The health reform of Gustavo Petro's Government is not dead, despite the fact that a few weeks ago the Seventh Commission of the Senate decided to sink it by an absolute majority. There is still one last opportunity in Congress to revive the bill that President Gustavo Petro has given the most importance to since he came to power. The strategy, led by senators Wilson Arias and Ferney Silva, from the ruling Historical Pact, consists of appealing the commission's decision so that the Senate plenary session decides whether to give it a new opportunity. This formula, stated in article 166 of the fifth law that regulates the functioning of Congress, had never been used in recent legislative history. “If a project is denied in its entirety or archived indefinitely, any member of the Commission or its author, the Government or the spokesperson of the proponents in cases of popular initiative, may appeal the decision before the Plenary of the respective Chamber” , says the article.
After receiving the appeal, the president of Congress, Iván Name, appointed the presidents of the seven Senate commissions to study the appeal and issue a opinion on its origin. The conclusions of that group, which must meet this week, will not be mandatory. That is, in the end it will be the majority of senators in the plenary session that will decide, by a clean vote, whether to accept the appeal. If he does so, Name must send the text of the health reform to a commission other than the Seventh, so that it can be discussed again. That would give a new opportunity to the reform that aims to fundamentally transform Colombia's health system, strengthen primary care and eliminate the financial and health insurance functions of the health promoting entities, EPS. President Petro would also score an unexpected and unprecedented political victory.
A few weeks ago this option seemed impossible because the Government did not have the necessary majorities in the plenary session of the Senate. But since this Monday the panorama changed. That day the Government managed to establish a legislative majority with the participation of nine senators from the Liberal party and seven from the U party, who voted for the presentation of the pension reform, another of Petro's three great social initiatives. Sources close to the Government say that the agreements reached with the majority of the parties of these two parties also include support for health reform. With this support, plus the votes of the Historical Pact, the Green Alliance, the former FARC of Comunes, the center party En Marcha and the Christian Mira, the Government could secure a majority.
In dialogue with EL PAÍS, Senator Wilson Arias explains the reasons for the appeal: “Many of my colleagues from the Seventh Commission who sank the project declared themselves prevented due to a possible conflict of interest, but among them the impediments to voting and keeping were denied. most. “This is questionable behavior for society,” said the veteran left-wing congressman. And he adds: “I think it is reasonable that the time invested in a reform that has accumulated consensus is not wasted.” The senator, one of the main defenders of the project, is optimistic. “I recognize the difficulties, but I have expectations. “You had to try everything.”
Ferney Silva, the newly inaugurated senator who arrived at the Capitol to replace the deceased Piedad Córdoba, agrees that the atmosphere in the plenary session is positive for the reform to be revived: “The background of the last few days in which a part has been approved “The important part of the pension reform allows us to think that there is an opportunity.” Silva explains the underlying reasons that motivated his decision: “We need a reform that allows us to restore dignity and the provision of the right to health to all Colombians. Colombia's maternal and child mortality and morbidity indicators are the worst in the OECD, that has to change with the reform.” Silva insists that there are 13 million people living in remote and rural areas of the country who cannot access the health system. “The system has been in crisis for years and requires an immediate solution.”
The former Minister of Health and godmother of the reform, Carolina Corcho, also spoke about this alternative: “We are going to observe the political stature of the Senate, which must overcome irrational and obstructionist obstinacy, in the face of the urgent need to stop the financial crisis and of health and initiate a transition towards a new health system.”
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Opposition senator Germán Blanco, from the Conservative Party, should form the accidental commission because he chairs the first commission. However, he explains to EL PAÍS that he has renounced that responsibility due to a possible conflict of interest: “My wife is the manager of an IPS [health care institution, such as clinics or laboratories] in Antioquia. I prefer to step aside so as not to be part of the commission. “I asked President Name to review the possibility that the person who replaces me could be someone from Cambio Radical or the Democratic Center [opposition parties].” Juan Felipe Lemus, also from Antioquia, from the U party and president of the fourth commission, explained that he has not yet been summoned to any specific meeting to study the appeal, but stated that he is going to “abstract himself from any political consideration to make the decision based on legal arguments.”
The progress outside the Capitol
In parallel to the strategy in Congress, the Government has begun to implement several of the central axes of the reform through administrative means. First, the Health Superintendency intervened in Nueva EPS and Sanitas, the two largest EPS in the country. With this, more than 17 million users, one in three Colombians, were insured by entities whose directors have been appointed by the Executive. Then a reorganization of the system began through administrative decisions. Last week, the Minister of Health, Guillermo Alfonso Jaramillo, issued a decree so that Adres, a kind of public bank for health resources, send more money directly to clinics and hospitals, and thus begin to eliminate one of the main functions of the EPS, which serve as intermediaries of resources between the State and the Health Providing Institutions (IPS).
In recent days, the president announced the launch of a unified command post, a figure usually assigned to natural disasters or large demonstrations, to monitor the health system crisis. At the same time, he created a space for dialogue with the EPS: “We have agreed with the EPS on a permanent 100-hour work session, starting from one base and that is that health reform is needed,” the president wrote in his account. X. “This space will be for consultation to find a way out of the crisis that has affected the health system for decades. “Inclusive and preventive health is the way.” Government sources have explained to EL PAÍS that the person in charge of leading this session will be Laura Sarabia, the director of Dapre and right-hand woman of President Petro.
The EPS, for their part, have shown that they are willing to reach consensus or at least open the way to dialogue with the Government. Six of them, which bring together more than 14 million members, announced this week that they agreed to become health managers, the same name that the reform proposed for them. Through a video, the representatives of Mutual Ser, Coosalud, Salud Total, Capital Salud, Familiar Deco and Cajacopi expressed that thanks to a consultation with the Ministry of Health, the Historical Pact and several senators from the U Party, they had arrived an agreement. We have made great progress in wanting to transform ourselves into health and life managers. Also that health reform advances. We have specified what functions we will have and we want to tell the country that the discussion must remain open. Now, we hope that patients, political parties, associations and providers will participate,” they said in a statement. Although it is not clear if by “managers” they mean the same thing as the Government in the reform, since they did not reveal what those functions would be, they demonstrated that dialogue is flowing.
The strategy in Congress, the interventions to the EPS, the decrees issued or in process and the permanent dialogue session demonstrate that the president is not willing to let die the reform that he turned into his great political banner. For now, the floor is up to the Senate plenary session. If the request to revive it is not approved, it is expected that the Government will file a new text on July 20, when a new legislature begins, and that it will maintain the spirit, but with fewer articles and the support of more parties. politicians.
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