Leachon: PhilHealth benefit expansion for paying members betrays UHC law

MANILA, Philippines — Public health reform advocate Dr. Tony Leachon has opposed Executive Secretary Ralph Recto’s proposal to provide expanded benefits for paying members of the Philippine Health Insurance Corp. (PhilHealth), saying it “violates” the Universal Health Care (UHC) law.

According to Leachon, implementing a two-tiered health care system — where separate benefit packages would be made available for PhilHealth’s direct and indirect contributors — would be a “betrayal” of the UHC law, which “mandates equal coverage for all Filipinos.”

“Recto is wrong. [H]is proposal violates UHC law,” Leachon told the Inquirer on Monday.

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“Every Filipino citizen must be covered — not just the middle class, who are already the ‘new poor’…The poor are getting poorer, while the rich gain an advantage under a two-tiered benefits system,” he added.

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Leachon also noted that PhilHealth, as a social health insurance program, is built on “shared risk, not privilege for those who pay more.”

He explained that under the principle of risk pooling, which is the core financing mechanism of PhilHealth, healthy individuals who require little medical care help pay for those who fall severely ill. Meanwhile, wealthier individuals, who pay higher PhilHealth monthly premiums, subsidize the coverage of lower-income populations.

This principle guarantees that health care is provided by the government based on members’ medical needs rather than their ability to pay.

READ: Recto pushes for more PhilHealth benefits for paying members

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Recto earlier said he would meet with PhilHealth officials this week to discuss the expansion of benefits for the more than 33 million paying members of the state-run health insurance provider.

According to the Malacañang official, he understands the frustrations of those who regularly pay their PhilHealth premiums but feel that the benefits they receive do not match their contributions.

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He noted that under Section 9 of the UHC law, PhilHealth shall provide “additional program benefits for direct contributors, where applicable.”

Under the law, all Filipinos are automatically enrolled as PhilHealth members. However, there are two types of PhilHealth members: direct and indirect contributors.

Direct contributors are required to pay a monthly contribution ranging from P500 to P5,000, depending on their basic salary, at the current 5-percent PhilHealth premium rate.

For employed members, the monthly premium is shared equally by the employer and employee. Meanwhile, self-employed members fully shoulder their monthly PhilHealth contributions.

Indirect contributors and their dependents are those whose premiums are subsidized by the national government, including senior citizens, persons with disability, indigents, 4Ps beneficiaries, and those without the capacity to pay.

PhilHealth originally requested P194 billion for government subsidy this year, but only P53.3 billion was allotted in the 2026 national budget.

READ: Gov’t: Zero hospital bill also for middle class

To ensure coverage for all Filipinos, regardless of whether they pay monthly PhilHealth contributions or are subsidized by the government, Leachon said the government should provide a higher budget for PhilHealth in succeeding budget cycles.

He urged the government to settle its P400 billion in arrears from sin taxes (derived from alcohol, cigarettes, and sweetened beverages), as well as shares from the income of the Philippine Amusement Gaming Corp. (Pagcor) and the Philippine Charity Sweepstakes Office (PCSO).

Budget watchdogs and health advocacy groups revealed that PhilHealth has yet to receive a single centavo of its share from Pagcor and PCSO since the implementation of the UHC Act in 2019.

Leachon also said government officials, including Recto, must be held accountable for the transfer of P60 billion in unused PhilHealth funds in 2024. The amount was returned to PhilHealth’s bank account last month following the order of President Ferdinand Marcos Jr. and a Supreme Court ruling.

“Fund diversion and neglect must not go unpunished,” he added.

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Last May, Leachon filed plunder, graft, and malversation complaints against Recto and other officials over the illegal transfer of PhilHealth funds. —With a report from Andre Esguerra, intern