay their way.

On the other hand, for the hospitals, especially the smaller ones that are operating with tight financial margins, it may be impossible to continue offering services effectively gratis. It is simply an unsustainable situation.

The fallout may already be critical if, as sources indicate, patients are already being turned away even now.

The state's government now must act swiftly to resolve the financial issue and reassure healthcare providers before the deadline hits. This will require quick action.

Ayushman Bharat is a key initiative aimed at achieving Universal Health Coverage (UHC) in India, in line with the National Health Policy 2017. The scheme's primary goal is to provide accessible, affordable and quality healthcare to the most vulnerable populations, especially in rural and underserved areas. The scheme, which covers people with an annual income of less than Rs 2.5 lakh, offers a wide range of services — from routine check-ups to major surgeries.

Particularly in areas where public healthcare infrastructure may be insufficient, these private hospitals are key to making the scheme accessible, especially to those with lower incomes.

However, this state of affairs in one of the foremost 'double-engine' BJP-ruled states does little to bolster the public's trust or the yet-to-be empanelled hospitals — not to mention opposition state governments, such as Delhi or West Bengal, which have already been critical and hammered out alternative healthcare plans.

The overarching issue, then, is why the union government is bent on making the scheme's operation so unnecessarily contentious when even the logistics are still shaky. Northeast Indian states and Kerala have already taken issue with the Centre's insistence since 2023 that the healthcare centres be named 'Arogya Mandirs' — in contexts where a large part of the population is Christian and some have argued this presents a challenge to local religious beliefs, but more importantly, where the name surely shouldn't be any reason to withhold support. After all, the ones most harmed are the citizens and not the recalcitrant state governments...

Left unresolved, this non-payment issue could potentially snowball into not just a healthcare crisis for the underprivileged, but further public discontent — and hand opposition parties a new whip to flay the state and central governments with.

It remains to be seen whether the government will be able to act in time to avoid such an outcome.

Yet the question remains why the central government is so tardy to make good on its promises for the Ayushman Bharat scheme, which was expressly designed to provide accessible and affordable healthcare to especially the economically vulnerable.

Surely there should have been sufficient fund allocations under the Union Budget for a scheme running since 2018?

Meanwhile, the following announcement from the Centre on Republic Day tomtoms the coverage achieved by the scheme: