A lei que regulamenta a Emenda Constitucional 29 foi sancionada nesta segunda-feira (16) pela presidenta Dilma Rousseff. Foram vetados, porém, 15 dispositivos do texto aprovado em dezembro pelo Congresso Nacional. A norma trata de investimentos mínimos em saúde pública por parte da União, de estados e de municípios, proporcionalmente à arrecadação ou ao Produto Interno Bruto (PIB).
Os vetos evitam a necessidade de ajustes nos cálculos caso haja revisão da variação do PIB de anos anteriores, para impedir “instabilidade na gestão fiscal e orçamentária”, segundo justificativa da Presidência. Outros dispositivos barrados por Dilma evitam brechas para o retorno da Contribuição Social à Saúde (CSS), imposto rejeitado durante a votação da regulamentação no Congresso, e a obtenção de crédito para alcançar o exigido por lei.
Os estados passam a ser obrigados a investir 12% da arrecadação com impostos e os municípios, 15%. O percentual para o Distrito Federal varia de 12% a 15%, conforme a fonte da receita, se é um tributo estadual ou distrital. A lei estabelece ainda que, em caso de variação negativa do PIB, o valor de investimento não pode ser reduzido no ano seguinte.
Para calcular se o valor investido está de acordo com o que prevê a lei, valem apenas aplicações em “ações e serviços públicos de saúde de acesso universal, igualitário e gratuito”. Caso as ações estejam previstas em planos estaduais e municipais para a área, também é possível contabilizar o valor. Isso inclui controle sanitário e de epidemias, compra de medicamentos e equipamentos médicos, reforma de unidades de saúde, desenvolvimento tecnológico e capacitação de pessoal.
A inclusão de gastos com pagamento de aposentadoria e pensões, merenda escolar, limpeza urbana, preservação ambiental e assistência social são vedados. A lei trata ainda da fiscalização da aplicação dos recursos.
Promulgada em 2000, a Emenda 29 previa percentuais do orçamento aplicados na saúde de cada esfera de governo pelos quatro anos seguintes. A partir de 2004, o dispositivo “caducou” e precisava ter sido redefinido por uma nova lei, o que aconteceu apenas em 2011.
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