Petro’s Health Reform: 2.4 Million Colombians Face EPS Shift to Troubled Nueva EPS

The government of President Gustavo Petro’s plans to change Colombia’s health system outside of Congress are gaining momentum. These changes could impact the healthcare access of approximately 2.4 million people, potentially shifting them to the Nueva EPS, an entity that has faced challenges for the past two years.

That figure represents the approximate number of users from other health insurance providers who would be transferred to Nueva EPS in at least 504 municipalities across Colombia. This means that 45% of the population in those areas would be under the management of an EPS currently under government intervention since April 2024.

These plans from the Ministry of Health will directly affect residents in these areas – located in 27 departments – who will have limited choice and will be required to join the EPS that has been under Petro’s government management for two years and is facing numerous issues.

These issues include the fact that Nueva EPS has not submitted financial statements since September 2023, its debts have quadrupled in less than two years (from $6 billion to $24 billion pesos), it has accumulated 120,000 unanswered legal claims (tutelas), and has had five different intervention managers in 23 months. Despite these red flags, Minister Guillermo Jaramillo and President Petro believe the situation is manageable.

These changes are outlined in Decree 182 of 2026, issued by the Ministry of Health, which establishes new rules for the territorial operation of EPS and, changes health affiliation based on location.

The decree defines “differential mechanisms for the operation of health insurance with a territorial and population focus.” This limits the number of insurers that can operate in a territory based on the number of inhabitants, meaning those with lower coverage must transfer their patients to larger EPS like Nueva EPS, Savia Salud, and Servicio Occidental de Salud (SOS).

In practical terms, this means that Nueva EPS – the largest health insurer in the country, with 11.5 million affiliates – will receive this influx of population. This presents not only an administrative challenge for a company that doesn’t even know its financial reality and is failing to address legal claims, but also exacerbates the insufficiency of the unit payment per capita (UPC), which is the funding the EPS receive from the state for the medical care of its affiliates.

While a consolidated figure is not available, control agencies, academics, and industry groups indicate that the insurers’ financial losses are between 110% and 120%. This means that for every $100 they receive, they spend between $110 and $120 to cover demand for care.

Nueva EPS is, of course, not immune to this situation. Adding 2.4 million more users will only increase this financial pressure that has been suffocating them since 2022.

The Ministry of Health’s plans, as detailed in Decree 182, are prompting legal challenges and raising concerns about the future of healthcare access for millions of Colombians.

The decree establishes that in departments with more than two million inhabitants, only EPS with at least 5% of the affiliates in that area can operate; in departments with a population between 390,001 and 2 million inhabitants, the minimum will be 10%; and finally, in departments between 100,000 and 390,000 inhabitants, the required participation will be 15%.

Read also: Report alleges “cancer cartel” in Nueva EPS: Clinic in Ibagué concentrates diagnoses

While the Ministry of Health has denied that this will result in a mass transfer and explained that the rule establishes technical mechanisms for allocation only when an EPS does not guarantee adequate operating conditions, a document from that entity shows that, in practice, for people living in 45% of the municipalities of Colombia, only Nueva EPS will be the legal option.

An official list from that ministry, detailing the EPS authorized to operate under the decree, indicates that the application of the rules will lead to a profound reorganization of health insurance, establishing which territories certain entities will remain in and which ones they will have to leave. This will inevitably require the transfer of millions of affiliates.

One of the most impacted departments is Antioquia. There, 80 municipalities will exclusively be under the operation of the intervened EPS Savia Salud and Nueva EPS, reducing the healthcare options available. This scenario reflects the magnitude of the changes and anticipates a large-scale logistical and administrative process to ensure the continuity of services for people.

in these 504 municipalities, where there will be no freedom of choice of EPS, You’ll see 1,830,813 users, distributed in the departments of Boyacá, Cundinamarca, Santander, Nariño, Bolívar, Tolima, Huila, Meta, Norte de Santander, Caldas, Caquetá, Magdalena, Guainía, Valle del Cauca, Córdoba, César, Atlántico, Vaupés, Guaviare, Arauca, Sucre, Vichada, Cauca, Risaralda, Putumayo, San Andrés and La Guajira.

This confirms an unprecedented level of concentration in the Colombian health model and changes the competitive balance in large areas of the country. Unless people move from where they live, there will be populations where some EPS will have to leave and transfers will be unavoidable.

That list from the Ministry of Health confirms that the projections about the number of transfers were real, despite the entity saying that it is fulfilling the “constitutional mandate to guarantee the continuity of service and protect the fundamental right to health.”

Read also: Can they move you from your EPS without your consent? Key points of the decree that redistributes affiliates

In Cundinamarca, the exodus is complete in towns like Albán, Anapoima, Bojacá and Tenjo, where authorizations for Sanitas, Salud Total, Famisanar and Compensar have been revoked, leaving Nueva EPS as the only legal provider of services in those territories.

This trend is more pronounced in the peripheral regions of the country; in departments like Guainía, Vaupés and Vichada, Nueva EPS appears as the only authorized insurer in practically all analyzed records, eliminating any competition in towns like San Felipe, Puerto Colombia, Taraira and Santa Rosalía.

In the Caribbean region and the south of the country, the technical report reveals a similar displacement pattern. In the Atlántico, towns like Galapa and Campo de la Cruz have lost the operation of Sanitas and Famisanar, while in the Huila, towns like Villavieja and Yaguará have seen the departure of Asmetsalud and Sanitas.

See the complete list of municipalities here:

On March 4, a popular action was filed against Decree 182 of 2026 of the Ministry of Health, which is the regulation that establishes the changes described in this article.

The legal action was filed before the First Section of the Administrative Court of Antioquia.

The objective is to overturn the regulation and is the second legal recourse filed before judicial bodies to halt these changes.

in October 2025, the Council of State temporarily suspended another decree issued by the ministry to change the health model. That regulation included changes that were part of the health reform.