Comparative Analysis of Ayushmaan Bharat Scheme (PMJAY) and Patient Protection and Affordable Care Act of USA
Written By:-Sreshta Satpathy
What is Ayushmaan Bharat Scheme (PMJAY)?
The healthcare sector in India has grown at a rate of life’s uncertainties. Over the last three decades, there has been an increase in the demand for health insurance coverage. The Indian government is committed to delivering improved healthcare services to its inhabitants in order to combat medical emergencies. The government of India has created the Pradhan Mantri Jan Arogya Yojana (PMJAY), which Prime Minister Modi announced from the Red Fort’s ramparts. This initiative incorporates the government’s flagship Ayushman Bharat Yojana, which provides financial assistance to the poor in the event of an unanticipated medical emergency.
Ayushman Bharat Yojana, considered one of the world’s largest healthcare plans, promises to cover more than 50 crore Indian citizens. It is aimed mostly at the country’s economically disadvantaged areas. The PMJAY was launched in September 2018 and offers health insurance coverage up to Rs.5 lakh in the maximum sum insured amount. If correctly implemented, the system might improve access to health care, particularly early detection and treatment services, for a huge segment of the population who would otherwise be unable to purchase them. The government-sponsored health insurance policy will provide free coverage of up to Rs 5 lakh per family per year for secondary and tertiary medical care at any government or even impaneled private institutions across India.
What is the Patient Protection and Affordable Care Act of the USA?
In the United States, the Patient Protection and Affordable Care Act (PPACA), often known as the Affordable Care Act (ACA) or Obamacare, is a healthcare reform bill signed into law by President Barack Obama in March 2010. It featured clauses requiring most people to have health insurance or face fines, as well as provisions that made coverage easier and less expensive to obtain, cracked down on abusive insurance practices, and aimed to rein in soaring healthcare costs. It was signed on March 23, 2010. It was largely regarded as the most comprehensive healthcare reform bill since the enactment of Medicare, the federal government’s health-insurance program for the elderly, in 1965.
The Act establishes the basic legal protections that have been missing until now: a near-universal guarantee of access to affordable health insurance coverage from birth to retirement, through a series of extensions and revisions to the multiple laws that make up the federal legal framework for the US health-care system. The Act aims to reduce the number of people without health insurance in the United States by more than half. The bill will cover roughly 94 percent of the American population, lowering the number of uninsured by 31 million individuals and increasing Medicaid enrolment by 15 million people.
Under Modi’s leadership, the government would invite insurance companies to submit bids to cover these 10 crore families. These insurance companies will form partnerships with healthcare organizations to provide treatment to the covered. It is a pledge of this scheme to provide a cover of up to Rs 5 lakh per family for secondary and tertiary care hospitalization. The United States government pays a premium subsidy to those whose income is between 100 and 400 percent of the Federal Poverty Line under the PPACA Act. In contrast to PMJAY’s Rs 5 lakh ceiling, there is no such limit or cap in Obamacare for critical health benefits.
The US Affordable Care Act also ensures that policyholders get health care even if they have run out of coverage in the event of a chronic condition. PMJAY is an Indian government program that focuses on the disadvantaged. PPACA is aimed not only at the poor but also at the middle class. More than 10 million underprivileged households will benefit from “PMJAY,” which will provide them with a health insurance plan worth Rs 5 lakhs per year that would include free hospitalization and medical treatment.
Under PPACA, every person in the United States was required to get health insurance, with the government subsidizing those who could not pay the premiums. PMJAY is restricted to a maximum of Rs 5 lakhs per family each year. There are no such restrictions in PPACA. In comparison to PPACA, PMJAY covers a significantly wider population. It is the world’s largest health insurance program. The ‘Individual Mandate,’ under which the government raised money by penalizing residents who did not have health insurance, was a contentious part of Obamacare. PMJAY does not have this issue. Both plans use the insurance mechanism to offer healthcare to low-income families and individuals. Every American citizen is required to purchase health insurance under Obamacare. Premiums will be subsidized by the government for individuals who cannot afford them. PMJAY, on the other hand, is absolutely free.
While the concept of universal healthcare is appealing, it takes considerable consideration and policy know-how to implement. A persistent and visionary approach that is tailored to the Indian health mindset and societal systems is required. Both PMJAY and PPACA use a private sector insurance-based model for public healthcare, but PMJAY appears to be significantly more efficient in terms of per capita government costs, and the number of beneficiaries exceeds the US population. However, PPACA outperforms PMJAY in one area: it provides unlimited benefits, whereas PMJAY has a ceiling of Rs 5 lakh.
PMJAY provides easier access and takes no premium from beneficiaries while Obamacare makes it compulsory for people to pay for access to universal healthcare. It will not be very wise to actually declare one of these schemes as a clear winner. Both have their own advantages as well as disadvantages and both of these are looked upon from the perspective of their respective countries. However since Obamacare has been an older scheme in this context, it’s also critical to draw lessons from other models, such as PPACA, in order to prevent errors and improve our approach. PMJAY would be improved as a result of this.
Ayushmaan Bharat Scheme, Patient Protection, PMJAY, Comparative Analysis of Ayushmaan Bharat Scheme