The BJP manifesto for the ongoing 2024 Lok Sabha elections includes among other things a promise to bring senior citizens aged 70 and above within the ambit of the government’s flagship healthcare programme for the vulnerable sections of the society is welcome. It addresses one of the prime concerns of the ageing population unable to wangle a health cover substantially but it could have been more liberal in its coverage. Launched on the eve of the 2019 general elections, it is supposed to provide health cover for some 50 crore people or 10 crore families to the extent of free hospital treatment upto Rs 5 lakh per annum. There has been some muted criticism of the coverage like including tailors of all hues for example little realising that even among tailors there may be many who are quite well off given the fact that Ayushman Bharat isn’t a freewheeling but a targeted subsidy.
The omission of senior citizens rankled, all the more so in a country where they are looked down upon with disdain by the health insurers as belonging to high-risk category who can be given health cover if at all at only an unconscionable premium vis-à-vis the quantum of the cover. So much so, that relatively well-heeled senior citizens have resigned themselves to self-insurance which consisting in foreswearing health insurance and instead building a health war chest, as it were, to be dipped into during a medical emergency and for routine geriatric treatments like teeth implants, kneecap replacement, cataract surgery etc. that invariably plague senior citizens during the autumn of their lives and which are in severe disfavour with the health insurers.
The BJP has done well albeit belatedly to address their concerns, though grudgingly. Why the 70-year requirement, when one gets the honorific ‘senior’ right at the age of 60 which normally coincides with the hanging up of one’s employment boots? To be sure, longevity in India has been going up steadily and according to the 2021 census it was around 67 years when an average Indian died. But then longevity cannot be left to providence. Geriatric diseases start afflicting seniors much earlier than 70. So, the government hopefully would be a little more liberal and offer Ayushman cover to those who have reached 65 years of age. The BJP manifesto must be hailed though for breaking a new ground. Mercifully, it has not promised Ayushman cover for ‘very senior citizens’ the entry point for which is 80 years as per the income tax law. Be that as it may.
One hopes the new initiative is wholehearted and doesn’t give short shrift to typical geriatric ailments like dental and eye problems. Furthermore, many seniors suffer from high blood pressure and diabetes, warranting swallowing of pills every day to control these life-threatening conditions which are often condescendingly described as lifestyle diseases. As it is, Indian health insurance is hospitalisation-fixated. There is no reason why the senior citizens’ cover in the offing should not pick up chemist bills so long as they are supported and certified by government doctors, say annually. The government trusts hospitals more than it trusts the ubiquitous chemists, on the facile ground that it is easier to wangle a fictitious chemist bill than a fictitious hospital bill. Be that as it may.
As it is, all that is done for senior citizens health is a heightened deduction under section 80D of the Income Tax Act both for the senior citizens themselves and youngsters who pay the health insurance premiums of their senior citizen parents. But that hasn’t even addressed the fringe of the problem. Extending Ayushman Bharat coverage to senior citizens is the first meaningful initiative of any political party. Hope the BJP walks the talk if it is voted back to power. One also hopes that the two escape routes — preexisting diseases and a long catalogue of exclusions — do not render the newly conferred health cover meaningless. Thinning of bones and teeth are old-age markers. Their treatment should not be in the negative list. The wiggle room available for insurers by citing preexisting disease clause is galling for the insured.
Rs 5 lakh cover per annum is nothing to scoff at but it ought not be put in a straitjacket. Suppose the hospital bills come to Rs 6 lakh, the excess over Rs 5 lakh should be reduced from the following year’s quota of Rs 5 lakh, lest at the sunset of one’s life one is constrained to sell the family silver. Of course, there can be fortuitous circumstances like one getting admitted to the hospital on March 15 and getting discharged on April 15, thus becoming eligible for a cover of Rs 10 lakh as hospitalisation fortuitously got spread into two financial years.
The scheme, as it is, caters to a family. In other words, the cover of Rs 5 lakh enures for a family of say five. This in a way penalises larger indigent families. Will the same family as a unit concept apply to senior citizen couples? To wit, if the husband is 75 and wife 72, will both have to make do with an overall cover of Rs 5 lakh per annum or each get a separate cover of Rs 5 lakh each per annum? The devil, as they say, is always in the details.
S Murlidharan is a freelance columnist and writes on economics, business, legal and taxation issues
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