February 24, 2020
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The Gurney Grinds To A Sad Halt

A sharp cut in ESIC payouts denies poor workers treatment of chronic ailments

The Gurney Grinds To A Sad Halt
Sanjay Rawat
The Gurney Grinds To A Sad Halt

Ever since it came to power, the Modi government has been battling the contention that it is pro-business. Now, a more worrying question is being asked: is the government actually anti-poor? For, hardly two months after coming to power, it had passed orders that made workers at the bottom of the pyramid more vulnerable than ever. Sweeping changes to the Employees State Insurance Corporation (ESIC) Act, made through administrative orders passed on July 31 last year, led to dramatic cuts in social security available to workers earning less than Rs 15,000 per month.

Under the insurance scheme—to which both workers and employers contribute—earlier governments provided full medical care to insurees and their families, from the day they entered service, with no ceiling on treatment. The 1948 legislation also provided benefits during exigencies like death, injury, maternity or unemployment.

The July 2014 order—implemented in August 2015 after a year’s moratorium—nullifies the purpose of having insurance. Most damaging are two provisions of the newly introduced Clause 5: the first sets the upper limit at Rs 10 lakh per beneficiary per year; the second says that in case of malignancies or chronic renal failure, pre-existing diseases shall not be eligible for coverage, essentially denying them aid when they need it most.

And the pretext for such changes? Essentially to avoid “potential misuse of the Super Speciality treatment”, acco­rding to the clause. But labour minister Bandaru Dattatreya says the purpose of the change is to ensure that more workers from the unorganised sector are covered under the ESIC scheme. As for misuse, he says not many complaints of that have been received.

“The changes were made so that more workers from unorganised sectors could get insurance arranged by the government.”
Bandaru Dattatreya, Union MoS for Labour & Employment

The new rules have kicked in. Even workers now under ESIC cover find themselves and their dependents denied treatment for renal failure and malignancies. “These orders have no statutory character and are aimed at frustrating the very character of the Act,” says Ashok Agarwal, an advocate at the Delhi High Court. “There is no provision in the 1948 Act that states that the benefits given to patients can be curtailed under certain clauses.”

It’s not as if the ESIC is hard up. The new provisos have been created while no more than a third (Rs 15,000 crore) of the funds with ESIC (Rs 45,000 crore) have so far been disbursed for medical coverage of beneficiaries. What’s more, the ESIC covers a small proportion of India’s workforce: the large majority is actually outside its ambit. Officials in the labour ministry admit there’s no paucity of funds and that ESIC hospitals should be able to deliver “AIIMS-like” treatment. “Yet there’s much to improve,” admits one official. “Most patients still come here owing to lack of other options.”

Protests against the new rules have started in Andhra Pradesh, Karnataka and other places. Unions call the changes inhuman, and directly hitting the poor. “The government has introduced these rules at a time when even private insurance companies are easing conditions for patients who genuinely cannot afford treatment. With no other means to continue the treatment, they are asking us to simply sit back and wait for death,” says 27-year-old Mandeep, a driver at a school. His widowed mother, Inderjeet Kaur (63), an ESI beneficiary, was undergoing dialysis after both her kidneys failed in 2012. She had been eligible for the insurance since 2010, but doctors have refused to perform the procedure as her disease has existed, albeit in a milder form, since 2008.

Sudden cut The orders (above) cutting out treatment for long-term diseases

“We started the dialysis as soon as doctors at the ESIC hospital asked us to. We’d been paying premiums for two years. I don’t know why we are being punished?” asks Mandeep. He earns Rs 8,000 a month, and dialysis was twice a week, at at least Rs 3,500 per session.

“You can’t compare the ESI scheme with other financial products. Its purpose: to uphold for the poor their right to life.”
Ashok Agarwal, Advocate, legal activist

Contacted by Outlook, the minister said that patients who have already been undergoing treatment would not be denied; written orders had already been sent out to ESIC hospitals. But the fact is, treatment has indeed stopped. It also implies that workers joining the ESIC scheme cannot get treatment for certain existing ailments for themselves and their dependents. This will include the huge masses of unorganised sector workers who are set to join the scheme.

Since the recent implementation of the order, Agarwal has successfully taken up at least a dozen cases of ESIC card-holders who have been denied treatment. In most cases, the Delhi High Court has stopped the organisation from denying treatment, saying this is unjust and ordering the government to bear all treatment costs.

Mohammed Kalim had petitioned the Delhi High Court after the ESIC refused to reimburse him for liver transplants for his children Arbas and Shahnawaz, aged 11 and nine years, both requiring the transplant owing to a genetic disorder. The ESI asked for reports of both children from the Institute of Liver and Biliary Sciences (ILBS), with an estimate of the treatment cost. The institute recommended liver transplants for both, at a cost of Rs 11.5 lakh each, but the ESIC refused to undertake the costs. “I have been contributing to the scheme since 2008 and my children were detected with the disease only in 2011. But since they were born before I had the card, they refused treatment,” says Kalim, a cook in a Delhi restaurant earning less than Rs 9,000 per month. The high court, however, took serious notice of the matter and ordered that the government should bear the entire cost of treating both children. One has already undergone the transplant; the younger one is expected to undergo the procedure soon.

While treatment continues at ESIC hospitals for a handful of patients who have moved court, a vast majority are being denied treatment. “The ESI cannot be compared to other financial products of the government such as pension. Its very purpose is to ensure that the poor are ensured the right to life, guaranteed by the Constitution,” says Agarwal. “More people should come up and fight for their rights by filing cases against the ESIC until the order is repealed.”

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