The government has no choice but to annul the recent increase of national health insurance (JKN) premiums after the Supreme Court ruled in favor of hundreds of millions of citizens who depend on the public health insurance.

The court granted victory to a group of petitioners who had challenged Presidential Regulation No. 75/2019, which mandated higher premiums for all service levels beginning this year. The regulation had sparked debate and compelled thousands of people to downgrade their service class or even opt out of the public health insurance altogether.

Pudjiatie from Malang in East Java said she welcomed the court’s decision because the premium increase had been a burden for her. The 50-year-old said she had paid the insurance for the past five years but had never used it herself.

As she pays for her own coverage and that of her nephew, both members of the second-class service, the extra cost was a double burden for her. “It is good that the price has been reduced again,” she told The Jakarta Post on Tuesday.

President Joko “Jokowi” Widodo signed the regulation on Oct. 30 of last year, raising the per-person premium for the first-class service from Rp 80,000 (US$5.60) to Rp 160,000 and for the second-class service from Rp 51,000 to Rp 110,000, while increasing the premium for the third-class service by 64 percent from Rp 25,000 to Rp 42,000.

The premium increase was intended to solve the financial deficit that has always plagued the insurance operator, the Health Care and Social Security Agency (BPJS Kesehatan), but it prompted many to downgrade their service level and risked overloading the cheapest third-class service.

As of March, the public health insurance covers about 223 million people, or 85 percent of the country’s population.

The judicial review petition was filed late last year by the Hemodialysis Patients Community — one group of many who protested against a premium hike they deemed excessive.

In its verdict, the court argued that points 1 and 2 of Article 34 of the regulation — which stipulate a 100 percent increase of BPJS Kesehatan premiums — contradict a number of prevailing laws.

“[The article] is not legally binding,” Supreme Court spokesperson Agung Andi Samsan Nganro said on Monday.

The court said the article contravened, among other laws, the 2004 National Social Security System (SJSN) Law and the 2011 Social Security Management (BPJS) Law that were based on principles of nonprofit service provision, gotong royong (mutual cooperation), compassion and social justice.

Members of the House of Representatives Commission IX, which oversees health, have also criticized the premium hike, especially with regard to the third-class level intended for the poor.

Saleh Partaonan Daulay, a Commission IX member from the National Mandate Party, hailed the court decision. “The Supreme Court’s decision is actually in line with what lawmakers have fought for, especially in Commission IX,” he said, adding that he hoped the government and the House would find another way to solve the insurer’s deficit.

Finance Minister Sri Mulyani Indrawati, who had advocated for the increase, expressed concern about the decision, saying it imperiled the insurer’s sustainability and the welfare of citizens.

“When the government drafted the regulation, all aspects were considered. We could not satisfy everyone. We should not only think about service but also its sustainability,” she said on Tuesday.

Sri said BPJS Kesehatan had a duty in providing public health services, but it also suffered a deficit of Rp 15.5 trillion in 2019, even after receiving a cash injection of Rp 13.5 trillion from the government.

The Indonesian Doctors Association’s coordinator for healthcare development and the JKN, Noor Arida, expressed hope that the return to lower premiums would not affect the quality of healthcare services. “Quality of service must also be supported with adequate funding,” Noor told the Post.

Watchdog BPJS Watch advocacy coordinator Timboel Siregar said the government should allocate the members’ overpaid premiums for January, February and March to help cover their premiums for April, May and June to ease the refund. “It is impossible to be paid in cash because the premium funds have already been paid to the hospitals,” Timboel said.

To help cover BPJS Kesehatan's deficit, he advised the government to increase compliance among customers and maximize revenue from the cigarette excise collected by regional administrations. (mfp)

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