The Karnataka government has framed a Draft Karnataka Right to Health and Emergency Medical Service Bill, 2025, but its moves ahead of enacting the Bill create doubts about intent.

Whether the effect of a recent policy, to rationalise care by reallocation of staff to busier taluk hospitals, will result in some closures of low-volume primary and community health centres remains to be seen.

The irony cannot be missed when the state's 2026-27 budget document says: "In health, the focus will remain on expanding primary healthcare networks, upgrading district and tertiary care facilities". The Bill must be passed with standards for the right to health set before these changes are enforced.

Given the current standards of health services, the government has a long way to go to fulfil the right to health. Despite being one of India's richest states, Karnataka falls behind on key indicators, such as maternal and infant mortality rates, levels of anaemia, and child under-nutrition. Karnataka has allocated 4.3% of its expenditure towards health for 2026-27, lower than the average allocation for health by states in 2025-2026 (6.2%; PRS India analysis).

The state is also grappling with poor infrastructure in its healthcare institutions, large-scale vacancies at all levels, a lack of medicines and preventive screening systems, and inefficient early management of diseases and disorders. Multi-morbidity is on the rise, while the increasing incidence of Non-Communicable Diseases (NCDs) - accounting for over 60% of the state's disease burden - indicates an epidemiological crisis.

Karnataka Janaarogya Chaluvali (KJC) has noted the risks of the Draft Bill legitimising large-scale privatisation by empanelling hospitals and outsourcing ambulance services, but without effective regulation of private hospitals and their costs. Sarvatrika Arogya Andolana Karnataka (SAAK) says the entitlements defined in the Bill are not comprehensive and lack the minimum features of an effective Right to Health Act.

For instance, the Bill fails to incorporate what percentage of the state budget is needed to provide 'health for all'; the human resources policy to ensure the availability of doctors and staff; the standards for infrastructure and the geographical/demographic criteria for providing healthcare facilities, etc. The Bill states that these will be determined according to standards "as may be prescribed."

In effect, the Bill is only an enabling legislation, expressing an aspirational wish-list and commits to no standards of service that a rights-based law should have prescribed. The state plans to frame these standards on the advice of the State Health Authority. There is no mention of adherence to the Indian Public Health Standards (IPHS).

KJC has demanded that the Bill "explicitly provide the right to universal, free healthcare services... for ALL citizens for ALL health conditions," without exceptions. The Bill proposes free healthcare only to "eligible households," as defined in the National Food Security Act.

In most countries with free healthcare, the models are based on the ILO Social Security Convention. The National Health Service (NHS) of England is primarily funded by the government, through deductions from wages of employees earning above a certain level,and equal contributions from employers, which makes the employers accountable for the health of their workforce. Karnataka can enact a similar law to finance a universal right to health. In this scenario, the government would have to contribute on behalf of those earning below threshold levels. The Draft Bill does not discuss potential financing models along these lines.

While regulating the private sector, a provision that private entities provide at least 25% of their services free to the poor may be incorporated, in line with a similar provision in the RTE Act, as many hospitals have received land from the government at subsidised rates.