Editorial: Why would you take away people’s health insurance overnight?
It’s people’s lives on the line
For a lot of Indonesians, the scariest thing you can see isn’t a ghost. It’s an “Inactive” status on the national health care and social security (BPJS) app, JKN Mobile. Especially when that status change happens while you’re queuing at a hospital registration desk with a family member in urgent need of their next round of dialysis or chemo.
Yet this is exactly the situation that unfolded last week when approximately 11 million people lost their BPJS insurance with no prior notice. Apparently, the government had changed the classification of those deemed worthy of the contribution assistance recipient (PBI)—a scheme where the government picks up the tab for the poor. Simply put, the rule change meant that the government decided those 11 million people just aren’t poor enough anymore to receive the subsidies.
To understand the mess, you have to look at the three tiers of BPJS schemes: waged workers (PPU) whose dues are paid through payroll deductions, non-waged workers (PBPU) who pay their dues out of pocket, and PBI. Amid widespread budget cuts, the government has recently set a threshold of 96.8 million people only to be covered under PBI, which explains the ‘sudden’ database purging.
The Social Affairs Ministerial Regulation No. 3/2026 mandates the reclassification to align BPJS database with the National Social and Economic Single Data (DTSEN) from Statistics Indonesia (BPS) and the Social Affairs Ministry, which ranks people based on monthly expenditure per capita. This new 10-decile ranking system effectively turns a statistical welfare score into a rigid “on/off switch” for PBI eligibility.
But we want to be clear here: the DTSEN itself is not the problem. After all, the intention is exactly what we’ve gravely needed for a long while now. A unified registry means that social assistance programs can actually be enjoyed by the most vulnerable among us.
How the DTSEN determines if you’re eligible for assistance
If you’re in Deciles 1 through 5, you’re eligible as PBI recipients. But if somehow you are bumped up to, say, Decile 6, you’re out instantly. That means you’re no longer an eligible PBI recipient and must pay your BPJS dues either as PPU or PBPU.
The logic is fine on paper—subsidies should indeed go only to those who need them—but the sudden implementation is borderline heartless. Even more so when you consider that the government may have bumped you up on the DTSEN for any possible reasons.
Perhaps you recently renovated your house or bought a new vehicle or got a new job. Little is known, though—as the methodology isn’t exactly transparent—if the data collection takes into account, say, that you renovated your house because of a recent flood, or if you bought a new vehicle on credit to make it easier to take care of an elderly member of your family, or if your new job comes with a fixed-term contract only. In other words, we don’t know the extent to which the BPS actually verifies the accuracy of the database.
With lives on the line, why the rush?
The most glaring problem in this case is the rapid, rushed PBI status revocation without giving those affected any chance to contest their reclassification.
When did we decide it was okay to turn off someone’s life support—quite literally so for patients with chronic conditions—without as much as a heads-up? If you’re being moved out of the PBI scheme, you shouldn’t find out about it at the hospital when your scheduled dialysis determines whether or not you get to live the next day.
There needs to be a mandatory notification period of, say, three months, where the status remains something like “Active (Pending Transition)” or something to that effect. This would give people time to either appeal the reclassification or at least figure out how to squeeze a new monthly bill into their budget. That’s not asking for too much.
Yes, the Health Ministry issued a statement warning hospitals and care providers not to turn down patients just because their BPJS status is “temporarily” inactive. But that warning came with no explicit reassurance that the patients’ bills would be reimbursed. In the aftermath, the government has yet again done what they seem to have mastered: shifting their responsibility elsewhere. This fiasco puts healthcare providers in a tight spot as they now must choose between treating patients and going under because nobody pays their bills.
Don’t get us wrong. As we said earlier, we’re all for “trimming the fat” i.e. ensuring that subsidies go only to those who are in genuine need. And yes—we are not blind to the fact that there are many well-off people out there who game the system.
When essential services such as BPJS are treated with a “just do it” mentality, we risk trading one problem for another much larger in scale and consequence. In the case of the 11 million people who now no longer have access to their BPJS coverage, their lives are quite literally on the line.
Whether the government learns from this and controls the damage remains to be seen. But we’ll be watching.