The forthcoming second-generation National Health Insurance (NHI) program is unworkable and unfair, academics and civic groups said yesterday, calling for a premium based on household income when the program begins in January.
The supplementary premiums, which were added to the proposed new NHI program after the National Health Insurance Act (NHIA, 全民健康保險法) was amended, use different rates for different groups and income categories, Taiwan Women’s Link president Huang Shu-ying (黃淑英) said at a public hearing organized by Democratic Progressive Party (DPP) Legislator Liu Chien-kuo (劉建國).
“It would discriminate against and punish certain groups of people and income categories,” Huang said.
Government agencies said a premium system based on household income — the original design of the new program — could not be implemented because of a lack of personnel and difficulties in tracking specific categories of incomes, such as stock dividends.
However, the supplementary premium system — which was created by a number of Chinese Nationalist Party (KMT) lawmakers and put together in less than three days because they wanted to pass the amendment as quickly as possible — would create more problems, she said.
For example, people who hold full-time jobs would be charged a premium of 1.47 percent of their salary while those who work part-time would be charged a 2 percent premium.
“Different premium rates for different types of income may be a violation of the Constitution,“ Huang said.
Under the new program, the handicapped and people with low incomes would have to reveal their status to their employers and insurers if they wished to be charged lower rates, which would pose humanitarian concerns, she said.
The Bureau of National Health Insurance’s recent decision to exclude stock dividends from the tax base and only calculate cash dividends as income was a violation of the NHIA, which stipulates that all stock market earnings should be counted as income, said Huang Shih-shin (黃世鑫), a retired economics professor.
Huang and participants of the hearing recommended a thorough review of the program, saying that a hasty implementation of the program would be a “disaster.”
“The basic spirit of the second-generation NHI program is that premium fees should be proportional to income. The best option is still a household income-based premium system,” Huang said.
“The supplementary premium system is here only because the government finds itself short-handed and it is difficult to implement the original program,” he added.
Other participants said that given the importance of the program, it should be redesigned from a long-term perspective before it is too late.
Chien Hsi-chieh (簡錫堦), convener of the Anti-Poverty Alliance, said Taiwan’s NHI program was patterned after those in Sweden and Canada, where governments tax people on their income and pay the majority of the health insurance premium for them.
For the system to be fair, all subsidies based on different status, professions and backgrounds should be eliminated, and the premiums should be charged based solely on income, said Lu Chien-te (呂建德), a professor of social welfare at National Chung Cheng University.