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By Yeh Yu-cheng 葉昱呈
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Minister of Health and Welfare Shih Chong-liang (石崇良) has spoken against offering coverage under the National Health Insurance (NHI) program to the elderly parents of Chinese spouses who move to Taiwan. Some people have said that, given the annual application cap of 60 recipients, the net economic impact is minimal. What Shih is speaking to is not the number of applicants or recipients to the scheme, but the inherently unfair nature of the policy, in two ways:
First, Article 7 of the Constitution of the Republic of China stipulates that “all citizens of the Republic of China, regardless of sex, religion, race, class, or party affiliation, shall be equal before the law.”
This principle of equality is designed to “guarantee
substantive equality in legal status for all people, which requires matters that are the same in nature to be treated the same and not be subject to arbitrary different treatment without justification.”
The problem is that under the Act Governing Relations Between the People of the Taiwan Area and the Mainland Area (臺灣地區與大陸地區人民關係條例), once a Chinese spouse obtains Republic of China nationality, their parents, if aged 70 or older, may move to Taiwan, obtain household registration, and become eligible for NHI after six months. However, the parents of spouses of every other nationality are not extended the same chance. This is a clear violation of the constitutional guaranteed principle of equality.
Second is the issue of contributions. Suppose a 70-year-old parent of a Chinese spouse moves to Taiwan and joins the NHI scheme. Their standard monthly premium of NT$826 over 20 years from the ages of 70 to 90 would amount to about NT$200,000. Let us compare this to a Taiwanese citizen who was born in Taiwan and has worked and paid taxes until the age of 90. Assuming standard premiums of NT$826 per month while they are children under 22 under their parents’ plan and after retirement at 60, and a personal monthly NHI contribution of NT$457 during their working years under the monthly minimum wage of NT$29,500 — as of Jan. 1 next year, this would amount to slightly more than NT$720,000 over 90 years. Is it fair for a Taiwanese citizen to contribute more than three times the amount as the spouse’s parent who moves here after retirement age?
The parents of Chinese spouses who have access to NHI through this scheme are, by definition, elderly, at a stage in life where individuals are most dependent on NHI, and their net healthcare expenditures would likely far outweigh their contributions. Beyond fiscal sustainability, there are concerns about the capacity of the healthcare system and national security.
Yeh Yu-cheng is a civil servant.
Translated by Gilda Knox Streader
