NHI bill could bring more harm than good

The Legislative Yuan on Friday passed the third reading of amendments to Article 22 of the Senior Citizens Welfare Act (老人福利法), which were pushed through by the Chinese Nationalist Party (KMT) and Taiwan People’s Party (TPP).

The move was touted as an expansion of National Health Insurance (NHI) premium subsidies for people aged 65 or older. However, lawyer Lai Chung-chiang (賴中強) said that the hastily passed amendments removed the legal basis for subsidies covering NHI copayments or other medical expenses not covered under NHI for elderly people who cannot afford them.

It is not the additional public spending that should be raising eyebrows, but rather that the legislature appears to have broadly expanded premium subsidies for people aged 65 or older while undercutting other subsidy supports for the most acutely disadvantaged among them.

A legal basis for the administration of subsidies is not just a nice-to-have measure. The original Article 22 of the act was explicit in listing three categories of subsidies: NHI premiums, copayments and medical expenses not covered by NHI. Downstream administrative regulations are based on this legal authorization, so removing two of the three categories in the parent law means that some of the regulatory provisions for subsidy enactments might no longer be legally viable.

Legislators should have ensured that existing protection would remain in place before amending the law, and that social welfare groups and government agencies are not left scrambling to find a fix afterward. Legislation must not be thrown around for campaign propaganda, and lawmakers cannot delete a few words and act like nothing has happened.

This amendment could cost the central government an estimated NT$40 billion (US$1.23 billion) annually. Yet having an income tax rate below 20 percent — the bracket which the original amendment targets — does not necessarily mean someone cannot afford to pay NHI premiums. Conversely, elderly people struggling to make ends meet might be unable to afford even regular medical copayments, let alone necessary expenses such as dentures that are not covered by NHI.

If the KMT and TPP genuinely want to broaden access to healthcare, they should prioritize safeguarding existing protections for low and lower-middle-income people, rather than exempting more people from paying premiums and leaving a gap in subsidies for disadvantaged groups in the process.

With their combined legislative majority, the KMT and TPP are certainly empowered to advance their policy agendas. However, majority rule does not justify bypassing legal scrutiny, nor should the risks be left for government agencies to bear.

The priority should not be to celebrate the amendment’s passage at its third reading, but to immediately publish a comprehensive assessment of its legal and policy implications, and confirm whether subsidies for disadvantaged people can continue. If necessary, the Executive Yuan should seek reconsideration of the bill or an amendment that corrects the problem.

Genuine welfare for elderly people does not mean allowing more people who can afford to pay to save on their premiums while stripping those least able to pay of legal protections. The greatest absurdity of the KMT’s and TPP’s actions is that, despite all the noise about their commitment to caring for older people, they might have ended up cutting protections for precisely those who need them the most.