Content

1. Governor’s Assent to State Bills
2. Not Just Insurance, Indians Need Universal Healthcare

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Governor’s Assent to State Bills

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Why is this in News?

• April 2025: Supreme Court judgment in State of Tamil Nadu vs Governor of Tamil Nadu
  • Fixed clear timelines for Governors to act on State Bills.
  • Held that indefinite inaction is unconstitutional.
  • Allowed judicial intervention, including deemed assent in cases of unexplained delay.
• Mid–2025: Supreme Court’s advisory opinion in Special Reference No. 1 of 2025 (Presidential Reference)
  • Held that:
    • Judicially imposed timelines lack textual constitutional basis.
    • Deemed assent is alien to the constitutional scheme.
    • Governors and President enjoy wide discretionary latitude, even permitting delays.
  • Effectively diluted the April 2025 judgment, though formally not overruling it.

Relevance

GS II – Polity & Constitution

• Articles involved: Article 200, Article 201, Article 361
• Themes:
  • Role, powers, and discretion of the Governor
  • Constitutional morality vs textualism
  • Legislative procedure and assent mechanism
  • Judicial review and advisory jurisdiction (Article 143)

GS II – Federalism & Centre–State Relations

• Cooperative vs coercive federalism
• Union control through Governors
• Reservation of Bills for President and its misuse
• Sarkaria & Punchhi Commission recommendations

Practice Question

• “The Governor’s power of assent under Article 200 is procedural, not supervisory.”
  Examine this statement in the light of recent Supreme Court judgments.(250 Words)

Constitutional Basics: Article 200

Article 200 – Governor’s Options on a State Bill

When a Bill is presented, the Governor may:

• Grant assent
• Withhold assent
• Return the Bill (except Money Bills) for reconsideration
• Reserve the Bill for the consideration of the President

First Proviso to Article 200

• If the Governor returns a Bill and the State Legislature re-passes it (with or without amendments),
• The Governor “shall not withhold assent” thereafter.

Core principle: The Governor’s role is procedural, not supervisory.

The April 2025 Judgment: State of Tamil Nadu Case

Key Findings

• Indefinite delay by Governors violates:
  • Federalism
  • Democratic accountability
  • Legislative supremacy
• Governors cannot convert assent power into a veto-by-silence.

Major Innovations

• Timelines imposed for Governor’s action.
• Prolonged inaction treated as constitutionally impermissible.
• Courts empowered to:
  • Direct action
  • In extreme cases, deem assent granted

Significance

• Strengthened:
  • Federal balance
  • Elected legislatures over unelected authorities
• Especially crucial for Opposition-ruled States facing Raj Bhavan obstruction.

Special Reference No. 1 of 2025: The Course Reversal

Core Holdings

• No explicit constitutional text authorising:
  • Judicial timelines
  • Deemed assent
• Governor’s discretion under Article 200 has “elasticity”.
• Advisory opinion claims not to overrule earlier judgment, but:
  • Carries high persuasive authority due to Constitution Bench status.

The “Constitutional Dialogue” Argument

Court’s Position

• Article 200 creates a dialogue between:
  • Legislature
  • Governor
  • President

Critique

• Dialogue requires:
  • Timely and meaningful response
• Governors’ motivated silence converts dialogue into:
  • Obstruction
  • Policy paralysis

Problem: The Reference judgment tolerates silence while preaching dialogue.

Dilution of Safeguards Under Article 200

1. Removal of Timelines

• April judgment: Clear, reasoned timelines.
• Reference opinion: Timelines unconstitutional.

Effect:

• Prolonged inaction attracts only:
  • A direction to “decide”, not consequences.

2. Undermining the First Provison

Earlier Position (Tamil Nadu Case)

• After reconsideration by Assembly:
  • Governor must assent
  • Referral to President only in exceptional cases

New Position (Special Reference)

• Governor can:
  • Refer even reconsidered and re-enacted Bills to the President
  • Do so without constraints

Impact:

• Converts President’s reservation into a constitutional black hole.
• Negates the binding nature of legislative reiteration, contrary to text.

False Equivalence: Checks vs Balances

Court’s Justification

• Governor must act as a check to:
  • Prevent repugnancy
  • Prevent unconstitutional laws

Counter-Argument

• Judicial review already exists to test constitutionality.
• Assent power is:
  • Procedural
  • Not a preliminary judicial review

Key Distinction:

• Courts correct unconstitutional laws after enactment.
• Denial or delay of assent leaves no effective remedy.

Federalism and Centre–State Relations

Missed Opportunity

• States and Sarkaria Commission concerns:
  • Arbitrary reservation of Bills to the President
• Reference could have:
  • Subjected such referrals to judicial scrutiny

Instead

• Confers unfettered discretion on Governors.
• Strengthens Union dominance over States.

Constitutional Implications

Democratic Deficit

• Unelected Governors gain:
  • Blocking power over elected legislatures

Federal Retrogression

• Shifts balance:
  • From cooperative federalism
  • To hierarchical control

Separation of Powers

• Assent power elevated from:
  • Procedural step
  • To quasi-constitutional gatekeeping

Overall Assessment

• April 2025 judgment:
  • Progressive, democracy-affirming, federalist.
• Special Reference No. 1 of 2025:
  • Constitutionally conservative in form,
  • Politically enabling in effect.

Net Result:

• Retreat from principled restraint on gubernatorial power.
• Assenting power transformed from a balance into a check, undermining legislative supremacy.

Conclusion

The advisory opinion in the 16th Presidential Reference represents a subtle yet significant constitutional retrogression. By dismantling judicially enforced discipline over gubernatorial assent and legitimising expansive discretion, the Court has weakened federalism, diluted democratic accountability, and reopened the door to executive obstruction of State legislatures—an outcome at odds with the spirit, structure, and text of Article 200.

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Not Just Insurance, Indians Need Universal Healthcare

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 Why is this in News?

• December 12 marked Universal Health Coverage (UHC) Day.
• Renewed policy debate in India on:
  • Rising out-of-pocket expenditure (OOPE).
  • Over-reliance on insurance-led models (e.g., PM-JAY).
  • Weak public primary healthcare and growing private sector dominance.
• The editorial argues that insurance ≠ universal healthcare, and India must pivot towards a publicly funded, comprehensive health system.

Relevance

GS II – Social Justice (Health)

• Public health system design
• Universal Health Coverage (SDG 3.8)
• Equity, access, and affordability in healthcare
• Role of the State in welfare provisioning

GS II – Governance & Federalism

• Health as a State subject (Entry 6, State List)
• Centre–State coordination under NHM and PM-JAY
• Fiscal federalism and health financing

Practice Question

• Distinguish between Universal Health Coverage and Universal Healthcare.Why is this distinction important for India’s health policy? (250 Words)

Universal Health Coverage (UHC)

• Defined by WHO as ensuring:
  • Access to promotive, preventive, curative, rehabilitative, and palliative care
  • Without financial hardship.
• Grounded in:
  • Right to Health (International Covenant on Economic, Social and Cultural Rights).
  • WHO World Health Reports (2010, 2019).
  • SDG 3.8.

Universal Health Coverage vs Universal Healthcare

• UHC (Narrow, insurance-centric):
  • Focus on financial protection.
  • Emphasis on hospitalisation and tertiary care.
• Universal Healthcare (Comprehensive):
  • Strong public provisioning.
  • Focus on primary and secondary care.
  • Addresses social determinants of health.

India’s Health System: Structural Reality

Persistent Challenges

• Low public health expenditure: ~1.3–1.5% of GDP.
• High OOPE: ~45–50% of total health expenditure.
• Insurance schemes mainly cover:
  • Hospitalisation.
  • Limited disease packages.
• Major exclusions:
  • Outpatient care.
  • Diagnostics.
  • Medicines.
  • Preventive services.

Consequences

• Medical expenses remain a leading cause of impoverishment.
• Insurance often:
  • Encourages over-medicalisation.
  • Leads to provider-induced demand.
  • Benefits private hospitals disproportionately.

Insurance-Led Model: Core Limitations

• Does not strengthen health infrastructure.
• Treats health as a market commodity, not a public good.
• Fragmented disease-based packages distort care priorities.
• Fails to address:
  • Continuity of care.
  • Preventive and promotive health.
• Increases private sector leverage over public policy.

Comparative Global Experience

East and Southeast Asia

• Countries like China, South Korea, Thailand:
  • Adopted UHC through insurance.
  • Simultaneously invested heavily in public health systems.
• Outcomes:
  • Strong primary and secondary care.
  • Better health indicators.
• Caveat:
  • High fiscal burden (China faced rising costs due to hospital-centric expansion).

Key Lesson

• Insurance works only when embedded in a robust public healthcare backbone.
• Private sector dominance without regulation leads to:
  • Cost escalation.
  • Policy capture.

India’s Missed Opportunity

Historical Commitment

• Bhore Committee (1946):
  • Advocated state-funded universal healthcare.
  • Emphasised primary care as foundation.
• Post-independence:
  • Chronic underinvestment.
  • Gradual shift towards selective, insurance-based interventions.

Current Schemes

• NHM (earlier NRHM): Strengthened primary care but remains underfunded.
• PM-JAY:
  • Expanded insurance coverage.
  • Did not significantly reduce OOPE.
• Result:
  • Parallel systems with weak integration.

False Equivalence: Insurance as Healthcare

• Insurance is a financing tool, not a healthcare system.
• Courts, policies, and political discourse often conflate:
  • Financial coverage with health outcomes.
• Health outcomes depend on:
  • Availability.
  • Accessibility.
  • Quality.
  • Continuity of care.

What India Actually Needs ?

Strategic Shift Required

• From UHC-as-insurance → Universal Healthcare-as-public service.

Core Pillars

• Substantial increase in public health spending (≥3% of GDP).
• Strengthening:
  • Primary Health Centres.
  • Community Health Centres.
  • Urban primary healthcare.
• Integration of:
  • Preventive, promotive, and curative care.
• Regulation of private sector:
  • Standard treatment protocols.
  • Price controls.
• Addressing social determinants of health:
  • Nutrition.
  • Sanitation.
  • Housing.
  • Education.

Governance and Federal Dimensions

• Health is a State subject (Entry 6, State List).
• Central insurance-heavy schemes risk:
  • Centralisation.
  • Weakening State public health systems.
• Cooperative federalism needed:
  • Flexible funding.
  • State-led health system strengthening.

Ethical and Constitutional Perspective

• Right to life under Article 21 increasingly interpreted to include health.
• Treating healthcare as insurance undermines:
  • Equity.
  • Universality.
  • Dignity.

Overall Assessment

• Insurance-based UHC is:
  • Necessary but not sufficient.
• Without strong public provisioning:
  • UHC becomes fiscally costly and socially inequitable.
• India stands at a policy crossroads:
  • Either deepen marketisation of health,
  • Or reclaim healthcare as a public good.

Conclusion

India’s health challenge is not merely one of financial protection but of systemic capacity and equity. Universal Health Coverage, when reduced to insurance, offers a narrow and inadequate solution. A genuine commitment to universal healthcare demands sustained public investment, strengthened primary care, and recognition of health as a constitutional and social obligation rather than a market-mediated entitlement.