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| Can Ayushman Bharat for All Be the Stepping Milestone Towards Viksit Bharat? | | | Dr Manorama Bakshi and Dr Arjun Kumar
At the historic joint inauguration of Bharat Innovates 2026 in Nice, France, Prime Minister Narendra Modi delivered a resonant address that captured the global innovation spotlight. Speaking alongside French President Emmanuel Macron under the aegis of the India-France Year of Innovation, the Prime Minister declared a profound paradigm for India’s technological rise: “Today, the world is looking towards technologies that are trusted, inclusive, human-centric, and dedicated to the global good. At such a time, India’s priority is clear, Technology for Humanity and Human-Centric Innovation.”
Crucially, the Prime Minister tied this philosophy to India’s healthcare achievements over the past twelve years, celebrating the collective journey to ensure that quality care becomes a benchmark for affordability and accessibility. “We feel proud,” he remarked, “when we are known as the nation with the world’s largest healthcare programme, Ayushman Bharat, which provides top-quality healthcare to the most vulnerable.” French President Macron reinforced this momentum, observing that “The question is no longer if India innovates, but who will innovate with India.”
India’s exceptional global performance demonstrates that its digital and technological architecture can compete with advanced Western frameworks. Yet this achievement sharpens a critical domestic imperative: our socio-economic security must match our geopolitical prestige. As underscored during recent IMPRI #WebPolicyTalk deliberations on Universal Health Coverage (UHC), a nation’s true development index is measured by the well-being of its people. Transitioning to a comprehensive and inclusive safety net is essential to honor the United Nations Sustainable Development Goals’ pledge to “Leave No One Behind.” SDG 3.8 specifically calls for universal access to quality healthcare services and financial risk protection for all citizens.
The 90-Crore ABDM Landmark: A Monumental Foundation for Connected Care
The technical rails enabling this transformation are anchored in the Ayushman Bharat Digital Mission (ABDM). In a historic development for India’s Digital Public Infrastructure (DPI), the mission has crossed 90 crore active Ayushman Bharat Health Accounts (ABHA). Inspired by the success of the CoWIN platform during the COVID-19 pandemic, ABDM has demonstrated India’s ability to scale secure, nationwide health-tech systems under immense pressure.
ABDM has expanded from 14.7 crore registrations in 2021 to over 90 crore today. Women constitute 49.75% of all ABHA holders, highlighting strong gender inclusion and the growing reach of digital health infrastructure.
However, this achievement reveals an operational paradox. While 90 crore digital health IDs represent a global benchmark, many citizens continue to confuse ABDM registration with actual health insurance coverage under PM-JAY. For most users, the account remains largely administrative. The next stage must therefore move beyond registration toward active clinical utility through seamless medical data portability, digital prescriptions, and integrated care across hospitals, private providers, and Jan Aushadhi centres, transforming digital infrastructure into an instrument of daily care.
The Decentralized Ecosystem: Comprehensive Interventions over the Last 12 Years
As highlighted by Union Health Minister J.P. Nadda, India’s healthcare approach has evolved beyond a reactive and curative model into a broader framework encompassing preventive, promotive, rehabilitative, and palliative care. At the foundation of this framework are more than 1.86 lakh Ayushman Arogya Mandirs providing diagnostics, immunization services, tele-consultations, and preventive screening. Their focus on early intervention has enabled screenings of 35.3 crore individuals for oral cancer, 16.5 crore women for breast cancer, and over 8.7 crore women for cervical cancer.
Simultaneously, India has undertaken a major expansion of tertiary healthcare and medical education. The number of AIIMS institutions has increased from 8 in 2014 to 23, while medical colleges have grown from 387 to over 820. Undergraduate medical seats now exceed 1.28 lakh and postgraduate seats 86,000, strengthening the healthcare workforce for the future.
Financial protection remains the backbone of this ecosystem. AB-PMJAY has generated more than 44.14 crore Ayushman Cards, covers nearly 12 crore vulnerable families, and has authorized over 12.03 crore hospitalizations worth ₹1.80 lakh crore through a network of 36,218 empanelled hospitals. Complementing this framework, ABDM is creating portable digital health records, PM-ABHIM has committed ₹64,180 crore toward strengthening healthcare infrastructure, and the Jan Aushadhi network of over 14,000 centres continues to reduce out-of-pocket expenditure through affordable generic medicines.
The Missing Middle: The Core Policy Blind Spot
Despite generous budgets, the scheme faces persistent structural bottlenecks. The most glaring gap is the crisis of the “Missing Middle” comprising nearly 40 to 50 crore citizens, including self-employed individuals, informal sector workers, agricultural laborers, and lower-middle-class professionals. They earn too much to qualify under traditional Socio-Economic Caste Census (SECC) criteria or ration card lists, yet lack the financial capacity to afford rising private health insurance premiums.
Real-world utilization is further constrained by documentation hurdles, limited awareness of benefit packages, transport challenges in semi-rural areas, and instances where private healthcare providers hesitate to participate fully due to delayed reimbursements or fixed pricing structures. When medical emergencies strike, this cohort remains especially vulnerable, bearing the brunt of India’s high out-of-pocket health expenditure that continues to push millions of households back into poverty.
The Lifestyle and Preventive Paradigm: PM Modi’s Call for Wellness
To prevent hospital systems from becoming overwhelmed, India’s healthcare strategy must place greater emphasis on preventive wellness. This aligns with the Prime Minister’s advocacy of Yoga and healthier lifestyles to address obesity, non-communicable diseases, and other metabolic conditions. Equally important is the integration of mental health into primary healthcare networks to build a healthier and more resilient population.
Dismantling Vulnerabilities: Empowering Women, Transgender Communities, and Senior Citizens
Within Indian households, medical shocks remain deeply gendered, with women often serving as primary caregivers while postponing their own healthcare needs. If fiscal constraints require a phased rollout of Ayushman Bharat for All, priority should be given to women, transgender individuals, and senior citizens aged 60 and above. Such an approach would strengthen health autonomy, promote inclusion, and provide protection to those facing the greatest healthcare vulnerabilities.
Leveraging States and Local Bodies
Translating this vision into reality requires central, state, and local institutions to function as collaborative catalysts. Urban Local Bodies and Gram Panchayats possess the grassroots networks necessary to conduct saturation drives, resolve registration bottlenecks, and facilitate doorstep enrollment.
Several states have already emerged as laboratories for broader healthcare inclusion. Jammu & Kashmir pioneered an “Ayushman Bharat for All” approach through AB-PMJAY SEHAT, extending coverage to its entire resident population and demonstrating that universal saturation is administratively feasible. Tamil Nadu’s Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS), covering more than 1.5 crore families across over 1,700 hospitals, illustrates how state-level innovation can successfully complement and strengthen the PM-JAY framework.
Is It Time for UHC or “Ayushman Bharat for All”?
The convergence of global expectations, state-level successes, and the expansion of India’s digital health architecture brings us to an inescapable conclusion: the time for fragmented and targeted welfare models is over. India is ready for a transition to true Universal Health Coverage (UHC), an “Ayushman Bharat for All.”
By decoupling health security from strict poverty classifications and anchoring it to a residency identifier such as a Voter ID or national health account, the state can eliminate costly exclusion testing while protecting the missing middle. Building on successful state models, such an approach is both a moral imperative and an economic necessity.
A practical pathway lies in a Co-operative Federal Model, where the Centre provides a standardized ₹5 lakh financial and digital baseline while states introduce targeted top-ups reflecting regional priorities. This approach minimizes administrative overlap while allowing localized innovation and flexibility.
Beyond fiscal considerations, universalizing Ayushman Bharat strengthens democracy and public trust by transforming healthcare from a targeted welfare benefit into a residency-based right. Universal coverage promotes citizen ownership, stronger accountability, and improved oversight of healthcare providers.
Universal health insurance is also the natural extension of India’s mission-mode approach to public service delivery. Just as food security, housing, sanitation, and education programmes expanded inclusion at scale, Ayushman Bharat for All represents the next step in strengthening India’s human capital. International experience from the United Kingdom, Thailand, and South Korea further demonstrates that universal healthcare strengthens social welfare, reduces medical indebtedness, and supports long-term economic productivity.
Funding the Transition: The Fiscal Blueprint
A common concern surrounding universal coverage is its fiscal cost. Yet India’s evolving macroeconomic landscape provides multiple avenues for financing such a transition through optimized state health allocations, targeted wellness cesses, and the continued expansion of GST revenues. The formalization of the economy has enhanced revenue capacity, creating opportunities to finance broader health protection while generating long-term economic benefits through reduced medical insecurity and stronger household consumption.
Conclusion: The Pillar of Viksit Bharat
As India advances toward its vision of Viksit Bharat, comprehensive healthcare must remain one of its foundational pillars. No nation can truly claim developed status while large sections of its population continue to live under the threat of medical bankruptcy.
PM Modi’s address at Bharat Innovates 2026 serves as a reminder that technological scale must be matched by human impact. By strengthening the clinical utility of the 90-crore ABDM architecture, addressing the limitations of the current PM-JAY framework, upgrading Ayushman Arogya Mandirs, and expanding successful state-level innovations into a national guarantee through cooperative federalism, India can move closer to an Ayushman Bharat for All. In doing so, it can fulfill its global commitments, protect the missing middle, and advance the promise of a resilient, secure, and healthy society moving forward together in unity and optimism.
About the Authors:
Manorama Bakshi is a distinguished public health expert, institutional leader, and dedicated policy advocate.
Arjun Kumar is Director, IMPRI Impact and Policy Research Institute, New Delhi. |
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