Supreme Court (SC) Associate Justice Jhosep Lopez on Wednesday cited the factual issue in the computation of the P89.9 billion Philippine Health Insurance Corporation (PhilHealth) fund.
In an oral argument proceedings, he noted that while cases involving transcendental importance can be directly brought before the SC only if it involves questions of law, they may have “to go into the factual issue” in case the questioned provisions will be held valid and constitutional.
Lawyer Paula Mae Tanquieng, counsel for petitioners, said the computation was “based on what the government paid for as subsidy for indirect contributors less the payment for claims for indirect contributors for the years 2021-2023.”
The computation is a “subsidy in the form of involuntary contributions of involuntary members minus the claim benefits not of the voluntary contributors but limited only to involuntary members and that will amount to fund transfer or excess fund,” according to Lopez.
Tanquieng expressed disagreement claiming that “there is a one-fund policy wherein you do not necessarily separate the funds that were paid for as premiums of indirect contributors versus those paid for by direct contributors.”
Meanwhile, PhilHealth Senior Vice President Renato Limsiaco, Jr. explained that there are two classifications of members which include direct and indirect contributors.
“The money that we transfer back to the national government is the money from indirect contributors meaning these are contributions or subsidies by the national government to the sponsored members indigent and so on. The transfer is limited only to the indirect contributors because the national government does not intend to task the direct contributors which are money from paying members,” he said.
Lopez clarified the computation of the P89.9 billion includes only the deduction of the claim benefits of indirect contributors.
Limsiaco responded that the “calculation speaks about the indirect contributors, meaning the contribution of the part of the national government subsidy and on the part of the expense as well only for the indirect contributors.”
There is an apple to apple calculation, he added.
Lopez noted that the premiums paid by the direct contributors are bigger such that there is a bigger fund balance available for the use of the government.
If both direct and indirect contributions were computed, the.amount will be larger than P89.9 billion, he said.
As to the calculation on the accumulated revenue, Limsiaco revealed that on the part of the direct contribution amounts to P201.6 billion while there is P100.3 billion on the part of the indirect.
Lopez posed the question if PhilHealth can be made accountable for the “idle, unrestricted, unexpended, and unused” fund from 2021 instead of increasing the benefits over the years.
He asked whether it is proper for the government to spend its own money for other appropriation instead of borrowing funds from other sources which the government has to pay interest.
In response, Limsiaco, who was already part of PhilHealth during those years, explained that “the availment is different because of the pandemic situation” claiming that the subsidy of the national government is continuous.
“From 2021-2023, we are using the money but because of the pandemic, the availment of benefits has decreased and the premium is legislated meaning it is continuous because it is provided by the law. The national government subsidy goes to PhilHealth,” he said.
Tanquieng also argued that assuming the computation is correct, the indirect premium contributions less indirect benefits claim yielded to negative from 2016-2020.
“It was the premium contributions of the direct contributors that were actually used to pay for the negative of the indirect contributors assuming it is not one fund under the social health insurance. [In data from 2013 when the RA 10351 was passed], it appears that PhilHealth from indirect premium contributions versus indirect benefits claims, it was only in the years 2014, 2015, 2021, 2022, and 2023 that there was actually excess but all the years, it yielded negative,” she claimed.
Also present during the proceeding were Finance Secretary Ralph Recto, Health Secretary Ted Herbosa, and other officials from the Department of Budget and Management (DBM).