Opinion – Saúde em Público: Supplementary Health: until when will we be able to pay the bill?

In the last month, we have followed the discussion on the taxation of the ANS list, with the hashtag #roltaxativomata was among the most used on social media. On June 8, however, the Superior Court of Justice (STJ) declared that the role of the ANS is, as a rule, exhaustive. This understanding limits health protection to a shortlist of medical procedures. Since then, health operators have started a crusade to stop medical treatments that were guaranteed by court injunctions.

But after all: will the decision handed down by the STJ actually harm the 50 million Brazilians who have health insurance?

The answer is yes, it is already hurting. Cancer patients, for example, began to be denied PET scan (fundamental for diagnosis and follow-up of the disease), because they are not included in the ANS List. Health Operators have been denying treatments, exams and even oxygen to users of homecare. Athlete Gildo Afonso, who suffers from multiple sclerosis, had his treatment with the drug Kesimpta suspended, with the justification of not being included in that list.

These are some of the examples of the helplessness of Brazilians that motivated the CRPD (Brazilian Committee of Representative Organizations for People with Disabilities) to file the Direct Action of Unconstitutionality nº 7183 before the Federal Supreme Court, in order to correct the injustice represented by the Tax Rol of the ANS.

The health plan is an indirect income, since the monthly amount of the paycheck is deducted to protect the health of the worker and his family. Now, it is not only a question of a benevolence of the system, but also of protection of the health of capital. Sick worker does not produce. It is known that families sacrifice themselves to bear the high costs of a plan, often compromising their own food budget to ensure decent health care.

How did we get to this point? Very simple: the operators managed to convince part of the Judiciary without ever having proved that the supplementary health system will collapse if it has to cover treatments not provided for in the ANS Role.

It is the biggest fake news of recent times, since since 1998 (when the Health Plans Law was published) Operators had been paying for treatments not foreseen in the list, due to courageous decisions of the Judiciary, and, nevertheless, they did not stop profiting.

To give you an idea, Unimed Campinas (which was part of the process that defined the taxation of the ANS list), closed 2020 with a turnover of 2.5 billion reais – an increase of 1.5% compared to 2019.

Contrary to the promise that an exhaustive list would reduce the costs of health plans, the ANS approved the 15.5% readjustment in individual and family health plans. Already the business plans that are not subject to the rule, the readjustments reach 133%.

The Federal Audit Court (TCU), in Audit 021.852/2014-6, makes it clear that the ANS has been systematically failing in its role as a regulatory agency. According to the TCU, the ANS does not have adequate mechanisms to prevent and correct abusive readjustments in collective and individual plans.

Furthermore, it has been proved that the ANS has added an extra portion to the maximum readjustment percentage to compensate for exogenous factors, which (amazing!) were already considered in the base calculation, leading to the double impact of the readjustment index values.

Exorbitant readjustments directly impact the income of workers and retirees, who need to juggle to pay daily expenses, without compensation for integral care by the plans. The Constitution protects the right to health and life as fundamental, which must be guaranteed by both supplementary and public health. Thus, even if it seeks financial gains, the private sector should not place economic interest above health protection.

Law 14,307, of March this year, aimed to support the argument in favor of the exhaustive list by, supposedly, having technical criteria for the elaboration of the list. Among the three criteria for adding a new procedure to the list, two of them protect the economic interests of health operators: the economic cost-benefit assessment and the financial impact of the procedure. Economic interests also govern the composition of the Roster Update Commission. Operators have two representative seats, while the 50 million consumers only have one.

As long as this understanding remains, several questions remain open. How many will be able to afford a plan that, paradoxically, does not guarantee health? How can a SUS overloaded by the non-compliance of the private network be able to function properly? How long will we have health guaranteed? What is the price of our lives?

At the moment, this answer is in the hands of the STF, specifically the Minister Luís Roberto Barroso, who has the possibility to correct this unfair scenario, which makes 50 million Brazilians pay for health plans, without the certainty of what awaits them.