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Reforma a la salud y su viabilidad financiera generan debate clave en el Senado
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El pasado 27 de mayo de 2025, la Comisión Séptima del Senado de Colombia llevó a cabo un Debate de Control Político centrado en la viabilidad financiera de la reforma a la salud que actualmente se discute en el Congreso. La sesión contó con la participación de los ministros de Hacienda y Salud, quienes defendieron el proyecto frente a cuestionamientos sobre su costo, fuentes de financiación y capacidad de los territorios para asumir nuevas responsabilidades.
Incertidumbres y cuestionamientos sobre el costo de la reforma
La senadora Norma Hurtado expresó preocupación por la claridad en las cifras económicas del proyecto, interrogando: “¿Cuánto vale la reforma a la salud?”. Denunció inconsistencias en los datos presentados y alertó sobre un déficit proyectado superior a 10 billones de pesos para 2024 en el aseguramiento en salud. Criticó, además, el uso de recursos del presupuesto general para financiar promesas de campaña como la implementación de la atención primaria sin respaldo fiscal suficiente.
La senadora Lorena Ríos sumó dudas sobre la capacidad financiera y operativa de los territorios para gestionar nuevas competencias desde 2027, especialmente en el marco de la reforma al Sistema General de Participaciones. También planteó inquietudes acerca de la atención a poblaciones vulnerables, incluyendo migrantes, y sobre subsidios contemplados, como las licencias de maternidad para personas no cotizantes.
Defensa oficial y fundamentos técnicos de la reforma
El ministro de Salud, Guillermo Alfonso Jaramillo, defendió la iniciativa gubernamental resaltando que el modelo busca “eliminar las desigualdades en el acceso a la salud, priorizar la prevención y llegar a las regiones más alejadas”. Destacó que el fortalecimiento de entidades como la ADRES y el INVIMA será fundamental para mejorar la eficiencia y trazabilidad en el manejo de los recursos.
Por su parte, el ministro de Hacienda, Germán Ávila, afirmó que el aval fiscal otorgado permite incorporar la reforma dentro del marco fiscal de mediano plazo, condicionado al cumplimiento de supuestos macroeconómicos como el crecimiento del PIB y la recaudación tributaria. No obstante, reconoció que la estimación de costos fue realizada internamente por el Ministerio de Salud, lo que generó inquietudes sobre la falta de verificaciones externas.
Perspectivas de otros legisladores y actores clave
Diversos senadores manifestaron posturas diversas frente al proyecto. Omar Restrepo (Comunes) defendió la reforma, criticando el modelo actual por su “lógica de mercado” que limita el acceso real a la salud. En contraste, Honorio Henríquez (Centro Democrático) expresó dudas sobre la sostenibilidad financiera del plan, mientras que Marta Peralta (MAIS) valoró el esfuerzo técnico y señaló que el balance fiscal podría ser positivo si se cumplen las metas económicas planteadas.
Félix León Martínez, presidente de la ADRES, destacó el impacto fiscal negativo actual por déficit en aseguramiento, problemas en pagos del SOAT y elevada siniestralidad. Subrayó la necesidad de fortalecer esta entidad para asumir nuevas funciones como la gestión directa de recursos, tal como prevé la reforma.
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