The House of Representatives has given the Philippine Health Insurance Corp. (PhilHealth) until Friday to submit a proposed schedule of new, higher case rates for 2026, warning that state subsidies for next year would depend on the agency’s compliance.
During plenary deliberations on the Department of Health’s proposed ?253-billion budget, House appropriations committee chair and Nueva Ecija Rep. Mikaela Suansing reminded the state insurer that since the chamber was proposing to realign ?60 billion that was slashed from the Department of Public Works and Highways’ (DPWH) proposed 2026 budget toward subsidies for the National Health Insurance Program, PhilHealth must commit to raising case rates.
Case rates refer to fixed reimbursement amounts given to hospitals and doctors per illness or procedure.
‘I hope that the PhilHealth will give us the updated case rates by Friday and that should already be the closest estimates to what would eventually be the increase in case rates,’ Suansing stressed. ‘We should not just see ballpark figures.’
‘We are doubling PhilHealth’s budget. Just looking off of that, [our] expectation is at least a 50 percent increase in case rates,’ she added.
Suansing’s deadline – announced past midnight of Sept. 30 – will determine whether the House would eventually approve the additional subsidy.
‘I think everyone is in agreement that the ?60 billion is a huge ask on the part of PhilHealth and we would need more information as to whether or not to ultimately approve it in the final version of the House general appropriations bill,’ she said.
The ?60 billion represents excess PhilHealth funds reverted to the national treasury in 2024 and ordered returned by President Marcos Jr. on Sept. 20.
This is on top of the ?53 billion already earmarked for state subsidies in the 2026 National Expenditure Program. This means PhilHealth could receive a total of ?113 billion – if the House is satisfied with its submission by Friday.
Both Suansing and Iloilo Rep. Janette Garin, a former health secretary under the Aquino administration, pressed PhilHealth officials to detail increases in packages covering major procedures such as angiogram and angioplasty.
Initially, PhilHealth officials were reluctant to commit to figures, saying that increases must undergo actuarial studies to ensure sustainability.
But later, through sponsoring lawmaker Bataan Rep. Albert Garcia, they estimated that coverage for an angiogram could rise to ?100,000, while angioplasty could increase to about ?200,000.
Suansing argued that PhilHealth could afford an ambitious increase in case rates as its massive reserve funds could cover the deficit.
Beyond case rates, the appropriations chair previously warned PhilHealth that it must not use the additional subsidies for investments.
PhilHealth’s case rate system was intended to simplify payments and curb fraudulent claims. However, it has long been criticized for failing to keep pace with rising medical costs.