Extend health cover to the ‘missing middle’

The National Health Authority plans to extend health insurance coverage under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojna (ABPM-JAY) to gig workers who earn between ₹15,000 and ₹25,000 per month, Mint reported on Monday. This scheme, if operationalised, will be a welcome step because the economy is moving from permanent employer-employee relationships to ondemand employer-employee relationships, and many employees cannot access health coverage since they fall in what the Niti Aayog calls the “missing middle” category, a broad group of 400 million Indians who work in agriculture and nonfarm sectors and are positioned between the deprived poorer sections and the relatively well-off who can access insurance products. The need to cover this category is essential because the nature of their work is often subject to occupational hazards.

Without insurance coverage and a robust public health system that forces them to make out-ofpocket expenditures, even a small health-related incident can impoverish families. An insurance can provide protection against such shocks, which may have inter-generational impacts because households try different coping strategies — reducing food consumption, pulling children out of school, dissaving, borrowing, and selling assets — to offset health-related expenditures.

The increasing cost of quality health care has made insurance imperative. Therefore, along with developing products that target the “missing middle”, the government must also invest in awareness building on insurance products, identify these new customers, and devise a strategy that focuses distinctly on the segment. No one can be left behind when it comes to basic needs such as health and education.