Deep Dive: Colombia's Petro government issues decree for radical EPS changes; Acemi warns of crisis for millions

Colombia's health system, centered on EPS (Entidades Promotoras de Salud, private and public health insurance entities that manage coverage for over 50 million affiliates), faces a pivotal shift under President Gustavo Petro's administration. Petro, a left-leaning leader elected in 2022 on promises of social reform, has prioritized overhauling what he views as inequities in healthcare delivery. The decree represents a bold executive action amid ongoing congressional gridlock, reflecting Petro's strategy to bypass legislative hurdles for policy implementation. Acemi's stark warning of a crisis for millions signals deep divisions between government reformers and industry incumbents. Historically, Colombia's 1993 health reform introduced the EPS model to expand universal coverage, blending public funding with private administration. This system has achieved high affiliation rates but drawn criticism for inefficiencies, high administrative costs, and uneven service quality, particularly in rural areas. Petro's push for radical change aligns with his broader agenda to dismantle neoliberal structures, framing EPS as profit-driven barriers to equitable care. Acemi, representing pharmaceutical distributors, medical suppliers, and related firms, counters that abrupt reforms risk collapsing provider networks without viable alternatives. Key actors include the Petro government, pursuing ideological transformation to bolster social welfare; Acemi, defending market-oriented stability; and EPS entities like Nueva EPS and Sanitas, which dominate affiliations. Strategic interests diverge: the government seeks centralized control to reduce costs and improve access, while industry players prioritize operational continuity to avoid financial losses. Cross-border implications are limited but notable for regional health investors from the U.S. and Europe, who hold stakes in EPS, and for migrants relying on Colombia's system. Looking ahead, judicial challenges from Acemi and EPS are likely, given Colombia's Constitutional Court history of intervening in health reforms. If upheld, the decree could accelerate Petro's reforms but provoke shortages; if struck down, it may fuel political polarization ahead of 2026 elections. This episode underscores Colombia's tense power dynamics between progressive executive ambitions and entrenched sectoral interests, with millions' health access hanging in balance.