Petro's healthcare reform fiasco
Colombian President Gustavo Petro's healthcare reform was supposed to be the cornerstone of his social reforms. It's turned into a political fiasco that's weakened his government and coalition.
The healthcare reform was one of the big promises of Gustavo Petro’s 2022 campaign.
The reform has turned into a fiasco and a major political defeat and humiliation for Petro’s left-wing administration. Even before it saw light of day, it divided Petro’s own cabinet and disagreements over it eventually led to the dismissal of education minister Alejandro Gaviria on February 27. In Congress, the original text was widely rejected by the other parties in Petro’s increasingly fledgling congressional coalition. After stonewalling in cabinet, Petro was forced to negotiate a compromise reform that significantly differed from his original reforms. But even this compromise reform didn’t satisfy the three traditional parties in his coalition, who, in late March, announced one by one that they wouldn’t support it.
The healthcare reform was supposed to be the cornerstone of Petro’s transformational social reforms. It ended up crystallizing and solidifying opposition to his government and weakening his congressional coalition. Let’s take a look at what the healthcare reform was, why it was unpopular and the political fiasco that ensued.
A transformational reform that wasn’t
Health minister Carolina Corcho’s healthcare reform, presented on February 13, laid out a total transformation of Colombia’s healthcare system. As Petro promised during the campaign, the reform would have largely replaced the current ‘mixed-market’ healthcare system created by Law 100 of 1993 with a single, predominantly government-run single-payer public system.
The current system is based around compulsory universal health insurance, divided into a contributory regime for those able to pay (12.5% of monthly covered earnings, split between employers and employees) and a subsidized regime for the poor. Beneficiaries enroll with public or private health insurance providers known as EPS (entidades promotoras de salud), are entitled by law to a basic benefits plan and receive care within their EPS’ network (providers are known as IPS).
Colombia’s healthcare system is not bad — it ranked highly in a WHO survey, it now has near-universal insurance coverage (split about 50/50 between the two regimes), low co-pays and a low proportion of out-of-pocket expenditures — but there are major deficiencies in the quality of care and the system has been beset by a never-ending series of corruption and fraud scandals in the EPS. The EPS, widely considered the biggest problem with the system, have become the lightning rod for criticism because of the poor job they do at managing clinical and financial risks but also because of their scandals, suspicious profits, spectacular rise and falls, financial crises, inefficiencies and for allegedly acting as a barrier between patients and care providers (denying treatment and care, leading to tutelas in court and congesting the judiciary). EPS owe 23.3 trillion pesos (over 4 billion dollars) to healthcare providers.
The government and its supporters argue that the EPS have turned healthcare into a business for a select few rather than a right, and blamed them for nearly bankrupting and collapsing the system (even pre-pandemic) in their corrupt quest for profit.
Petro and Corcho’s healthcare reform was to be a structural transformation of the system.
Corcho’s healthcare reform claimed to change the focus of the system from treatment to prevention and primary care. In his rally/public announcement of the reform on February 14, Petro said that there’s never been preventive healthcare in Colombia, neither before or after Law 100. This isn’t entirely correct, but preventive healthcare has been weak and the current system has largely focused on treating illness.
One of the main elements of the new system would have been primary care centres (centros de atención primaria integral y resolutiva en salud, CAPIRS or CAPS), the gateway to the system, offering medical consultations and checkups. There would have been one CAPS for every 20,000–25,000 people and residents would have been assigned to the centre closest to their house (with no ‘freedom of choice’ in the matter). The centres would have referred patients to an integrated network of providers (hospitals, clinics, labs etc.) providing secondary and tertiary care. The CAPS would also have been the base for the preventive medical teams that would visit local residents, announced by Petro and Corcho in November 2022.
The reform essentially eliminated EPS as insurers and intermediaries. In the new system, the system’s financial administrator (ADRES) would directly pay all healthcare providers (public, private or mixed). Currently, the ADRES makes capitated payments to the EPS based primarily on their number of enrollees and their age. Direct payments already exist: since 2011, the ADRES makes direct payments to IPS in the subsidized regime and to some in the contributory regime.
The quasi-elimination of the EPS had been Petro’s promise and Corcho’s goal, but the government’s messaging had become more ambiguous and confusing, with interior minister Alfonso Prada announcing just days before (on February 9) that the EPS would not be eliminated. Technically, he was correct, since the reform gave the EPS new roles, like creating and administering CAPS. To defend the reform, Corcho repeated ad nauseam that EPS don’t provide care to people — or, as she put it more crudely on Instagram in early February, las EPS no curan, las EPS facturan (the EPS do not heal, the EPS bill).
The ADRES would have managed all healthcare funds and paid providers through seven regional funds at a fixed fee schedule for secondary care, while primary care centres would have been paid directly via territorial funds at the local government level (departments and municipalities), which would not manage funds themselves. The reform did not propose any changes to healthcare funding.
The reform proposed to strengthen the position of the health ministry, to be assisted by a rather large national health council (a similar body was abolished in 2007) made up of representatives from the government, local governments, business, unions, civil society, patients’ organizations, academia, medical professionals, medical institutions and civil society. The council would have been in charge of proposing and coordinating public policy and regulations and evaluating the system. The reform also sought to strengthen the monitoring and control powers of the national superintendence of health (Supersalud).
The new system would have been territorialized, with people assigned to the CAPS closest to where they live in their municipality and other healthcare providers organized in networks at the departmental level. In addition to the national health council, the reform wanted to create a plethora of new ‘participatory’ bodies — territorial health councils, the boards of regional health funds (overseeing the proper management of funds at the regional level), departmental health planning and evaluation councils and ‘participation and monitoring councils’ for the operations of CAPS.
In addition, the reform proposed the creation a single health information database (SPUIIS) that would provide real-time access to medical histories, epidemiological, pharmacological and administrative information and a record of economic transactions. The reform also wanted to modify the legal status of public healthcare institutions, guarantee better working conditions for healthcare workers in public institutions and set basic labour standards for healthcare workers in the private sector.
The reform left the length of the transition period to the new system undefined, although the government would have had one year to regulate the new system. During this period, EPS which are not in a liquidation process would have needed to settle the terms for the ‘gradual and orderly’ transfer of their members to the new system (in CAPS). To facilitate the transition, the government wanted to ‘territorialize’ the EPS to harmonize them with the new system. The Nueva EPS (owned by the state and by some family compensation funds) would have taken over patients from EPS being liquidated and in regions without presence of an EPS, and contributed to the organization of the new system. In addition to their current 10 million members, Nueva EPS would have receive 11.4 million new members from other EPS, making them the big winner of the reform.
The bill would have given Petro extraordinary powers including establishing ‘incentives’ for the EPS to participate in the transition and to secure more money to capitalize the Nueva EPS.
The remaining EPS would have been forced to transition to new roles in creating and administering CAPS, change the purpose of their business (offering auditing services, creating new healthcare providers themselves — many EPS already own their own network of IPS), or suspend their operations and sell their infrastructure to the government. Corcho told RCN that only eight or nine EPS — out of 27 — would meet the requirements to ‘survive’ in the new system.
A very divisive reform
Petro and Corcho seemed to have deluded themselves into thinking that people’s oft-repeated complaints about EPS meant that they would have hailed their complete elimination.
While people have a lot of complaints about the EPS, there isn’t a lot of appetite for the kinds of structural changes the government is proposing. A poll on healthcare sponsored by the employers’ association, the ANDI (critical of the reform) in late January found that only 32% agreed with the elimination of the EPS and 32% said that the system should change entirely. A majority of respondents were relatively happy with the healthcare system (34% excellent and 39% acceptable) and with the management of both the subsidized and contributory regimes. A substantial majority (58%) support some changes and modifications to the system, primarily seeking smoother and better access to care. Petro took to Twitter to criticize the poll, saying that the biggest problem with it was that those who died while waiting for medical care could not be polled.
Without the EPS’ financial intermediation and risk management, financial and clinical risks would be managed directly by hospitals. For many critics, one of the biggest risks with the new system would be the lack of cost controls.
Firstly, the ADRES lacks the operational capacity and expertise to manage the entire healthcare budget and the complicated structure laid out by the reform created more bureaucracy and increased the risk of political interference and corruption. Colombian local governments have a long, infamous history of healthcare corruption—like the hemophilia cartel in Córdoba. On this point, Corcho repeatedly said that governors and mayors won’t be handling money.
Secondly, as hospitals and clinics would be paid for each service/procedure, they would have incentives to overuse the system and spending could spin out of control. Even the fixed fee schedule would not be enough to rationalize and control costs, and could create perverse incentives (billing unnecessary procedures, while providers with higher costs reduce services to avoid losses). Out of control spending could lead to the collapse of the system. Indeed, one of the persistent fears about Petro’s reform is that it would lead to a repeat of the crisis of the old Seguro Social system in the late 1990s and, more generally, a return to the segmented and very unequal pre-Law 100 system.
As explained in a good article in El Espectador, any healthcare reform is complicated because it deals with a system with many actors and competing interests. Past attempts at structural changes quickly ran into opposition, although there have been significant changes to the system through laws like the 2015 statutory law. It’s no different this time. Corcho’s reform was opposed by several former health ministers (most prominently her predecessor, Duque’s last health minister, Fernando Ruiz), the ANDI and various sectoral groupings/lobbies (like the ACEMI and Gestarsalud, the main federations of EPS). On the other hand, the Colombian Medical Federation (of which Corcho was president before becoming minister) supported the reform, along with public hospitals, while 12 other medical federations which support a reform in principle expressed some concerns in a joint statement.
Cabinet crisis
Even within cabinet, the reform was divisive — and led to Petro’s first cabinet crisis. A group of centrist ‘liberal’ ministers led by Corcho’s rival, then-education minister Alejandro Gaviria, who served six years as health minister (2012–2018) under Juan Manuel Santos and defends the positive aspects of the current healthcare system (and the role of EPS in it), opposed Corcho’s ‘radical’ reform. In November 2022, Gaviria said he disagreed with Petro and Corcho’s argument that Colombia’s healthcare system is one of the worst in the world. In January, Gaviria cryptically tweeted that “reforms need dialogue, discussion, debate, scrutiny” and that this is the only way to “build legitimacy and avoid big mistakes.” Gaviria was supported by two other centrist-liberal ministers — finance minister José Antonio Ocampo and agriculture minister Cecilia López.
Carolina Corcho, the health minister, is a doctor and activist. A permanent critic of Law 100 and the EPS, much of her life has been dedicated to activism: leading the national association of interns and residents, opposing a healthcare reform proposal by health minister Alejandro Gaviria in 2013, and, as vice president of the Colombian Medical Federation, a strong critic of the Duque administration’s response to the COVID-19 pandemic and vaccination campaign. She sometimes bases her arguments on her own opinions rather than facts, making misleading, inaccurate or false statements during the pandemic or blaming all 11.8 million preventable deaths between 1998 and 2011 on the healthcare system. As minister, Corcho saw the healthcare reform as her ultimate battle.
In January, a document detailing Gaviria’s concerns with the healthcare reform project was leaked to the press. In the document, Gaviria said that the current system has many strengths and that destroying it would be suicidal, and claimed that eliminating EPS would not solve problems like financial unsustainability, corruption and regional inequalities. He also posed several questions that the reform left unanswered, and argued that Colombia’s experience with single-payer systems has been disastrous.
La Silla Vacía revealed in early February that Laura Sarabia, Petro’s chief of staff, had called Gaviria to ask him to publicly retract the document and insinuated that he should resign if he did not. Gaviria refused, but agreed to publish tweets in which he explained that he prepared the documents before a cabinet retreat in Villa de Leyva and reiterated his firm commitment to Petro’s government while saying that he’d contribute “responsibly and with good judgement” to internal cabinet discussions.
On February 26, Cambio confirmed the existence of another document by the ‘dissenting’ ministers. The document, prepared by Gaviria, Ocampo, López and national planning director Jorge Iván González contained their concerns with the draft version of the reform presented in cabinet by Corcho on February 9, including the financial costs of the reform. Essentially, the ministers complained that Corcho didn’t take into their account their comments (the fundamental point of disagreement being the single-payer model and the role of the EPS) and that she was greatly underestimating the costs of the reform. According to Cambio, Petro would have said that “if this documents leaks, the reform will fall.”
Petro said that the document was real and that it was discussed for “hours and days”, and that changes were made as a result of the discussion. The finance ministry released new numbers of the costs of the reform, although even with new numbers the reform still left a major funding gap that’d require new revenues (about $1.6 billion). However, the final text of the reform did not take into account the dissenting ministers’ comments.
On the evening of February 27, surrounded by his ministers (with Corcho placed prominently to his side), Petro announced the dismissal of Alejandro Gaviria as well as culture minister Patricia Ariza and sports minister María Isabel Urrutia. Urrutia and Ariza claimed that they didn’t know that they’d be fired, while Gaviria thanked Petro for the opportunity to be part of his cabinet. Gaviria’s opposition to the reform increasingly distanced him from Petro, but he was fired primarily because Petro distrusted him after the two leaks — even though it’s unlikely that Gaviria was the leaker (and he has denied it himself). W Radio claimed that Petro also considered firing López (who had also publicly spoken out about her concerns with the text) and Ocampo.
The loss of one of the most vocal centrist/liberal voices in cabinet sent a a signal that Petro isn’t good at managing dissent and isn’t conciliatory . It also brings back memories of the heavy turnover in Petro’s mayoral administration in Bogotá.
Petro’s disastrous show of force
Petro made the healthcare reform the cornerstone of his social reforms. In the face of criticism and controversy around it, he chose to amp up social agitation in the streets to support his reforms. In January, Petro called on the ‘forces of the government of change’ to “discuss the reforms in the street” on February 14 and May 1.
Petro wanted to make the pro-government marches on February 14 a massive theatrical show of force for the healthcare reform (presented a day before) to impress Congress and to upend the anti-government protests (rescheduled for the following day). Petro released a flashy video on Twitter and opened up the Plaza de Armas in front of the Casa de Nariño (the presidential palace) to the crowds (the square, which faces the back of Congress, is usually closed to the public and reserved for protocolary events). Petro addressed his supporters from the balcony of the Casa de Nariño, which is unprecedented in recent Colombian history but which recalls Petro’s defence from the balcony of Bogotá city hall when he was dismissed from office as mayor in 2013.
However, Petro’s big show backfired. The petrista mobilization on February 14 was a flop: few people showed up (those that did were Petro loyalists), only filling up the Plaza de Armas (much smaller than the main Plaza de Bolívar). Petro’s lengthy speech was his usual harangue against neoliberalism along with only cursory explanations of his healthcare, pension and labour reforms. In other cities, turnout was just as unimpressive.
The anti-government protests that Petro had wanted to upend with his own mobilization turned out to be a much bigger draw and magnified the failure of Petro’s mobilization. According to police numbers, 47,000 people participated in the Feb. 15 protests whereas only 28,000 people turned out the day before. In Bogotá, protesters largely filled the much bigger Plaza de Bolívar. The protesters were mostly motivated by old right-wing themes — anti-communism, anti-abortion, support for law enforcement and the armed forces and general opposition to Petro and the left. Petro and his supporters on social media put the projectors on the extremists and occasional violence in the protests: vandalizing a replica of Fernando Botero’s paloma de la paz in Medellín, a man wearing a Nazi armband and protesters knocking down fences to enter the public square of La Alpujarra (Medellín’s administrative centre) — part of Petro’s strategy to minimize and discredit his opposition as far-right extremists. However, Petro clearly lost in his bid to mobilize popular support for his reforms and only managed to stir up right-wing opposition. Granted, it’s much easier to protest while in opposition than it is to mobilize in favour of a government, particularly when the government has nothing that can mobilize and fire up huge crowds (its reforms are too technical and poorly understood by most).
Congressional agony
The February 14 show of force was supposed to show Congress that ‘the people’ supported Petro and his reforms and to impress upon them that they should follow the will of the people. That, of course, backfired epically.
Even before the Feb. 14-15 fiasco, it was clear that support for Corcho’s reform in Congress was limited. Every party besides the Pacto Histórico expressed serious reservations if not outright opposition.
First there was controversy about the legislative procedure to be followed. 25 congressmen from different parties (Humberto de la Calle, Paloma Valencia etc.) asked that the bill be considered a statutory law as it affects fundamental rights. Petro replied that the reform changes Law 100, which is an ordinary law. A meeting of the presidents of the permanent commissions in the House and the president of the House, David Racero (Pacto), decided that the reform would be an ordinary law and begin its congressional consideration in the seventh commission of the House. The congressmen insisted, and even filed a tutela in court. Adoption of a statutory law requires an absolute majority of members, must be done in the time of a single legislative year and requires revision by the Constitutional Court before its promulgation.
The decision to begin the legislative process in the lower house was not random. The president of the Senate, Roy Barreras (Pacto), was very critical of Corcho and the reform. In an interview with El Tiempo, Barreras called Corcho an arrogant “ideologized” minister who doesn’t listen and imposes her decisions, and while he claimed that the reform would be adopted he noted that the current system can be “corrected without being destroyed” and that destroying the current system overnight without the new system being ready would be the worst thing that could happen. In a later interview with El País, he said that if Corcho’s reform was approved, Colombia would have an unmanageable health crisis. He insisted, however, that he broadly agreed with the bulk of the reform, including the end of EPS in their current state. Barreras has staked out his differences with some ministers and on some policy issues, all while continuing to support Petro and the government’s broader agenda. Of course, Roy Barreras is a shrewd political operator and pragmatist-opportunist who has little time for activists like Corcho.
The Conservatives, Liberals and the Partido de la U are the three ‘traditional parties’ in Petro’s congressional coalition, whose support is key to forming majorities in Congress. All three opposed the essence of Corcho’s reform. The Conservative Party announced its opposition to Corcho’s text but said it was willing to work on a different text, based around six so-called ‘blue lines’ (largely main elements of the current system). The Liberal Party expressed concerns on a number of points, and the Partido de la U’s leader Dilian Francisca Toro said that her party didn’t support Corcho’s text. All three parties presented an alternative reform. Suddenly faced with significant dissent within his coalition, Petro, who refused any compromise on Corcho’s reform in cabinet, was suddenly forced to make concessions to the other parties.
Outside the coalition, the opposition Centro Democrático (CD) immediately presented a counterproposal and Germán Vargas Lleras returned to the ring to present Cambio Radical’s own counterproposal which is largely identical to CR’s 2020 proposal (supported by Duque’s administration but dropped following the protests).
On March 13, Toro and Conservative leader Efraín Cepeda, later joined by Liberal leader César Gaviria, announced that they had reached an agreement on a compromise reform with Petro. The compromise would retain the mixed private-public system and patient choice, with EPS surviving under another name to manage clinical risk. Direct payment to healthcare providers would become the general rule, though the EPS would still manage some money and decide how much is paid and to whom. La Silla Vacía pointed out that, in the meetings with the party leaders, Corcho was conspicuously absent. They had complained that she is stubborn and doesn’t listen to their concerns, and so Petro chose to exclude her from those meetings.
95%, 99% and 0%
That wasn’t the end of the drama.
On March 23 and 24, various media outlets claimed that the agreement between the government and parties was wobbling. El Colombiano reported that Liberal leader César Gaviria was unhappy with the text and the lack of progress in discussions. The next day, RCN and others reported that the other two party leaders were also unhappy with what they were seeing. The three parties were working on a document presenting their five non-negotiable points and that they’d get off the train if the government didn’t respect them.
Petro sought to dismiss those stories, tweeting that after various discussions they had agreed on 95%, with just three points to be defined. He promised that the text would be presented to Congress on Monday March 27.
The media was correct. On March 27, César Gaviria cancelled his meeting at the palace with Petro and the other parties. The government and the parties met that evening to discuss the healthcare reform. Following the meeting, interior minister Alfonso Prada said that they had now reached a consensus on 99% of the reform. Prada’s optimism, however, contrasted with Dilian Francisca Toro and Efraín Cepeda’s much more reserved and cautious attitude following the meeting.
The Liberal Party confirmed the next day that they were withdrawing from the agreement with the government on the healthcare reform and that they would instead present their own proposal. The party said that they had been unable to reconcile their views with that of the government.
The Liberals’ withdrawal was a severe, but not a fatal blow to the reform. If they could still keep the Conservatives and the U on board with them, then the government would have the bare majorities required to adopt the text, at least in the seventh commission. That cope didn’t last long.
On March 29, Toro tweeted that what they had agreed upon was not included in the final text of the reform they received, and that her party would present an ‘alternative text’. That same evening, Cepeda said that they wouldn’t attend any more meetings with the government, considering them a waste of time. The Conservatives and the U believe that the text they received that Wednesday was the same text that had caused the Liberals to drop out on Monday.
The supposed agreement on 95%, then 99% in the end became agreement on 0%, for all intents and purposes. Essentially, the ‘compromise’ reform that the government had drafted following all these meetings with the parties did not seriously take into account the red lines (blue lines) of the parties. The new text looks an awful lot like the initial text, keeping the broad outlines of the original reform—the focus on primary care with mandatory registration in a CAPS and the ADRES as the single payer of the system with a confusing array of territorial and regional funds. As explained in this article, the new text keeps the EPS, under a new name (gestoras de salud), but eliminates their role as insurers and intermediaries and gives two years to existing EPS to become gestoras de salud according to new requirements (like having no debts). These gestoras de salud would administer provision of secondary and tertiary care within their territories and manage some clinical and financial risks, although the wording of the article leaves a lot of questions unanswered. The new text also keeps the territorial and regional funds from the original reform that the parties had opposed.
As if that wasn’t enough, on March 30 some Green legislators led by rep. Duvalier Sánchez announced that they’d present their own ponencia (rapporteur’s report), annoyed that they were excluded from the negotiations with the other parties and that the spotlight had been left to the traditional parties. But the Greens are internally divided: some remain committed to the government's text, including Martha Alfonso (Green-Tolima), one of the rapporteurs for the bill in the seventh commission of the House.
Desperate measures
Despite his deal with the three traditional parties falling apart, Petro is desperate to save his healthcare reform. Without the support of the three party leaders, Petro wants to negotiate directly with congressmen, believing that Gaviria, Cepeda and Toro don't fully control their own caucuses and that they can convince individual congressmen to support the reform (the version rejected by the three party leaders).
This is a difficult and complicated strategy, but there is some hope it could work. While some congressmen want to prepare a counter-reform together that would force Corcho to negotiate on their terms, rather than the other way around, and others want to send out feelers to the opposition (CR and CD) to work with them, not all of them want to completely close the door on the government. Some want to insist on correcting the text presented to them in late March rather than starting from scratch.
However, César Gaviria has warned his Liberal caucus that there would be consequences for those who went against his orders and supported the government. These sanctions could include denying them endorsements for their candidates in the local elections this fall, so it's unlikely any Liberal congressman would take such risks to support an unpopular and battered reform. The Conservatives will meet on April 11 to adopt a common position as a caucus, which could imply sanctions for those who don’t follow.
Petro seems to have come out quite unhappy from the whole negotiations with the parties, and feels tempted to return to a populist strategy he likes: mobilizing popular support in the streets and “speaking from the balcony” to pressure Congress. Even though this already failed badly once, in February, he has given hints that he could try again. In Villavicencio on March 28, after Gaviria announced his opposition, Petro said that reforms would not come from sitting down with Gaviria in the “cold and golden rooms” of the Casa de Nariño and that changes would come if “society moves.” Petro has announced that he'd speak from the balcony again on Labour Day, May 1, and called on the ‘working people’ to mobilize in support of the reforms.
Some radicals in the Pacto are also pushing for a populist response. Alfredo Mondragón, the Valle representative who is one of the rapporteurs for the bill, said that “society will need to react if the whims of some sectors of power impose themselves against the agenda of change.” Other supporters of the government argue that the traditional parties and elites have economic interests in opposing the reforms of the ‘government of change’, receiving massive campaign contributions from the powerful economic groups who stand to lose from the reforms (they’re not entirely wrong).
Meanwhile, health minister Carolina Corcho is looking for scapegoats. In Arauca on March 30, Corcho blamed the media for creating an "adverse environment" for her reform, saying that it was preoccupying and dangerous that Colombia was subjected to a "state of opinion" where the media rather than Congress decided whether a bill was approved or not. Her argument may have been more credible if the government had not tried to create a "state of opinion" with its pro-government marches on February 14. On April 2, Petro joined in, blaming the media for waging a merciless campaign against the government.
For now, however, the government’s strategy of negotiating individually with legislators may be working out. On the evening of March 31, the ponencia of the reform was presented, signed by the Conservative and Partido de la U rapporteurs (Gerardo Yepes of Tolima and Camilo Esteban Ávila of Vaupés, respectively) as well as the Pacto, Green, Comunes (ex-FARC) and victims’ seat rapporteurs. The Liberal rapporteur, Germán Rozo, didn’t sign on, probably fearing Gaviria’s wrath.
The Pacto president of the seventh commission, Agmeth Escaf, tweeted that the report had been concerted with the Conservative and U caucuses, but in reality the signatures of those parties’ rapporteurs do not represent the parties. Toro tweeted that Camilo Ávila’s signature was not consulted with her and that he signed under his own responsibility, while the Conservative Party declared that Gerardo Yepes’ signature does not represent the position of the party.
The government is desperately trying to keep its healthcare reform alive, even though it's in critical condition. The failure of the healthcare reform would be major political humiliation and defeat that Petro can ill afford right now, especially when it needs a big win after a difficult start to 2023 and the collapse of its political reform.