The current paper examines the issues and the impact of India’s National Health Insurance Scheme-Rashtriya Swastya Bima Yojna (RSBY) from equity and efficiency perspectives. The paper gives a brief background of India’s poverty situation and health care financing. It provides a detailed review of relevant literatures and evaluation papers on RSBY to highlight issues related to its design, coordination between different agencies and issues related to enrolment and utilisation of health care under the program. It also examines NSSO- Consumer Expenditure Survey (CES) of the years 2007-08 and 2009-10 of Government of India to see whether the scheme has really helped to increase the health care utilisation by the resource poor families. The result of NSSO-CES analysis shows no such indication and in fact it shows that per capita medical expenditure has reduced for the lower decile groups in the year 2009-10 compared to the year 2007-08 implying that there has been no increase in health care utilisation. It also shows that expenditure is highly skewed towards higher expenditure decile groups with very high per capita medical expenditure compared to poor decile groups. The per capita medical expenditure were also analysed for different social classes to understand the health care utilisation from the equity perspective. There was a wide variation in the medical expenditure patterns in the different social categories. However, to understand that whether the scheme has really succeeded to provide financial security from out-of-pocket payments and catastrophic health care expenditure, there is a need to do a scientifically designed population level study across the country from equity and efficiency perspectives. This will also enable us to understand the enabling and hindering factors related to RSBY which are affecting to achieve its intended objective of providing financial security to the resource poor families. Since inequities in health care expenditure continue to remain, policy makers need to relook at the scheme to make it more accessible to the poorest and vulnerable sections of the population.