Disability deserves equal health rights

A new white paper has confirmed what disability rights advocates have long raised, though policy has yet to fully confront. More than eighty per cent of Indians with disabilities remain without health insurance, and over half of those who apply are rejected, often without explanation. The study, released by the National Centre for Promotion of Employment for Disabled People, surveyed over five thousand persons across thirty four states and union territories. The findings do not describe individual hardship. They reveal a systemic pattern of exclusion that raises a fundamental question: can India credibly commit to universal health coverage while sixteen crore people remain outside its protection?

The responses collected in the survey point to widespread barriers. Applicants were denied coverage solely because of their disability or pre-existing conditions. Rejections were highest for persons with autism, psychosocial and intellectual disabilities and blood disorders such as thalassemia. Many respondents reported being asked for repeated medical certificates or charged unaffordable premiums, only to be turned away again. Others said their applications simply went unanswered. This is not a gap of information or infrastructure. It is a failure of policy design. And it persists despite legal and regulatory safeguards that already exist.

India has a legal framework that recognises disability as a protected category. The Rights of Persons with Disabilities Act 2016 prohibits discrimination in access to healthcare and requires equal opportunity across sectors. The Insurance Regulatory and Development Authority of India has also issued circulars directing insurers to develop clear underwriting policies for persons with disabilities and avoid blanket exclusions. Yet the protections written into law and regulation are rarely translated into practice. That divide now lies at the centre of the health coverage debate.

The contradiction becomes sharper when seen alongside recent policy decisions. Ayushman Bharat has been expanded to cover all citizens aged seventy and above, irrespective of income. This step acknowledges vulnerability as a valid basis for universal protection. By the same logic, persons with disabilities should qualify automatically. Instead, they must apply, negotiate and wait, with little certainty about outcomes. The government has accepted that age merits guaranteed coverage. Disability, despite clear health risks, remains outside the same framework. This is not only a gap in welfare. It is a contradiction in policy logic.

At the launch of the white paper, Additional Secretary Manmeet Nanda of the Ministry of Social Justice and Empowerment said that disability insurance cannot be managed by a single ministry. It requires coordination between IRDAI, the Ministry of Health and Family Welfare and the Department of Empowerment of Persons with Disabilities. She proposed the integration of the Unique Disability ID database with insurance processes to enable real time tracking of rejections, reduce repetitive documentation and monitor compliance. If implemented, such a system would mark an important shift. It would move responsibility away from the applicant and place the onus on the system. It would also align with the wider direction of digital governance already being applied across sectors.

NCPEDP Executive Director Arman Ali described the findings as a moral and constitutional challenge. His language reflects what many in the disability community have argued for years. If insurance is denied on grounds of disability, despite statutory protections, the issue becomes one of rights, not welfare. Equality before law and equal protection of the law are constitutional guarantees. A system that leaves a population this large and this vulnerable outside the health protection net risks contradicting those guarantees. Persons with disabilities do not require exemption or sympathy. They require parity in access and clarity in policy.

There is also a growing fiscal case for wider inclusion. International experience shows that excluding high need groups from insurance systems does not reduce cost. It merely delays it. Families who lack coverage postpone treatment, deplete savings and eventually incur far higher expenses for late stage care. The cost of exclusion is therefore absorbed not only by individuals but by the system. Early assessment, rehabilitation and mental health support bring costs down over time. Larger risk pools stabilise premiums. Inclusion is not only socially responsible. It is economically practical.

The white paper does not call for a redesign of the entire insurance sector. It proposes moderate and implementable steps that build on existing systems. These include automatic coverage under Ayushman Bharat for persons with disabilities, without age or income criteria; standardised and non-discriminatory premiums across insurers; wider coverage for mental health care and assistive technologies; mandatory accessibility of insurance platforms and a dedicated Disability Inclusion Committee within IRDAI. It also calls for training programmes that equip medical staff and insurers to engage with persons with disabilities in ways that reflect both legal obligations and basic sensitivity.

These recommendations match the direction of governance that India is already pursuing. Digital authentication systems are being expanded. Identification databases are being integrated with service delivery. Public health platforms are being made interoperable. These shifts could be extended to disability inclusion without major structural change. The barrier is not technology or capacity. The barrier is prioritisation.

The country now faces a broader question. Will disability remain a subject to be revisited later, or will it be recognised as a core feature of any credible health protection strategy? India speaks of inclusive growth and social dignity as national commitments. It has invested heavily in digital infrastructure, financial inclusion and health system reform. It has launched the Unique Disability ID platform, national health databases and universal health coverage ambitions through Ayushman Bharat. The foundations have been laid. The data exists. What remains is to align health security with the principles already present in law.

To insure health is to recognise its place in human dignity. Persons with disabilities cannot remain outside this recognition. They are not asking for favour. They are asking for inclusion in what has already been declared a national objective. Insurance built on negotiation is not sustainable. Insurance that excludes is policy without purpose.

India often presents inclusivity as aspiration. It is now time to treat it as obligation. The infrastructure is ready. The legislation exists. The data is clear. The question left is political rather than technical: whether health protection will reach every citizen, or remain conditional on capacity to negotiate. The cost of exclusion is already high, and it will only grow. The moment for correction is not in the future. It is now.

The writer comments on health issues, focusing on public health policy and non-communicable diseases.