CHRISTIAN BEUTLER
Anyone who does not pay the health insurance premiums ends up on a black list in the cantons of Aargau, Lucerne, St. Gallen, Ticino, Thurgau and Zug and may only be treated in an emergency. An entry is made on the list if the insured person does not settle a debt enforcement for premiums or co-payments within the statutory period.
Such lists of defaulting insured persons are controversial. The instrument has already been abolished in Graubünden, Solothurn and Schaffhausen. The St. Gallen Cantonal Council also voted in the first reading for the abolition of the list. The Aargauer Great Council wants to defuse the list that is currently on hold.
The Council of States wants to give the cantons the opportunity to keep such lists. At the request of a majority of his Commission for Social Security and Health (SGK-S), he voted on Monday with 22 to 22 votes and the casting vote of President Alex Kuprecht (SVP / SZ) against the abolition.
A majority of the commission wanted to allow the cantons, for federalist reasons, to keep lists of insured persons who do not pay their premiums. Brigitte Häberli-Koller (center / TG) and Jakob Stark (SVP / TG) broke a lance for the black lists. It takes a certain amount of effort, but then it works, as the example of your canton shows.
There, the municipalities contact people who have not paid their premiums as part of case management. The reason is clarified and solutions are examined.
The Council of States has now specified the term emergency treatment. Accordingly, this is the case if the treatment cannot be postponed. This is the case if the insured person has to fear damage to health or death without immediate treatment or if the health of other people can be endangered. In such cases, defaulting premium payers must also be dealt with.
A minority of the commission, like the Federal Council, wanted to hold on to the abolition. Josef Dittli (FDP / UR) said he was of the opinion that such lists could affect the basic medical care of people who lived in modest circumstances. Many of the people on the list of defaulting policyholders are effectively insolvent. For these people, the list fails to encourage payment of outstanding health insurance benefits.
In addition, Maya Graf (Greens / BL) stated that the usefulness of these black lists could never be proven. There were problems in some cantons because some of the health insurers did not report the names. An overly narrow interpretation of the emergency term was corrected in court rulings. For this reason, for example, 19 cantons and the Conference of Cantonal Health Directors (GDK) agreed to abolish the black list during the consultation process.
The National Council will deal with the controversial issue next. There was consensus in the Council of States that minors should not be included on such black lists. No canton has added minors to the lists since the beginning of 2021.
The other points of the amended enforcement of the premium payment obligation were not disputed either in the Commission or in the Council. Anyone who does not pay the premium, the franchise or the deductible in spite of operating the insurance should in future be insured in a model with a restricted choice of service providers. In addition, the number of debt enforcements is to be limited to two per year.
The cantons who wish to do so should be able to take over the certificates of loss for ninety percent of the claim from the insurers and manage them themselves. The insured would then be free to change health insurance and model. After all, young adults should no longer be liable for the premiums that were not paid by their parents while they were minors.
The starting point for the legislative work of the SGK-S was a professional initiative by the Canton of Thurgau and several motions from the National Council. The reason for this is the high costs for the cantons. These had to take over more than 385 million francs in 2018 without being able to influence the collection.