Kerala’s migrant community is passing through another period of uncertainty. The continuing war and geopolitical instability in the Gulf have placed thousands of Malayali workers and their families under considerable economic and psychological pressure. The disruptions caused by the COVID-19 pandemic, the loss of employment, declining opportunities for re-emigration and the growing difficulties of rehabilitation have already disturbed the lives of many migrants. It is against this background that the Kerala government’s decision to substantially increase premiums under the NORKA Care health insurance scheme has come as another shock.For a community that has sustained Kerala’s economy through decades of hard work and sacrifice, the decision raises disturbing questions about the state’s commitment to migrant welfare.The controversy, related to an increase in insurance premiums, also concerns the larger relationship between the Kerala state and its migrant population, particularly those belonging to the working classes. Migrants are routinely celebrated for their remittances, investments and contributions to Kerala’s development. However, their everyday struggles, uncertainties and vulnerabilities seldom receive the same attention. The prevailing tendency to see migration primarily through the volume of remittances obscures the unstable conditions under which a substantial section of Malayali migrants live and work.The common image of the ‘prosperous Gulf Malayali’ has never adequately represented the migrant community as a whole.Behind Kerala’s impressive remittance figures are construction workers, drivers, cleaners, domestic workers, shop assistants, security personnel, technicians and thousands of other low-paid employees. Many spend the most productive years of their lives abroad, separated from their families and working under difficult conditions. Their savings are often exhausted in meeting household expenses, educating children, constructing modest houses, repaying loans and supporting elderly parents. A considerable number return home without adequate savings, pension benefits or reliable healthcare protection.The COVID-19 pandemic exposed the weaknesses of this migration-dependent livelihood system. Thousands returned after losing employment or experiencing salary reductions. Many were unable to find suitable jobs in Kerala, while others struggled to finance another journey abroad. The renewed instability in West Asia has aggravated these uncertainties. Workers facing the possibility of displacement, unemployment or forced return are now being asked to bear substantially higher healthcare costs. The timing of the government’s decision could hardly have been more insensitive.Insurance, financial viability and the welfare questionIntroduced in 2025, NORKA Care was presented as an important initiative to provide health insurance protection to non-resident Keralites and return migrants. Approximately 1.32 lakh people enrolled in the scheme, indicating considerable expectations among migrants and their families. Its attraction lay partly in the inclusion of people with pre-existing medical conditions, who frequently encounter difficulties in obtaining affordable private health insurance.The revised premium structure, effective from November 1, 2026, has fundamentally altered the affordability of the scheme.The annual premium for a Rs 5 lakh family floater policy, previously Rs 13,411, has reportedly increased to Rs 21,960 under the general category. For beneficiaries aged 51-60, the revised premium is Rs 35,640; for those aged 61-70, Rs 44,718; and for the 71-80 age category, it reaches Rs 77,773.These are not marginal adjustments. For an elderly return migrant without regular employment, an annual premium approaching Rs 45,000 or ₹78,000 is simply beyond reach. Even the revised general premium represents a considerable burden for low-income workers supporting families on modest earnings.The government has defended the increase by citing the financial difficulties of the scheme. According to figures presented in the Legislative Assembly, approximately Rs 145 crore was collected in premiums against insurance claims amounting to nearly Rs 210 crore, leaving a difference of Rs 65 crore. Nearly 80% of claims reportedly involved serious illnesses, including cancer, while beneficiaries aged 40-70 accounted for claims worth approximately Rs 120 crore. Insurance companies were reportedly unwilling to continue the existing arrangement without substantial revisions.These figures deserve examination. Financial sustainability is undoubtedly important, and no insurance programme can operate indefinitely without adequate resources. However, the government’s explanation raises a more fundamental question: should a welfare-oriented health insurance scheme be evaluated primarily according to the commercial calculations of insurance companies?The high incidence of claims involving cancer, cardiac ailments and other serious illnesses should not be treated merely as evidence of financial failure. It also shows the enormous healthcare needs of the migrant population. Many return migrants have spent decades undertaking physically demanding work, often with inadequate preventive healthcare. Illness and declining health frequently become visible during the later stages of their working lives or after their return.To describe the inclusion of people with pre-existing illnesses as a structural weakness is to misunderstand the very purpose of social protection. If insurance is made affordable only for those who are young, healthy and financially secure, it ceases to serve those who need it most.The controversy has understandably provoked criticism from different quarters. Opposition Leader Pinarayi Vijayan has demanded withdrawal of the increased premiums, arguing that they impose an unreasonable burden on ordinary migrants.The Riyadh-based Keli Cultural Forum has called for the uninterrupted continuation of NORKA Care and greater consultation with migrant organisations. Others questioned the government’s willingness to protect vulnerable migrants when insurance companies insist on commercial viability. These criticisms converge on a central concern: the state cannot transfer the financial risks of migrant healthcare almost entirely to individual beneficiaries while continuing to describe the programme as a welfare initiative.The neglected life-world of migrantsThe insurance controversy cannot be separated from the larger weaknesses of Kerala’s migrant welfare system. Reports of delayed pension payments to return migrants have already caused considerable anxiety. According to figures presented in the Assembly, the Pravasi Welfare Fund receives approximately Rs 16.7 crore monthly while its expenditure approaches Rs 35 crore. Three months of pension payments, involving around Rs 105 crore, were reportedly pending. More than Rs 700 crore in welfare contributions also remained uncollected.These figures point to serious problems of financial planning, contribution collection and institutional accountability. But the consequences are borne by people who depend on modest pensions for their daily existence. For elderly return migrants, even a small pension is often an essential source of income. Delayed payments affect their ability to purchase medicines, meet household expenses and maintain a minimum level of economic independence.There is another aspect that rarely enters official discussions: a substantial section of the migrant population remains inadequately informed about the welfare programmes supposedly designed for its benefit. The study initiated by the Inter University Centre for Social Science Research and Extension (IUCSSRE), Mahatma Gandhi University among the return migrants in Kerala revealed this. Our interactions with migrant communities during a series of workshops conducted across six districts of Kerala over the past three years brought to light a disturbing gap between the existence of welfare schemes and their actual accessibility. Many participants, particularly those from economically weaker backgrounds, had little knowledge of the available programmes, eligibility conditions, registration procedures and benefits.The problem is not necessarily the absence of welfare measures. It is also the institutional assumption that beneficiaries possess the information, documentation, digital literacy and administrative capacity required to access them. Workers with limited education, irregular employment histories or inadequate documentation frequently find themselves outside these arrangements. Migrants who remain connected to organised associations or possess better educational and financial resources are generally in a stronger position to understand administrative procedures. The poorer and less informed often remain excluded. Consequently, the benefits of migrant welfare programmes may be disproportionately accessed by those who can satisfy procedural requirements, rather than by those experiencing the greatest hardship.This is a serious contradiction. Welfare cannot be reduced to the formal announcement of schemes, accompanied by elaborate eligibility conditions and online registration facilities. Its effectiveness must be judged by whether the most vulnerable can actually obtain the promised benefits. The larger migration experience also demands attention. Kerala has benefited enormously from the labour of migrants, but the economic and social costs of migration have largely remained within migrant households. Separation from families, occupational hazards, indebtedness, emotional distress, interrupted education of children and difficulties of reintegration are integral to the migrant life-world.Return migration often marks the beginning of another struggle rather than the successful completion of an economic journey. The transition from relatively stable earnings abroad to uncertain employment at home can be particularly difficult.For older workers, the possibilities of finding suitable employment are severely restricted. The state cannot reasonably expect such people to finance increasingly expensive healthcare protection from savings that may already have disappeared.Reclaiming migrant welfare as a public responsibilityThe immediate requirement is to reconsider the revised NORKA Care premium structure, particularly for low-income workers, elderly returnees and those suffering from chronic illnesses. A temporary continuation of affordable coverage, supported by government assistance, would prevent vulnerable beneficiaries from losing protection while a more equitable financing arrangement is negotiated.The reported Rs 65 crore gap between premiums and claims must be subjected to transparent financial scrutiny. It is necessary to distinguish claims submitted from claims actually settled, examine administrative expenses and assess the assumptions underlying the revised premiums. The government should place the relevant financial details in the public domain and undertake consultations with migrant organisations, healthcare professionals and independent experts.A publicly supported insurance programme cannot depend entirely on the commercial preferences of insurance providers.Kerala should explore a broader risk-sharing arrangement involving state subsidies, contributions from financially better-off migrants and negotiated participation by insurance companies. Public-sector insurance institutions and hospitals could play a more substantial role. Premiums should be differentiated not merely according to age but also according to economic circumstances. A retired construction worker and a highly paid professional cannot reasonably be expected to bear identical financial burdens simply because they belong to the same age group.Means-tested subsidies, affordable family coverage and protection against exclusion for pre-existing illnesses should become essential components of the revised scheme. Equally important is the urgent settlement of pending Pravasi Welfare Fund pensions. Delayed pension payments cannot become a routine instrument of financial adjustment. The government must establish a predictable funding arrangement, improve contribution recovery and ensure timely disbursement.There must also be a fundamental reorientation of welfare administration. NORKA and related institutions should move beyond a predominantly application-driven approach towards active identification of vulnerable migrants and returnees.Local self-government institutions, migrant associations and community organisations could assist in identifying eligible beneficiaries, explaining schemes and facilitating enrolment.The experience of our district-level workshops suggests that direct engagement with migrant communities is indispensable. Information campaigns must reach workers and their families in accessible language, without making digital proficiency or bureaucratic familiarity a condition for receiving assistance. Kerala also needs a comprehensive policy for return migration that connects healthcare, pensions, livelihood rehabilitation, skill recognition and social security. Uneven schemes cannot adequately address the interconnected difficulties of ageing, unemployment, illness and economic insecurity.The present controversy raises a question of political and moral responsibility. Migrants have never been merely external sources of income for Kerala. Their labour has transformed its economy, educational opportunities, housing conditions and social mobility. But many have paid a heavy personal price for these achievements. A state that celebrates migrant remittances as a measure of economic success cannot treat migrant illness, ageing and unemployment as inconvenient financial liabilities.K.M. Seethi is director, Inter University Centre for Social Science Research and Extension and academic advisor to the International Centre for Polar Studies at the Mahatma Gandhi University (MGU) in Kerala. He also served as ICSSR senior fellow, senior professor of international relations and dean of social sciences at MGU.