Bond paper, big money: Why a $865M MAIFIP insert in the Philippine budget is exploding
Not free health care, just a small dent… with a big politician’s name on it
Manila: Every day, thousands of Filipinos with loved ones stuck in hospital limbo perform a familiar ritual: they line up outside a congressman’s or senator’s office, clutching folders, medical abstracts — and hope.
What are they hoping for?
A guarantee letter.
So what is this magical paper?
It’s usually just plain bond paper, but with powerful upgrades:
the name (and often the photograph), and signature of a politician on the stub, plus a promised amount.
Political coupon
Think of it as a political coupon.
The value? Often around ₱5,000 (<$100). The luckier ones, or those close to the lawmakers, could get more.
The patient’s relative submits it to the hospital, and — poof — it’s deducted from the final bill.
Not free health care, just a small dent… with a big politician’s name in bold face emblazoned on it.
As Filipino culture puts a premium on "utang na loob" (debt of gratitude), this guarantee letter is the perfect, though subtle tool for vote buying.
Why is it controversial?
It's the current the talk of the town, because money is exploding.
During this week's deliberations, the bicameral conference committee (comprising both the Senate and House members) pumped the MAIFIP (Medical Assistance for Indigent and Financially Incapacitated Patients) appropriation for the 2026 General Appropriation Act (GAA).
The Bicam’s move was simple and swift: raise MAIFIP funding to ₱51 billion, after the House of Representatives had earlier increased it to ₱49 billion from the original ₱24 billion proposal.
Now, the supersized MAIFIP is set to be hammered out before Christmas 2025 recess:
Critics cite several potholes in the MAIFIP scheme:
Auditors, budget-watchers and some lawmakers say the it is poorly-vetted;
It is vulnerable to political patronage (use of politicians’ “guarantee letters”)
In parts, it is under-utilised or unspent.
What is MAIFIP?
MAIFIP is a Department of Health (DOH) programme meant to help indigent or financially incapacitated patients pay medical bills — often implemented through hospital agreements.
This usually comes in the form of "guarantee" letters issued for individual patients.
The institution that rendered the medical service then reimburses the amount stated in the stub, or guarantee letter.
Key opponents
Those who oppose this scheme include Sen. Panfilo “Ping” Lacson, health critics and physicians (e.g., Dr. Tony Leachon), the Catholic leader Cardinal Pablo Virgilio David, and budget/civil-society commentators.
They warn the allocation undermines budget discipline, and can be abused for pork/patronage.
More fundamentally, it may run counter to existing health-system rules.
Economics Professor Cielo Magno expressed dismay over the Bicam's drive to raise funding for the MAIFIP in the 2026 national budget.
“It’s really disappointing because this MAIFIP system requires people to still ask for a guarantee letter from politicians before they can receive health assistance,” Prof. Magno said in an interview on True FM.
Senator JV Ejercito also called on the Bicam to carefully reconsider its proposal to supersize MAIFIP.
People would see this as “politically mediated access to healthcare.”
“Since we are willing to allocate a higher budget for health, I recommend to lodge it directly to Philhealth as the first payor of healthcare expenses or even directly to hospitals implementing zero balance billing,” Sen. Ejercito said.
“If our goal is to ensure proper medical assistance to the poor and to those just one illness away from poverty, we must seriously reconsider the massive increase in MAIFIP,” he added.
How much is 2026 MAIFIP?
This time, despite earlier Senate cuts and public objections, the "bicame" conference committee boosted MAIFIP to about ₱51 billion for 2026.
It is a form of shady budget "insertions" at the Bicam level, that helps perpetuate the culture of mendicancy and ensuring Filipinos remain of poor health at the mercy of their politicians.
It happened again this time at the Bicam level for 2026 GAA, and a bigger scale.
It's no different from the multi-billion flood control insertions, where the lawmakers themselves pick and choose beneficiaries of medical assistance.
The increase looked less like careful budgeting of Filipino taxpayers' money; it looks more like a last-minute political add-on.
Patronage, 'utang na loob' medicine
Critics do not oppose financial aid to the indigent facing crippling medical expenses. They want it expanded. But not the way they it is currently done.
They point out that jump at the Bicam level to ₱51 billion for 2026 was inserted despite earlier Senate reductions and public pushback.
Local media reported that it was driven by political requests rather than technical budget review.
If not clipped, MAIFIP "guarantee letters" issued by politicians is expanded as mechanism that lets incumbents steer funds to supporters and create unequal, non-transparent access.
Poor accounting
Unvetted or unspent money is another issue.
Face: the Commission on Audit and reporting outlets flagged portions of MAIFIP/related items as previously unspent or poorly accounted for (Philippine Star notes COA flagged about ₱3 billion left unspent), raising questions about whether expanding the pot is prudent.
Legal / policy mismatch concerns
Senator Lacson, a vocal critic of the MAIFIP system, argues the way funds are being allocated or guaranteed may not comply with the spirit or technicalities of the Universal Health Care Act and proper public-finance rules.
What is the alternative to MAIFIP?
Because MAIFIP relies heavily on guarantee letters, critics warn it turns health assistance into a political favour system.
Keep MAIFIP—but strip it of politics (minimum reform option)
Bad system:
“Get sick → line up at a politician’s office → hope for a signature.
Incumbents get to decide who gets help, when, and how much
raising concerns about unequal access, weak transparency, and “utang na loob” medicine.
Doctors and commentators have repeatedly flagged this risk.
In short: It’s health care — but with a queue, a photocopied face, and a lawmaker standing between the patient and the hospital cashier.
Better system:
Get sick → go to hospital → system automatically helps you.
If MAIFIP must exist:
Ban politicians from issuing guarantee letters
Rename it (remove individual attribution)
Set fixed benefit amounts and eligibility rules
Require real-time public disclosure
Penalise misuse explicitly
This turns MAIFIP from soft pork into social protection.
Reimagining MAIFIP
It's possible to re-imagine this system in a way that improves the process, not the political standing of those who dispense the letters. For example, hospital-based Medical Assistance Desks and funds go straight to public and accredited private hospitals, while the lawmakers focus on making good laws, not running medical social service.
Hospitals must be mandated to run these social service units with uniform eligibility rules.
Guardrails
National DOH guidelines.
Random COA audits.
Public dashboard of disbursements by hospital.
Replace guarantee letters with QR-coded digital medical vouchers.
Eligibility tied to 4Ps / Listahanan / PhilSys databases.
Why it’s better
Patients apply at the bedside, not in congressional offices.
Faster processing; less humiliation.
Clear audit trails (patient ID → hospital → payment).
Removes human discretion.
Prevents double-dipping.
Full transaction history, easy to audit.
With the Bicam deliberations hitting the Christmas homestretch, it's anyone's guess if any improvements sought would actually happen.
If nothing else, President Ferdinand Marcos Jr could line-veto the MAIFIP and bolster PhilHealth coverage.
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