Universal Health Coverage in India hinges as much on State buy-in as on Central funding.

Q. Universal Health Coverage in India hinges as much on State buy-in as on Central funding. (15 marks, 250 words)

Health is a State subject (List II, Entry 6), yet Universal Health Coverage (UHC) is pursued largely through centrally-sponsored schemes like AB PM-JAY, the world's largest health assurance programme offering ₹5 lakh/family/year [1]. Its reach therefore depends on a Centre-State partnership, not Central money alone.

Central funding: the enabling condition - Fiscal backbone: shared cost of 60:40 (90:10 for NE/Himalayan states), enabling poorer states to sustain cover for 10.74 crore SECC-2011 families ≈ 50 crore persons [1][2]. - National public goods: SECC targeting, IT backbone and cross-state portability that no single state can build alone [3]. - Curbs catastrophic out-of-pocket spending, the largest driver of health impoverishment.

State buy-in: the decisive multiplier - PM-JAY runs only via an opt-in MoU with the NHA; without it, funds remain unusable — hence its dynamic count, with Delhi 35th and West Bengal 36th [1][4]. - West Bengal long stayed out, running its own Swasthya Sathi, showing that branding, credit and political will—not finance—were the true bottleneck [1]. - States empanel hospitals via the State Health Agency, run implementation modes (trust/insurance) and drive last-mile awareness [3].

While the Centre supplies scale and equity through funds, delivery is switched on only by State consent and administrative ownership. UHC is thus a test of cooperative federalism: West Bengal's 2026 accession, completing near-universal sub-national coverage, shows that aligned political will—advancing Article 47 and SDG-3—is what finally converts funding into health outcomes.

(~248 words)

Sources: 1. West Bengal Set to Become the 36th State/UT to Implement AB PM-JAY, PIB (2026) — WB as 36th, opt-in MoU with NHA, Swasthya Sathi, ₹5 lakh cover 2. Ayushman Bharat PM-JAY overview, PIB — 60:40 funding split, scheme scale 3. SECC 2011 targeting & empanelment data, PIB — 10.74 crore families, portability, State Health Agency, empanelment 4. Delhi becomes 35th State/UT to implement AB PM-JAY, PIB (2025) — Delhi as 35th State/UT