Medical aid with no strings attached
President Marcos signed earlier this month the P6.7 trillion national budget for 2026, which includes P51 billion for the government’s controversial Medical Assistance for Indigent and Financially Incapacitated Patients (Maifip)—dubbed by critics as political patronage in the guise of medical assistance.
Maifip has been likened to the Priority Development Assistance Fund (PDAF), declared unconstitutional by the Supreme Court in 2013 for violating the separation of powers between the executive and legislative, as it allowed legislators to exercise executive functions, such as project identification and fund release after budget approval.
The Maifip evolved from the Medical Assistance to Indigent Patients, which started in 2014, and was later institutionalized under Republic Act No. 11463 or the Malasakit Centers Act in December 2019. The law aimed to create one-stop shops for medical assistance but was heavily criticized for being exploited as a political platform by its principal author, Sen. Bong Go, then an aide to former President Rodrigo Duterte who ranked third in the 2019 senatorial race despite being a first-time national candidate.
Patronage politics
The program has since ballooned into a multibillion-peso budget item that its critics said is merely a reinvention of the pork barrel and highly encourages the culture of patronage politics. Under this practice, patients or their relatives make a beeline to politicians’ offices to secure guarantee letters (GLs) that they present to hospitals to cover their hospitalization expenses.
Take what happened in July last year: the Private Hospitals Association of the Philippines Inc. suspended honoring GLs issued by government officials for indigent patients to avail of the Maifip after payables under the program reached about P530 million. The GLs, usually coming from senators, representatives, governors, mayors, even barangay chairpersons, have gone out of control, so that the government could no longer keep up with the payments.
On top of the unpaid balance, hospitals were also wary that GLs sent by those who lost in the May midterm elections would no longer be honored—highlighting further how public services like health become precarious when tied to politics.
Dignified access
Maifip, during deliberations on the 2026 budget, became a hot button issue, with its 50 percent increase from the P24.23 billion proposed under the National Expenditure Program raising even more red flags.
This time, Secretary Teodoro Herbosa assured that GLs will no longer be necessary to access the Maifip. But critics like health reform advocate Tony Leachon remain skeptical, warning that the program revives “pork barrel politics” and undermines the foundation of Universal Health Care (UHC).
In a Facebook post, Leachon pointed out that Maifip bypasses the Philippine Health Insurance Corp. or Philhealth and duplicates its functions, and are vulnerable to discretionary use. He added that in reality, even though GLs will no longer be needed, “access often depends on influence, offices, and political mediation. This perpetuates inequality.”
To address these concerns, lawmakers included an “anti-epal” provision in the 2026 General Appropriations Act banning political involvement in aid distribution. The Department of Health (DOH) is set to issue implementing rules and regulations for Maifip following this new provision, with guidelines expected by mid-February. The agency has also committed to ensuring easy and dignified access for patients “without political interference.”
Harsh penalties
These guidelines must then spell out the process of how to avail of the program and remove loopholes that could be abused. It should be taking notes from the PDAF case and the flood control corruption scandal, which has seen the fall of many officials, including those in nonelective positions.
Aside from the DOH guidelines, lawmakers must fast-track proposals to place the program under the UHC law. One such measure, Senate Bill No. 1593 filed by Sen. Ping Lacson, sees this consolidation as necessary to eliminate overlaps and redundancies with other medical assistance programs implemented across different government agencies by placing them under a “universal medical assistance program.”
Lacson’s bill also proposes harsh penalties for government officials who exploit and manipulate the program, including endorsing individuals or violating the provision against grabbing credit. Aside from possible criminal, civil, or administrative charges, they will also face perpetual disqualification from holding public office.
To be clear, a program like the Maifip that seeks to ease the burden of poor Filipinos is not execrable. It only becomes unacceptable when it is distributed as a political token to gain access to a public service that, in the first place, every Filipino has the right to, without any conditions or strings attached.
