“Illness should never be the gateway to political dependency”
THE Medical Assistance for Indigent and Financially Incapacitated Patients program, known as MAIFIP, is intended to provide government support to Filipinos who cannot afford the cost of medical treatment even after PhilHealth and other sources are exhausted. From 42 billion pesos in 2024, it has been increased to 51 billion pesos for 2025.
This is wrong legally, politically, and ethically. Cardinal Ambo David and Dr. Tony Leachon correctly called this out as wrong morally and from a policy perspective,
As a social protection measure, its objective is legitimate. What has rendered MAIFIP Constitutionally suspect and politically troubling is the way it is commonly accessed and implemented through guarantee letters issued by legislators to individual patients.
In practice, MAIFIP often operates outside a purely administrative and rights based framework.
Patients or their families approach politicians for help when faced with serious illness, mounting hospital bills, or denial of services due to inability to pay.
Legislators then issue guarantee letters addressed to public hospitals, private hospitals, or executive agencies, endorsing the patient for MAIFIP assistance. These letters identify the individual beneficiary and request that public funds be used to cover specific medical expenses.
Although these guarantee letters are framed as requests or endorsements, they function in reality as decisive instructions.
Hospitals and agencies treat them as binding because they come from lawmakers who control appropriations and exercise political influence.
The decision on who receives assistance is therefore made after the budget has been enacted and is effectively determined by a legislator, not by an executive agency applying uniform standards.
This arrangement violates the Constitutional separation of powers.
The Constitution grants Congress the authority to appropriate public funds and vests the Executive with the exclusive power to implement the budget.
In Belgica v. Ochoa, the Supreme Court struck down the Priority Development Assistance Fund precisely because it allowed legislators to intervene in post enactment budget execution.
The Court was categorical that once the General Appropriations Act becomes law, legislators must step back and allow the Executive to administer funds in accordance with law.
Guarantee letters for MAIFIP repeat the same Constitutional defect.
Legislators identify beneficiaries after enactment and thereby exercise influence over the release and use of public funds.
The fact that the funds are used for medical assistance does not alter the analysis.
What the Constitution prohibits is not the purpose of the spending but the location of power.
Decisions on who qualifies for MAIFIP assistance must be made by the Department of Health or other implementing agencies based on objective criteria, medical need, and program guidelines, not on political access.
The use of guarantee letters also transforms MAIFIP from a social protection program into an instrument of patronage.
Assistance is no longer experienced as a legal entitlement or a component of a functioning health system.
It is experienced as a personal favor granted by a politician.
Patients feel gratitude to individuals rather than accountability from institutions. Those without connections to lawmakers are left to navigate a system that appears arbitrary and inaccessible.
This has damaging consequences for public health governance.
Hospitals are pressured to prioritize politically endorsed patients regardless of triage protocols or administrative processes. Health officials are forced to reconcile medical judgment with political expectations.
None of this denies the reality of suffering or the inadequacy of the current health system.
In fact, I must disclose that I have used this system for relatives and friends faced with serious illnesses. And my experience has not been bad as my relationship with politicians is based on mutual respect.
Indeed, the demand for medical assistance is real because public hospitals are underfunded and out of pocket expenses remain crushing for the poor.
But Constitutional violations cannot be justified by institutional failure. Compassion does not require the suspension of Constitutional boundaries.
The proper response is to strengthen MAIFIP as a rules based, executive administered program with clear eligibility criteria, transparent processes, and sufficient funding.
Medical assistance should be accessed as a right through hospitals and health agencies, not through letters signed by politicians. The role of legislators is to enact laws and provide adequate appropriations, not to select individual beneficiaries after the fact.
Illness should never be the gateway to political dependency.
A Constitutional democracy demands a health system that works through law and institutions, not through favors granted one letter at a time.
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