Livestreaming to the public the Bicameral Conference Committee (Bicam) failed to deter legislators from creating another discretionary fund of P51.6 billion under the Medical Assistance to Indigent and Financially Incapacitated Patients (MAIFIP).

Bicam leaders insisted MAIFIP is “not a pork barrel,” a statement which, for many, is an assurance that indeed the questioned fund will be used for patronage politics.

In a 2013 ruling, the Supreme Court struck down all forms of pork barrel, including the Priority Development Assistance Fund (PDAF), holding that such discretionary allocations violate the Constitution.

The MAIFIP requires political mediation to access medical assistance. The Bicam’s MAIFIP proponents argued that funds for the program are disbursed directly to hospitals, that it no longer involves guarantee letters and that it is governed by set provisions.

It, however, necessarily contravenes the Universal Health Care law that mandates PhilHealth as the sole provider of the health care program.

UHC advocates argued that the MAIFIP creates a parallel, discretionary system that undermines PhilHealth rather than strengthens it.

Bicam defenders said the guarantee letters (GL) from politicians, which enable the MAIFIP, are optional and that this is never a choice for a poor patient.

Access to GLs largely depends on influence, offices and political mediation, perpetuating inequality.

A UHC champion indicated that PhilHealth’s all-case rates already cover hospitalization costs, which MAIFIP duplicates, resulting in wasted resources and weakening the systemic reform.

The 2026 national budget still contains up to P245 billion in unprogrammed appropriations, funds that are vulnerable to discretionary use. The MAIFIP is among the budget items with an opaque framework and without clear liquidation safeguards.

Opponents of the program said its existence was primarily due to the “Floodgate” scandal.

When the flood control programs were investigated, the opportunity to pocket public money was diminished.

Still, the Supreme Court, in a ruling rejecting the methods used to pilfer P89.9 billion from PhilHealth, made clear the UHC provision that states PhilHealth is the source of health service-related funds.

In 2024, P60 billion was taken from PhilHealth, and this year the agency was defunded of its subsidy.

Increasing the budget for MAIFIP weakens the UHC. The 2026 budget proposal seeks P53 billion in subsidies for PhilHealth, but MAIFIP was also increased by P51 billion. In the long run, health activists believe that MAIFIP will grow, whereas the UHC, with a structured program, will weaken.

Patients end up begging politicians, which violates the SC decision that there must be separation between the legislative and executive functions. Lawmakers should have no role in the implementation of projects.

UHC supporters said the 2026 budget item may again be challenged before the SC. The lament of health service advocates is that it would be a waste of the hard work invested in landmark laws, including the sin tax laws intended to finance the UHC, which reduced people’s out-of-pocket expenses.

If the MAIFIP is continued, free universal healthcare will never be achieved.

The MAIFIP racket begins with the GL, obtained from the office of a politician, who calls the regional or provincial hospital director.

If the allocation is P10 million, an agreement can be struck in which P8 million will go to the government official, P1 million to the hospital head, and only P1 million to the patient.

Patients line up and, after several hours, receive only P5,000 or P10,000, owing a debt of gratitude for the puny amount compared with their need.

The UHC has case rates for heart attacks where improvements were made. Angiograms and angioplasties are now covered at P500,000, which is deducted from the hospital statement of account. There is auditing and liquidation and doing the transactions does not require leaving the hospital.

Under MAIFIP, the beneficiary must leave the hospital, obtain abstracts and certificates of indigence, process numerous documents, go to the DoH and still not find the relevant official. The patient’s treatment is delayed.

One patient remained hospitalized for six months because a politician had promised assistance but failed to deliver, according to a health advocate.

From one corruption portal to another, MAIFIP replaces flood control as the new conduit for pork.