The Legislative Yuan passed the amendment to the "Elderly Welfare Law" on the third reading. The health insurance premiums for eligible elderly people over 65 years old will be fully subsidized by the central government. The National Federation of Medical Associations of the Republic of China issued a statement in strict opposition, pointing out that tens of billions of dollars in annual subsidies may crowd out nursing manpower, acute care and rural medical budgets. Once medical accessibility and medical quality are affected, the elderly will bear the brunt.
Chen Xiangguo, chairman of the All-Federation of Medical Doctors Association, said that doctors take care of elderly patients on the front line every day and know the medical needs of their elders better than anyone else. The correct way to take care of the elderly is to spend money on the medical services themselves, rather than weakening the health insurance financial resources that support the elderly's medical care by almost completely exempting them from premiums.
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The Legislative Yuan passed the amendment to Article 22 of the "Elderly Welfare Law" on the third reading yesterday. If the comprehensive income of seniors over 65 years old in the past year has not reached the reporting standard, or the comprehensive income tax rate has not reached 20%, the health insurance premiums will be fully subsidized by the central competent authority. The All-Federation of Medical Associations expresses solemn opposition and deep regret to this, believing that the amendment may cause generational injustice, hollow out the foundation of health insurance, and crowd out medical resources.
The All-Federation of Medical Associations pointed out that the comprehensive tax rate must reach 20%, and the annual income must be approximately 1.33 million yuan or more. The vast majority of elderly people over 65 years old are below the threshold. This case is called taking care of the disadvantaged, which is essentially equivalent to "comprehensive exemption from health insurance premiums for those over 65 years old."
The All-Federation of Medical Associations further pointed out that the income tax rate cannot reflect the real financial ability of the elderly. Most of the elderly’s income comes from pensions, tax-free income, rent, and dividends. The low taxable income does not mean that they cannot afford it. According to the 2021 fiscal and taxation data analyzed by the China Academy of Economics, those over the age of 65 whose tax rate does not reach 20% have an average personal income of about 120,000 yuan, but the average wealth is nearly 16 million yuan; the young adults aged 25 to 64 in the same tax bracket have an average income of nearly 400,000 yuan, and an average wealth of only about 7 million yuan. Using income tax rates to exclude the rich may result in increasing the health insurance burden on young people.
The All-China Federation of Medical Associations stated that according to data from the National Health Insurance Administration, the number of insured persons over the age of 65 will account for approximately 19.6% in 2025, but medical expenses will account for approximately 43.59%. In the past 10 years, more than 60% of the growth in health insurance medical expenses has come from the group over 65 years old. The medical needs brought about by the aging population will continue to increase, and health insurance needs stable and sufficient financial resources most at this time. This case requires tens of billions of yuan every year, and is expanding year by year with the super-aging population, which is completely opposite to the financial demand for health insurance.
The All-China Federation of Medical Doctor Associations emphasized that the government’s financial resources are limited, and tens of billions of yuan in subsidy expenditures every year will inevitably crowd out the budget for total health insurance growth, point value protection, nursing manpower policies, emergency and rural medical care and other budgets. After years of public-private collaboration between the government and the medical community, health insurance finances have gradually stabilized and manpower has returned slightly. If the results are reversed, front-line hospitals and medical staff will be under pressure again, and ultimately all patients will suffer.
The Federation of Medical Associations criticized that social insurance financial changes involving millions of people and tens of billions of dollars every year were passed without complete actuarial calculations and without fully listening to the opinions of the medical profession and experts. "This is not a responsible legislative approach." It emphasized that national health insurance is the cornerstone of social unity and mutual assistance in Taiwan and should not be used as a bargaining chip for election offense and defense. It called on all walks of life to consider the sustainability of health insurance so that today's elders and tomorrow's elders can continue to receive the medical care they deserve.
