Three or four years ago, celebrity Huang An (黃安), who lived and worked in China for a long time and gained notoriety for accusing people of supporting Taiwanese independence, returned to Taiwan for medical treatment under the National Health Insurance (NHI) system. Now, some legislators are proposing amendments to the National Health Insurance Act (全民健康保險法) that would restrict the access of overseas Taiwanese to such treatment, which the media are calling the “Huang An clause.”
I recently received a letter from Taiwan’s representative office in Germany that sought feedback from Taiwanese living overseas to the results of an opinion poll that said more than 90 percent of respondents supported the “Huang An clause,” as the proposed amendments would significantly affect them.
The NHI’s resources are limited and precious so it is reasonable for the government to apply income brackets and restrictions to NHI premiums and allocate subsidies accordingly, for example by examining whether a person’s monthly income exceeds NT$180,000 and whether the person has resided in Taiwan for 183 days each year.
This would promote the rational, fair and appropriate use of the NHI, so the amendments are a good idea in principle.
However, further discussion is needed over the details and implementation.
Legislators want to add an exclusion clause for a seventh category of insured person that would include personnel stationed abroad and their dependents, workers in the offshore fishing industry and overseas students.
This would be a reasonable way to differentiate the treatment they receive, so Taiwanese working abroad or those who are economically disadvantaged would not be affected, in keeping with the NHI’s goal of social justice.
However, the proposal says that insured people would have to report their overseas income, and that those who cannot prove their income would have to pay the maximum premium. This seems reasonable at first glance, but it could cause people to fall into the trap of probatio diabolica, requiring them to prove something they cannot prove.
International marriages and partnerships have become commonplace. Just as there are many foreign spouses in Taiwan, there are also many Taiwanese spouses living abroad.
Although foreign spouses might be knowledgeable and qualified in specialized occupational skills, because of linguistic, cultural or legal barriers, or because of social pressures concerning their sex or race, they might nonetheless find it difficult to apply their knowledge and skills. This could leave them economically disadvantaged.
They might be dependent on their spouse, or their parents if they are divorced or become single parents. If they cannot show proof of their income, they would have to pay the maximum premium, which would run contrary to social justice.
Lawmakers must address how to prevent this unjust burden of proof.
The NHI system is a means of attaining social equity. It provides a social safety net that gives economically disadvantaged people reasonable access to healthcare resources. In the process of formulating the “Huang An” amendments, executive and legislative bodies should address the needs of every Taiwanese who genuinely needs the NHI.
Allen Hertzberger lives in Germany and is the former coordinator of National Taiwan University’s women’s and gender studies program.
Translated by Julian Clegg
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