In early February 2026, Indonesian social media platforms were flooded with distressing videos and heartbreaking stories from hospitals. These weren’t tales of long queues or medical staff shortages, but rather of kidney failure patients being denied critical dialysis services. The reason, chillingly technical and indifferent, was the deactivation of their BPJS Kesehatan PBI (National Health Insurance – Contribution Assistance Recipients) status.
The controversy began on February 1, 2026, when the Ministry of Social Affairs deactivated approximately 11 million PBI participants from the National Health Insurance program. The official explanation cited data cleansing and verification efforts to eliminate duplicates, inaccuracies, and individuals deemed capable of self-payment or deceased. However, this sweeping policy was implemented without adequate prior notification to the affected participants, setting the stage for widespread distress.
The immediate consequence was an outpouring of chaos in healthcare facilities. Dozens, even hundreds, of kidney failure patients discovered their BPJS coverage was inactive just as they were undergoing or preparing for dialysis. One particularly viral story featured Ajat, a 37-year-old resident of Lebak, Banten, who was tragically turned away from Dr. Adjidarmo Regional General Hospital. Despite Ajat’s repeated visits to the social services office and BPJS offices, no swift resolution emerged to save his deteriorating condition, highlighting systemic failings.
The Indonesian Dialysis Patient Community reported at least 160 similar cases from various regions across the archipelago. Videos of frail patients, rejected by hospitals and bewildered by the bureaucratic system, spread rapidly across X, Instagram, and TikTok. Many netizens vociferously described the situation as a perilous gamble with human lives, fueling a massive public outcry.
Dialysis is not a procedure that can be postponed; kidney failure patients require this life-sustaining therapy routinely for life. Even a single delayed session can lead to a dangerous buildup of toxins in the blood, severe shortness of breath, and ultimately, death. With each session costing hundreds of thousands to a million rupiah, self-payment is simply not an option for the vast majority of PBI participants, underscoring their absolute dependence on the social security system.
Under mounting public pressure, the government finally responded. On February 6 and 7, 2026, the Ministry of Social Affairs announced the reactivation of PBI membership specifically for dialysis patients and reiterated that hospitals must not refuse patients in emergency conditions. Around 100 to 160 patients were prioritized for status restoration. Administratively, the immediate crisis appeared to subside.
However, the real issue did not end there.
This incident unmasked deeper questions concerning the fundamental relationship between the state and its citizens. It moved beyond mere data management or inter-agency coordination, delving into how the state conceives of who is truly worthy of protection within its borders.
In his seminal work, Imagined Communities, Benedict Anderson posited that a nation is not an intrinsic entity but rather lives through a shared imagination of fraternity. Citizens, though often strangers to one another, believe they are bound within a single community that cares for its members, forming the bedrock of national identity.
The National Health Insurance program, particularly its PBI component, has historically served as a tangible manifestation of this collective imagination. The state envisioned every citizen, especially the poorest and the sickest, as an integral part of “us.” Within this framework, illness was never meant to be a reason for exclusion from the social fabric.
The mass deactivation of PBI participants, however, starkly exposed the fragility of this shared imagination. Overnight, the boundaries of citizenship were redrawn by cold data points and economic deciles. Citizens who were once deemed deserving of protection found themselves arbitrarily cast out of the system without any humane process. The state reappeared as a protector only after viral pressure mounted, rather than proactively embodying its role from the outset.
This case tragically illustrates how the utopia of universal healthcare can collapse at the administrative desk. The state presented itself primarily as a database manager, yet was conspicuously absent as a guarantor of its citizens’ fundamental sense of security.
Criticism of this policy does not imply a rejection of data updates or the refinement of social assistance programs. Indeed, the state must ensure that aid reaches its intended beneficiaries effectively. However, the *method* of policy implementation profoundly determines whether public trust is nurtured or irrevocably shattered.
Transparency, adequate advance notification, swift grievance mechanisms, and an unwavering assurance that chronic patients never face service disruption should be foundational principles. Without these safeguards, health insurance risks becoming a mere slogan rather than a genuine shield of protection for its most vulnerable citizens.
Indonesia is not solely constructed from regulations and budget figures; it thrives on the security and well-being of its people. When vital healthcare access can be abruptly withdrawn and reinstated only after going viral, what is truly jeopardized is not merely BPJS services, but the profound trust in the state as a collective home for all its citizens.