A

fter a long election battle and with his victory confirmed by the Constitutional Court, president-elect Joko '€œJokowi'€ Widodo and Jusuf Kalla will move into the State Palace in October. One of the key promises considered to have contributed greatly to his victory was the Indonesian Health Card (Kartu Indonesia Sehat, KIS). The main challenge of the KIS is how to implement it within the current legal framework.

It was obvious that Jokowi wanted to continue his personal experience of offering the health-card policy, as a means to cover health care for all people, when he led Surakarta and Jakarta. On some occasions Jokowi and his team mentioned the Jakarta Health Card (Kartu Jakarta Sehat, KJS) as the model for the KIS. Debate on how the new president will implement and finance the KIS has highlighted, among other issues, that Jokowi would be violating the Social Security Law if he tried to implement the KIS. But he would be accused of betraying the people if he did not fulfill his KIS promise.

The KJS initially aimed to cover health care for every legal resident of Jakarta. Finally the KJS insured 4.5 million residents who lacked health insurance with PT Askes, the company that insures the country'€™s civil servants, police and military members. Those who have health insurance through their employers continued to be insured under the employers'€™ coverage. The administration of the KJS by Askes was designed to comply with national health insurance (JKN), which is administered by the security management agency for health (BPJS Kesehatan). Currently the Jakarta Health Card, along with other local health coverage programs, has been integrated into JKN.

 Media reports revealed suggestions by Jokowi'€™s support team that the KIS should be entirely financed by the national budget, on the grounds that all citizens have the right to health care, in line with the Constitution. However, the implementing regulations of the right to health care have been determined as contributory as regulated by the Social Security Law. The contributory nature of health coverage has been reviewed several times at the Constitutional Court and the court has rejected all requests to review the law on this issue. Therefore Jokowi'€™s team should not insist on its initial view of the KIS as free health care for all, funded entirely by the national budget.

Jusuf Kalla should know that Indonesia enacted the above law when he was coordinating minister of people'€™s welfare under then president Megawati Soekarnoputri. The law mandates all income earners to contribute to their health care and mandates the government to contribute to the poor and those of low income. And certainly, the kind of budget needed to cover the nation'€™s entire health care is not available in the coming 2015 budget, and it violates the above law.

So how should the KIS be implemented? The National Social Security System (SJSN) has no specific name for the card. The BPJS Kesehatan unilaterally names the card as the BPJS Card. This is not an appropriate name; in many countries similar cards are named after their national health-insurance programs. So Jokowi could simply rename the BPJS Card as the KIS by issuing a presidential regulation.

The rational and legal way to finance the KIS is by subsidizing contributions for self-employed low-income families and all elderly citizens who lack health insurance. This category may reach 150-160 million citizens. There are 86.4 million poor and marginally poor people who are receiving the government contribution of the universal health coverage.

 So Jokowi has to add to the list about 55 to 65 million people who do not have a monthly salary. However, the current state contribution for the poor, at about Rp 20 trillion (US$1.7 billion) is too low to ensure good quality health care. All salaried employees and their employers will contribute 5 percent of monthly salaries with a higher ceiling of wages (to about Rp 10 million of monthly salary) to ensure good health care.

The Jokowi administration must ensure, first, the necessary budget to cover the additional subsidy for the poor, to about Rp 60-70 trillion '€” only about 4 percent of the proposed 2015 budget. It is very small compared to the average allocation in countries of similar per-capita income and it is still below the 5 percent required by the Health Law. Second, Jokowi should revise the Presidential Regulation 111/2013 to increase the state contribution to the health subsidy, and the Government Regulation 101/2012 to increase the subsidy for the poor. And finally all ministerial and Security Management Agency (BPJS) regulations under universal health coverage, such as payments to healthcare providers, must be revised by the incoming health minister and the new BPJS executives.

Yet the fiscal capacity for the KIS would be available only if the country could rationalize subsidies and improve efficiency in the energy industries. Increasing efficiency at the state-owned oil firm Pertamina and the state electricity company PLN could reduce the energy subsidies to better finance the national health cards.

Therefore Jokowi does not need to increase oil prices in the short run to finance the KIS. Certainly the energy subsidies should eventually be reallocated to be more appropriate and better targeted at the low-income group. Luckily, Jokowi-Kalla is ready to reallocate the energy subsidies to more appropriate spending and better targeting the low-income group. Welcome Mr. President, the people await your KIS.