West Bengal recently announced its withdrawal from Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY).

Why has West Bengal exited?

• Beneficiaries of the Centre's Ayushman Bharat insurance programme have been sent a two-page customised letter from the prime minister outlining the importance and benefits of the project.
• The government also planned to send similar letters to 10.74 crore beneficiary families across the country.
• The letter mentions that the beneficiary family can avail the scheme in hospitals in their area and health facilities empanelled under the scheme across the country.
• Since the letter sent to beneficiaries has photos of Prime Minister, the state contended that as over branding.
• The West Bengal government feels that given the 60:40 partnership in the scheme, the state government should get similar space on documents.
• Also there is a problem with name of the scheme itself, wherein the West Bengal government chose to call the scheme Jan Arogya Yojana rather than Pradhan Mantri Jan Arogya Yojana.
• The MoU of JAY signed between Government of West Bengal and Government of India clearly stipulated that since West Bengal already had a well-established scheme Swasthyasathi, the state government would like to retain the name Swasthyasathi in the scheme.
• But the entitlement letter/card issued by the central Ministry mentions the name of the scheme as PMJAY.
• The state contended that as not only a violation of the stipulations of the said MoU but has created confusion at the grassroots level.

What are the consequences?

• West Bengal’s Swasthyasathi scheme was launched in 2016.
• It provides a basic health cover for secondary and tertiary care up to Rs 5 lakh per annum per family, the same as PMJAY.
• So far, around 1 crore people have been enrolled under the central scheme in West Bengal while the state scheme already had 40 lakh beneficiaries.
• For PMJAY, the pullout is a setback because it affects the national portability of the scheme.
• Kolkata serves as the preferred destination for many people from the Northeast and from states such as Bihar for healthcare.
• Thus, officials fear it could impact more people than just the beneficiaries in West Bengal.

Why have three other states stayed out?

• Along with West Bengal, other states like Delhi, Telangana and Odisha have also stayed out of the programme. 
• Odisha announced the launch of Biju Swasthya Kalyan Yojana (BSKY), about 40 days before the launch of PMJAY in September 2018.
• BSKY will give an insurance cover up to Rs 5 lakh per eligible family and Rs 7 lakh for treatment of female members.
• The state also lists other state schemes such as Niramaya (free medicines), Nidan (free diagnostics), and Sahay (dialysis and chemotherapy in all districts) to every beneficiary family.
• Delhi, like West Bengal, has an issue with the name of the central scheme and has also raised this with the implementing agency - National Health Agency.
• Delhi wanted the name of the scheme as Mukhya Mantri Aam Aadmi Swasthya Bima Yojana Ayushman Bharat for implementation in the union territory.
• However, the NHA responded that, since this is a national scheme with national character, it’s critical that the name of the scheme starts with AYUSHMAN BHARAT.
• It also added that this will also help in operationalising portability and easy identification of beneficiaries.
• Since either sides failed to lower its taken stand, NHA has started empanelling Delhi hospitals on its own rather than through the State Health Agency as has been done in all other states.
• Telangana has one of the oldest functioning tertiary care health schemes in the country.
• The Arogyashri scheme provides financial protection to families living below the poverty line up to Rs 2 lakh in a year.
• Altogether 949 treatments are covered, including treatment of serious ailments that requires hospitalisation and surgery.
• According to a 2017-18 report, there are 77.19 lakh beneficiary cards with 330 empanelled hospitals.
• Thus, the state has so far not enrolled itself into the Ayushman Bharat programme.

What is the stand of the centre in this issue?

• It says that Ayushman Bharat family letter is neither a beneficiary card nor an entitlement card.
• The said letter is only one of the modes of spreading awareness among eligible families.
• The distribution of the letter is an integral part of the beneficiary identification guidelines, given that Ayushman Bharat is an entitlement based scheme.
• Hence, the centre urges West Bengal to reconsider its position and to co-operate in the implementation of the scheme.