Senator predicts R$ 45 billion increase in healthcare spending.

The Senate Agency Senator Humberto Costa (PT-PE) is working with a set deadline to finalize an agreement with the government on a new rule for allocating federal funds to the health sector. According to the rapporteur of the temporary committee studying the matter in the Senate, the conclusion of the negotiations, which he estimates could lead to an increase of more than R$ 45 billion for the sector in the medium term, should not go beyond this month of August.

"If there is an agreement, we will then present a report to the commission reflecting that result. If there isn't, then we will move on to a proposal based on our understanding of what is necessary for the sector," he added.

Negotiations have intensified since last week, when a working group formed by the Executive met for the first time, with the participation of four ministries, parliamentarians from both Houses of Congress, including Humberto Costa, plus representatives of the National Movement in Defense of Public Health - Health+10. On Monday (19), a new round of discussions will take place.

Humberto dismisses the idea that the creation of the working group might be a mere strategy to prolong the debate on the allocation of resources, a topic that has mobilized organizations linked to the sector for at least two decades. The senator said that, in addition to recognizing that current funding is insufficient, the government is "fully aware" that this is a demand from the population and that a project with this purpose will be approved regardless.

"So, there's no way we're going to drag this issue out. Otherwise, we'll vote here and that's it!" he warned.

Initially, the social movement for health aimed to allocate a minimum share of resources to the sector, corresponding to 10% of the gross domestic product (GDP), which would mean having at least R$ 400 billion per year to finance actions and services. Later, it softened to a proposal involving the same percentage, but applied to the annual gross current revenue (RCB). Now in 2013, this would represent investing more than R$ 129 billion per year, if the allocation occurred immediately, based on the full percentage.

Today the federal government spends just over R$ 83 billion in this area, equivalent to 6,42% of gross revenue. If the percentage is raised to 10%, projections indicate that expenses would reach more than R$ 129 billion in 2014, with the announced increase of just over R$ 45 billion.

Alternative

The senator notes that the second solution under discussion takes into account the allocation of a percentage not to gross revenues, but to net current revenue (NCR). According to this concept, those amounts transferred to states and municipalities by constitutional or legal mandate are primarily deducted from the gross base.

The rapporteur of the temporary committee – chaired by Senator Vital do Rêgo (PMDB-PB) – prefers the second alternative. However, since the calculation base will be smaller due to the RCL concept, Humberto Costa advocates for the application of a higher allocation percentage of 18,5%.

In 2014, by one criterion or another, the extra resources would have remained practically the same at the aforementioned R$ 45 billion. Over time, however, there would be a divergence between the projected amounts, with less significant growth for the calculation based on the Net Current Revenue (RCL). In 2020, for example, resources for the sector would reach more than R$ 314 billion, based on 10% of the Gross Current Revenue (RCB). With the application of 18,5% of the RCL, the amount would fall to just over R$ 303 billion.

According to the rapporteur, despite everything, investments in the sector will be more secure based on the concept of net revenue. This is because, as he explains, there is currently no clear definition of what gross revenue actually is. Thus, he fears that in the future there may be a "subjective interpretation" by governments in power that could lead to a reduction in investments.

"Therefore, it's better that it has a clear definition and that it cannot be subject to legal challenges in the future," he noted.

popular initiative

In favor of allocating 10% of gross revenue to the health sector, the "Health +10" Movement sent representatives to Brasília this week. One of their objectives was to deliver a popular initiative project addressing this proposal to the presidents of the Federal Senate, Renan Calheiros, and the Chamber of Deputies, Henrique Alves. The organizers gathered more than 2 million signatures for the project nationwide.

The movement added the brand "Health+10" to its original name to commemorate the 12th National Health Conference, held in 2003 and considered a landmark in discussions on public health. Participants include entities such as the National Conference of Bishops of Brazil (CNBB), the Brazilian Bar Association (OAB), the National Council of Health Secretaries, the National Council of Municipal Health Secretariats, labor unions, and popular organizations.

Transition

The proposed allocation rule is expected to replace the one maintained by Congress last year with the approval of a supplementary law regulating Constitutional Amendment 29. After lengthy debate, during which there was talk of adopting a percentage of GDP or revenue, the government asserted its will and preserved the existing calculation: applying the amount from the previous year plus the nominal variation of GDP. As before, states were obligated to allocate 12% of tax revenue, and municipalities, 15%.

But the issue now is not whether the Union should immediately invest all the resources under the new allocation rule. Without prior definition of objectives, priorities, and goals, this "would be the same as throwing money away," according to Humberto Costa. Therefore, discussions also involve defining a transition rule that takes into account the increasing incorporation of resources. For the senator, a good measure would be to start with extra resources of around R$ 7 billion as early as 2014.

"With this money, we could meet immediate demands and, at the same time, begin more planned investments," he considered.

Sources

With the approval of the bill allocating 75% of total oil royalties to education and 25% to health, now in the signing phase, Humberto Costa says that part of the problem of financing the new expenses has been resolved. In his view, due to the current moment of recession and strong external competition, the productive sector needs stimulus. Therefore, he considers it complicated to address new forms of taxation to cover the new expenses at this time. Among the alternatives always mentioned are taxes on large fortunes, as well as a new type of contribution.

"We have to work with what's possible now and discuss this further later. Then we can examine various alternatives," he said.

In his opinion, the most urgent matter at the moment is the approval of a legal norm that makes it possible to punish those who mismanage public health policies in the country, those who fail to comply with legal obligations or commit fraud to divert resources. A bill with this purpose (PLS 174/2011), authored by him, is being processed in the Senate. He expects the vote to be concluded this semester and then proceed to the Chamber of Deputies. He recalled that the Ministry of Health itself is requesting urgency for this matter, with a similar bill also being processed in the Chamber.

We need to show the population that there is control over resources, both to increase the legitimacy of the Unified Health System and to justify the demand for more resources.