WHAT do you call it when lawmakers do not understand and violate the law they wrote?
For lack of a better word, let’s call it moronic. Maybe, hare-brained. That is just what all this fuss over supposed “subsidy” to the Philippine Health Insurance Corporation (PhilHealth). Mind you, this extends even to the officials of the Executive Branch—the Department of Finance and Department of Health, for one, and the officials of PhilHealth no less who don’t seem to have an iota of understanding of the PhilHealth law and the Universal Health Care Act (RA11223).
Let’s begin with the basics.
Why do they keep calling the money that the national government appropriates for PhilHealth a subsidy? It is not.
It is payment for the premium contributions of PhilHealth members classified as “indirect contributors,” which RA 11223 defines “as all others not included as direct contributors, as well as their qualified dependents, whose premium shall be subsidized by the national government including those who are subsidized as a result of special laws.” Special laws include the Senior Citizens Law.
The law says the national government shall subsidize the premiums, not PhilHealth. Therefore, it is the national government’s payment for the premiums. It is no different from the premium share of any private employer or any government agency, instrumentality, or GOCC that has employees.
Let’s say the Department of Finance does not include in its annual budget its employer share of the PhilHealth premiums of all its employees. Will that not be a violation of RA 11223, and will the honorable members of Congress raise a howl or not against it?
So, because our legislators have only a moronic understanding of the same laws that they wrote, they gave PhilHealth zero funding in the national budget for 2025.
But by refusing to appropriate funds for the premiums of indirect contributors (10 million or so senior citizens plus 40 million or so indigent individuals and their dependents), Congress is violating RA11223.
Section 10 of RA 11223 states in part: “That for indirect contributors, premium subsidy shall be gradually adjusted and included annually in the General Appropriations Act (GAA): Provided, further, That the funds shall be released to PhilHealth: Provided, furthermore; That the DOH, in coordination with PhilHealth, may request Congress to appropriate supplemental funding to meet targeted milestones of this Act: Provided, finally, That for every increase in the rate of contribution of direct contributors and premium subsidy of indirect contributors, PhilHealth shall provide for a corresponding increase in benefits.”
Senators and representatives commanded themselves to adjust and include the premium subsidy every year in the GAA. Nowhere does the law say that they can wipe it out in one fell swoop.
Let me put it in clearer terms: Inutusan nila ang sarili nila na ilagay sa GAA ang bayad sa PhilHealth premiums ng mga indirect contriubutors, pero ayaw nilang sundin and utos nila sa kanilang sarili.
Senate President Francis Escudero and Sen. Grace Poe pointed to PhilHealth’s PhP600-billion reserve as the reason for the “zero subsidy.”
Said Poe: “Sa ngayon, ang PhilHealth ay hindi nabigyan ng budget sapagka’t kailangan nilang gamitin muna ‘yung kanilang reserve funds.”
Escudero even tied the reserve funds to what he calls PhilHealth’s “absorptive capacity,” obviously liking PhilHealth to an agency that has a budget for, say infrastructure, but fails to carry out the project and is then deemed to have low absorptive capacity.
Absorptive capacity does not apply to PhilHealth because it is a social security fund and its operations are governed primarily by actuarial rules and regulations.
And Sen. Poe, the reserve funds cannot be used or spent by PhilHealth. That’s why they’re called reserve funds.
Section 11 of RA 11223 says: PhilHealth shall set aside a portion of its accumulated revenues not needed to meet the cost of the current year’s expenditures as reserve funds: Provided, That the total amount of reserves shall not exceed a ceiling equivalent to the amount actuarially estimated for two (2) years’ projected Program expenditures: Provided, further, That whenever actual reserves exceed the required ceiling at the end of the fiscal year, the excess of the PhilHealth reserve fund shall be used to increase the Program’s benefits and to decrease the amount of members’ contributions.
Clear? The reserves are intended to meet actuarially estimated future obligations of up to two years of current needs. So PhilHealth cannot spend the funds without violating the law. And Poe is telling PhilHealth to violate the law.
Only the amounts over the ceiling determined by actuarial standards may be used to increase benefits. And any unused portion shall be invested, not spent.
In reality, Congress is not denying PhilHealth subsidy. It is denying nearly half the population access to health care. Because these honorable lawmakers refuse to allocate funds for their premiums.
And why would they do that? Because they’d rather that these people go to their district offices to ask for medical assistance instead of simply showing their PhilHealth card to a doctor, hospital or pharmacy.
They want these people indebted to them for life so they’d vote for them every election—in exchange for 12 tablets of paracetamol.
