Bill risks stability of the NHI, health minister says

LANGUAGE CONCERNS: Provisions for subsidies for copayments and medical expenses not covered by the NHI were removed in amendments, an official said

• By Sam Garcia / Staff writer, with CNA

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The National Health Insurance (NHI) system could face collapse due to a bill passed on Friday that would exempt an estimated 83 percent of people aged 65 or older from paying premiums, Minister of Health and Welfare Shih Chung-liang (石崇良) said yesterday.

Under the amendment to the Senior Citizens Welfare Act (老人福利法), backed by opposition lawmakers, the central government would fully subsidize NHI premiums for people aged 65 or older if their income for the most recent year fell below the tax filing threshold or was taxed at an income tax rate of less than 20 percent.

Using income tax rates as the sole criteria to determine eligibility for NHI premium subsidies is too crude an approach, Shih said.

The National Health Insurance logo is pictured in an undated photograph.

Photo: Chiu Chih-jou, Taipei Times

The government should prioritize low-income and lower-middle-income households that cannot afford the premiums, he said.

The revision only provides subsidies for premiums, while the original law allowed authorities to establish subsidies for elderly people unable to afford premiums, copayments and medical expenses not covered by the NHI, Shih said.

The core principle of the NHI system is shared responsibility, with the government providing necessary assistance, he said.

The current system does not determine people’s ability to cover medical expenses based solely on age and income tax rates, he said, warning that the “unreasonable amendment” could cause the healthcare system to collapse.

Before Article 22 of the act was amended, the subsidies primarily covered three categories of expenses: NHI premiums, NHI copayments and medical expenses not covered by the NHI, Ministry of Health and Welfare’s Social and Family Affairs Administration Director Chou Tao-chun (周道君) said.

If the revised provisions are implemented as stipulated, low and middle-income people aged 65 or older could be affected, she said.

Medical expenses not covered by the NHI include items such as subsidies for dentures, Chou said.

They might also include subsidies for out-of-pocket costs associated with some treatments, such as for intraocular lenses used in cataract surgery and cardiac stents, she said.

The actual scope of subsidies affected by the amendment would depend on the specific regulations governing each program, she said.

Asked whether the central government could cover these expenses, Chou said the subsidies for NHI copayments for low-income people in the 65-or-older age group remain authorized under the Public Assistance Act (社會救助法), enabling the central government to provide funding.

However, there is no clear legal basis under the act for subsidizing NHI copayments for middle and low-income elderly people or medical expenses not covered by the NHI for them in either income group, she said.

The provisions in Article 22 concerning subsidies for NHI copayments and medical expenses not covered by the NHI for economically disadvantaged people were removed through the amendment, Chou added.

Agencies must review laws and regulations to determine whether other legal provisions can serve as an alternative basis for continuing these subsidies, she said.