Tenggara Strategics, Jakarta – The passage of the omnibus health bill into law appears set to take place this month, notwithstanding a recent delay in the House of Representatives plenary vote.
The postponement of the vote to July 13, from the initial date of June 20, provides another small window for the bill's critics to continue their opposition. The Indonesian Medical Association (IDI) has led the fight from outside the House, as it seeks to maintain its role in the issuance of medical licenses, which the bill would revoke.
As the substance of the legislation has become clearer, the IDI, now backed by many more civil society groups, has a new narrative of its protest. The narrative has shifted from criticizing the bill for undermining the quality of health workers and health services to criticizing the removal of mandatory spending of 5 percent on the health sector from the state budget and 10 percent from local administrations' budgets.
The Civil Society Coalition for Health Access Justice has said the removal of mandatory spending will negatively impact vulnerable communities such as the elderly, disabled people, women and those living in the remote areas with regard to access to health services, which is protected under the existing Health Law.
Apart from the IDI and the coalition of civil society organizations, the political parties in opposition to the current administration, such as the Islam-based Prosperous Justice Party (PKS) and the Democratic Party, also opposed the passage of the omnibus health bill. The PKS mentioned that the omnibus legislative method had resulted in rushed legal processes, while the Democratic Party supported the mandatory state spending quota, which it said helped ensure the public's access to health care.
The continuing protests by health workers, ongoing criticism and the number of civil society organizations that have spoken out against the bill demonstrate the scale of the backlash. However, the rapid progression within the policymaking system – from the Health Ministry giving the problem inventory list to the House and the speedy deliberation of the bill by the House's working committee and government representatives to the plan of holding a plenary session to pass the bill into the law – shows that the government and the House are unfazed by the heightened opposition to the bill.
The omnibus method has indeed provided a way for the government to accelerate the passage of the health bill with minimum input from relevant stakeholders. The government has held public hearings and stakeholder consultations with several organizations, but critics remain unconvinced by the government's arguments and question the thoroughness of its efforts to take public opinion into account.
The IDI in particular faces massive restructuring if the bill is passed. Its role of providing recommendations for doctors to obtain medical permits will be taken over by the Health Ministry, and doctors' permits will last indefinitely. The IDI has argued that this will jeopardize the healthcare system by removing regular checks of doctors' qualifications and services. Furthermore, the diminishing role of the IDI has been accused of providing leeway for the government to invite foreign doctors into Indonesia, weakening the position of Indonesian doctors who belong to the IDI. Under the existing regime, it is almost impossible for foreign doctors to practice in the country as they need a recommendation from the IDI.
The Health Ministry argues that the bill will provide a new and beneficial structure for medical workers' associations. The ministry says the IDI can now focus on the welfare of its members, instead of focusing on regulating medical licenses. The current system grants the IDI hold extraordinary power in health governance, from medical education to the distribution of doctors, leaving the government with a relatively small role in resolving issues with the uneven geographic distribution of doctors.
With the new health bill, the government will likely hold a greater role in the distribution of doctors and, further, could collaborate with the IDI as a partner. The IDI, however, has vowed to continue its fight even if the bill is passed by challenging the law at the Constitutional Court.
What we've heard
The government and the House of Representatives were apparently set to pass the Draft Omnibus Law on Health in mid-June 2023. The draft law received majority approval in the House during the first-stage meeting of House Commission IX overseeing public health. Two factions rejected the draft, namely those of the Prosperous Justice Party (PKS) and the Democratic Party. However, the House has not held a plenary meeting to enact the draft into law.
A senior lawmaker mentioned that the Health Bill was waiting for the House leadership to discuss and approve it, but the discussion was postponed because several House leaders had planned to go on the haj through the end of June. "The leadership meeting has not been held and thus, the bill cannot be further brought to a plenary meeting for discussion," said the lawmaker.
According to the senior lawmaker, the leadership meeting will determine whether the bill is submitted to the House Steering Committee (Bamus). Afterward, the House will decide on passing the bill into law. The source also mentioned some other matters that could hinder the law's passage, such as the draft's disorganized structure, similar to the Draft Omnibus Law on Job Creation that contained many typos. The source also said the House Secretariat was still revising the draft health law to prevent legal challenges after it was enacted.
Other factors allegedly contributing to the bill's delayed passage include provisions that categorize tobacco as an addictive substance. Several lobbies from the tobacco industry continue to oppose the inclusion of such articles, fearing that they could disrupt the industry and tobacco farmers' welfare. However, according to another inside source, these factors had been resolved and agreed by House representatives of constituencies with a significant number of tobacco farmers. "The matters regarding the tobacco issue are now resolved," said the source.
Separate pro-government sources said the House had overarching priorities, such as drafting the state budget and deliberating other draft laws, such as the Asset Seizure Bill. However, these sources said they would make sure that the House passed the Health Omnibus Law before the legislature entered recess. "The decision will take place in mid-July at the latest", said the source.
[This content is provided by Tenggara Strategics in collaboration with The Jakarta Post to serve the latest comprehensive and reliable analysis on Indonesia's political and business landscape.]