Proposition 51K2764

Projet de loi portant des dispositions diverses en vue de la réalisation de l'intégration des petits risques dans l'assurance obligatoire soins de santé pour les travailleurs indépendants.

General information ¶

Submitted by

PS | SP MR Open Vld Vooruit Purple Ⅰ

Submission date

Nov. 22, 2006

Official page

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Status

Adopted

Requirement

Simple

Subjects

health costs social security self-employed person health insurance

Voting ¶

Voted to adopt

CD&V Vooruit Ecolo LE PS | SP Open Vld N-VA MR FN VB

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Discussion ¶

Jan. 18, 2007 | Plenary session (Chamber of representatives)

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Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker.

The bill submitted today for approval was discussed at the joint meeting of the Social Affairs Committee and the Committee on Economy, Scientific Policy, Education, National Scientific and Cultural Institutions, Middle Class and Agriculture on Wednesday, January 10.

According to the exposition of the Minister of the Middle Class, Ms. Laruelle, it can be recalled that the bill meets five main objectives:

- cover all independent workers against small risks;

- allow them to make full use of the maximum invoice as well as the preferential regime;

- to eliminate the concept of the "most favourable regime";

simplification of insurance rules;

- organize the payment by mutualities to their members of financial reserves "small risk free insurance".

During the general discussion, colleagues unanimously welcomed the measure and recognized its usefulness. Questions and comments have been made. Ms. Pieters asks how the amount in Article 2 will be adjusted. It also asks whether social contributions are not at risk of increasing if the growth rate of 4.5% remains unchanged or increases, which would involve exceeding the financial possibilities of the independent average. She asks why the health index adjustment is not applied only to small risks if it is true that the increase in contributions, as indicated by the management committee, would no longer be proportionate to the cost of integrating small risks. Finally, it asks whether the notion of starting is abandoned.

Ms. Gerkens asks what the amount of contributions will be, how these contributions will be calculated, if there will be ceilings, if it will still be possible to make the difference with a self-employed in the single regime, if there will be a will to divert the financing.

by Mr. Bultinck asks and asks whether the increase in contributions will be proportionate to the cost of insurance and whether guarantees are provided to avoid deficits. According to Ms. Ghenne, a competition between mutualities must be avoided; internal solidarity with the regime is not settled by the project even if Article 7 already marks the ground; the PS is not against an increased participation of collective solidarity to improve the social status of self-employed workers. It also asks whether there will be a different treatment for start-ups depending on whether the taxation takes place before or after 31 December 2007, what will be the amount of the contribution to be paid by the pensioner and what will be its degressivity.

The MR group, through the voice of Ms. Cahay and Denis Ducarme, says all the good that it thinks of the project.

by Mr. Demotte, Minister of Social Affairs and Public Health, recalls the structural measures introduced during the legislature to control the increase in the social security budget.

As for the question of whether the 4.5% growth standard is realistic to cover the costs associated with this project, the Minister recalls that this project is the result of a compromise: a new system of financing of health care has been introduced, under which the growth standard is correlated with the actual increase in social contributions. The difference between the two must be financed through alternative financing. This new system calls for better structural control of the evolution of healthcare spending, regardless of the nature of those spending.

Remember that 85% of self-employed individuals insure themselves for small risks with a supplementary insurance. For the 15 percent who cannot secure themselves, mutuality is important. Since 1963, the concept of small risks has also evolved: thus, extremely expensive drugs for the treatment of leukemia are subject to small risks. Finally, it is the actual reimbursement of health care benefits.

The development for 2008 cannot be based on the figures for 2007 without a corrective coefficient. Laruelle, Minister of the Middle Class and Agriculture, said that negotiations have begun with independent organizations to determine by 2008 who will pay what and how. Principles regarding costs and the financing of those costs have, however, been determined. Independents do not want to drop their contributions in the coming years. The healthcare sector, for its part, does not want to face structural underfinancing.

It was therefore necessary to ensure a viable and sustainable system. Self-employed individuals with an elderly income guarantee and start-ups already benefit from compulsory healthcare insurance; this financing therefore exists. Thus, public funding has been recalculated taking into account the fact that all self-employed people will benefit from compulsory health care insurance.

The amount to be funded has been determined. This funding will not be ensured by an increase, but by an adjustment of contributions. Self-employed persons who are now insured on a voluntary basis will now pay their contributions to compulsory insurance. Only those self-employed who do not insure themselves today for small risks will actually experience an increase in contribution, since they currently do not pay any contribution. The average of contributions paid by others should be reduced. The structure of these contributions is being discussed.

In response to the questions asked by Ms. Pieters concerning beginners, the minister specifies the two separate measures in question. Royal Decree No. 38 provides for specific contributions for beginners for three years. This three-year period is a problem not only for the beginners themselves but also for every independent. In the future, this provision will need to be adapted. The transposition of this three-year period for small-risk coverage seemed excessive and that is why a 18-month period was decided.

Regarding ABC’s remarks, some of which were taken back and others did not, the Minister recalls that it was about developing, from 1 January 2008, a positive system within sustainable budgetary limits. Independent organizations were associated with the reflection on the project in discussion.

As part of the replicas, Pieters notes that the Minister of the Middle Class says that the growth rate is linked to two elements but asks whether this growth rate will increase or decrease. The Minister of Social Affairs answers that it is not possible to answer this question and that it will be possible to answer it only from the month of July 2007.

Ms. Pieters reiterates her question regarding the high risks. The Minister of Social Affairs responds that the system of double adjustment of the base amount remains limited to small risks. Ms. Peters responds that a problem remains. If the norm is between 3 and 5%, the contributions of independent workers will be revised upwards. The minister points out that the best way to control expenditure will be to mutually allocate risks.

Amendments by Ms. Peterson and Mr. So many are rejected. The majority amendment aiming at removing the date from which the mutualities and the National Union can neither decide on the adjustment of contributions nor create new categories of members is adopted unanimously.

Finally, the bill with various provisions for the realization of the integration of small risks in the mandatory health care insurance for self-employed workers was approved unanimously by the members of the two committees gathered.

I now come to my own speech.

The inclusion of small risks in the compulsory health insurance represents, in my opinion, a fundamental step forward in the process started at the beginning of this legislature, namely the improvement of the social status of self-employed workers.

At the round table established in 2003 by Minister Laruelle, the independent representative organizations immediately made known that this was a fundamental criterion for a better social status.

Currently, self-employed workers only benefit from a coverage for high risks (hospital care). Within the framework of compulsory insurance, social contributions paid by self-employed persons for compulsory health insurance do not give them any right to reimbursement of small risks.

While 85% of self-employed already contribute voluntarily for small healthcare risks, we should not forget the remaining 15% (about 180,000 people) that are composed of young self-employed at the beginning of their career and pensioners often excluded from the system.

The integration of all small risks from July 2007 for startups and beneficiaries of GRAPA and from January 2008 for all others will finally allow independent workers to benefit from the same health care coverage as employees. This is fundamental especially since we are not without knowing that, today, health has a cost and not the least. I am convinced that some self-employed still hesitate between taking care and waiting for it to happen for the simple and good reason that they can not, sometimes, afford such expenses.

Now, how do you want, for these independent workers, to do a good job while sick? For a self-employed, taking one day of rest means one day of less income. Not everyone can afford it. The integration of small risks is indeed a decisive step forward in improving the status of the self-employed, as it will enable self-employed to get care in time, which will also avoid expenses in terms of greater health care, which most often result from late care of the disease.

In addition, they will also benefit, like employees, from the so-called MAF, and as well as BIMs from the preferential repayment system. This legislature will be ⁇ rich in advances regarding the social status of self-employed workers. This is a chance, because let’s not forget that the self-employed is not a worker like the others! Not only does it account for about 60% of the employment in our country, but in addition to creating its own jobs, it creates the employment of other people.

The figures of the INASTI prove this, the number of independent workers is constantly increasing. This demonstrates that in the last few years, workers have regained confidence in the status of self-employed, young people too, and that they are no longer afraid to engage in it. Indeed, after the improvement of pensions, of the family allowances of the self-employed, today, the coverage of small risks demonstrates that it was necessary to come out of class solidarity, because the self-employed create wealth for all, employment for all, the attractiveness of our cities and our villages for all, conviviality for all.

Depending on this, the Reform Movement group and I will vote in favour of this bill that favors the self-employed, the business leader by giving him a more attractive situation through improved social protection. They are well worth it!

Mr Ducarme, I thank you. I understood that after assuming your role as a rapporteur, you spoke, in the second part, on behalf of your group.

We are moving forward quite quickly. I will point out to the group leaders that we can vote in fifteen to twenty minutes, so that the colleagues do not get too far away from the House.

Mr. Speaker, Mrs. Minister, Mr. Minister, dear colleagues, this day is important for thousands of independent workers in our country who, let us not forget, contribute to the dynamism and creativity of our economy.

Without them, the overall level of well-being would be seriously lower than what we know today. Thus, in order to arouse entrepreneurial vocations and support economic activity, it was our duty to guarantee to these women and men, who dare to undertake, a greater security of existence.

Indeed, as long as some workers in our country, namely self-employed workers, will have a separate diet on a voluntary basis for what is called small risks, it will be difficult to claim that we really have a universal and effective protection in health care.

Currently, ⁇ 200,000 self-employed and dependents are unfortunately not covered for small risks. This problem does not only concern self-employed persons for whom it is difficult to pay contributions whose variability, it should be remembered, can be important depending on the choice of the mutual, but also depending on the family situation.

It also concerns the many active or retired self-employed persons who, due to their age, face direct discrimination as regards membership in the free insurance.

To address this gap in the social status of self-employed workers, the government decided to ensure the integration of small risks into the mandatory health care insurance. It is this bill, submitted by Minister Demotte in collaboration with the Minister of the Middle Class, that implements this decision.

Starting in 2008, the integration of small risks into compulsory insurance will allow to permanently remove this deficiency in the so-called universality of health care coverage in Belgium.

It is, in a way, the completion of the socialist will to ensure all citizens of this country, active and non-active, equal health care coverage at an affordable price.

Article 7 is the cornerstone of this bill. Of course, we will be very attentive to how solidarity will be redistributed for future enforcement orders that will have to be submitted to the legislative chambers. In this regard, we sometimes hear that solidarity is already sufficient within the social status of self-employed workers. Solidarity in social protection is not measured by the relationship that exists between the ceiling income and insufficient or flat-rate benefits but is judged by the contributing capacity of each for proportional and ceiling benefits. The real redistributive justice is here.

In the regime of the independent, it is imperative to see that it is a backward solidarity that persists. This is a historical constatation. How can we not be shocked by a model where contributions are degressive by income tranches and where, beyond a certain ceiling, one no longer contributes even when the rights are ⁇ ined?

This bill already paves the ground for greater justice in the perception of social contributions. The effort to be consented by the social status for the integration of small risks is already numbered and the way in which this cost will have to be covered will not be able to operate in a linear way on the 180,000 self-employed who, today, due to lack of resources, simply cannot participate in solidarity.

Whether through a revision or even removal of ceilings or through a change in the rate of contributions, the important thing is to progress without taboo and to find a fair solution in consultation with independent workers’ organisations.

Numerous surveys show that many startups perceive uncertainty about the economic situation and the precariousness of social protection as the main obstacles to creating their own business. These two factors co-operate in a not negligible proportion with the definitive abandonment of projects potentially creating activity, economic wealth and jobs.

A solidary social network in case of illness will undoubtedly be able to support new economic initiatives. Here, however, I would like to reiterate my statements made in committee: our group advocates for maximum solidarity for this category of new workers, but the text under consideration is not exempt from some ambiguity since it states, on the one hand, that their contributions can only be adjusted beyond the first 18 months of their activity and that it specifies, on the other hand, that a so-called reduced adjustment could nevertheless occur during this period of taxation.

For our group, if it should appear that the means of the overall management would not be sufficient to cover the small risks of those who create business in our country, it is the solidarity of those whose business is already performing that should be sought. Not surprisingly, my group will vote on this text, which constitutes a significant step forward in improving the social protection of self-employed.

This bill has been quickly addressed. It was submitted on November 22, without urgency. The committee dealt with it on 15 January. The report was presented on 15 January. It will be discussed in the plenary session on 18 January. That is not bad.

Mr. Speaker, as I said in the committee, the ECOLO Group will also support this bill that responds to a great concern: to ensure access to quality health care for all citizens, including self-employed, and to do so through a generalized system rather than through a system of voluntary contributions paid to mutual funds, as we now know it.

It is known that in fact about 20% of self-employed do not insure themselves due to the high cost of contributions. Young people are convinced that they are never sick, that they do not need medication. The elderly, too advanced in their careers, are not sure to get a return even if they start paying contributions to their mutual.

This bill responds to this concern of independent people and governments.

This progress follows the trend that, I think, began in 1999, 2000, when it was proposed as the objective of analyzing the quality of the social security of self-employed persons in order to result in an equivalent quality of social security for self-employed persons and employees. Even if one knew that one could not ⁇ a social security equivalence, one could hope to obtain a quality equivalence.

Gradually, measures were therefore implemented under this government to improve the status of independent individuals by enriching themselves with the reflection and research work that had been carried out in particular by Béa Cantillon.

It is unfortunate that this project does not reflect the terms of funding. How will the independent ensure this? With what amount of contributions? How will these contributions be calculated? According to what structure? Will it be the same for all self-employed, regardless of income or according to a certain proportionality? It is a pity that this text comes now without these clarifications. However, one could have waited, for example, a month for the discussions to end with the representatives of the independent before voting here in Parliament a draft containing all the concrete modalities.

I use this intervention to address the more general context of improving and financing the social status of self-employed persons. In my opinion, one of the advances in this area is the coverage of small risks and therefore the possibility of resorting to the health care system in general, in case of a health problem. This will allow to treat and guarantee access to care without distinction and without the concern of who pays what, since the participation of self-employed will be calculated fairly in relation to the participation of employees, knowing that many self-employed also pay contributions from the employer side for access to employee care.

However, in order to improve the social status of self-employed persons, measures will still need to be taken to improve replacement income in case of disability, disability, as well as pensions. I would tend to say that the awareness, the improvement that has been drawn since 2000 or 2001 (with the report of Béa Cantillon in particular) took place relatively easily. Indeed, the revenues of INASTI were good. The debts have been repaid. Now, the financial flows in our possession can be directly attributed to independent workers. The trend has been positive.

At no time has really been raised the question of the advantage of continuing to improve the social status by eventually seeking additional funding from the self-employed. Alternative financing has been improved for both employees and self-employed, which has fulfilled a number of expectations.

But, in my opinion, it is imperative to continue the improvements of this status, because it is necessary to allow the self-employed, in case of cessation of his activity due to illness in particular, to continue to operate so that he is not double penalized by low income and an activity that is temporarily no more profitable.

So we still have work to do. In my opinion, there will still arise the question, so far taboo, of how to calculate and perceive the social contributions of independent workers.

I have no religion on the adequacy or not of the current system of self-employed solidarity; I know that the return of contributions paid by high-income is not at the height of what they could expect given the weakness of what is granted. From the moment you enter a system that will improve this return, you may need to consider it necessary to review contributions, maybe you might say that a low-income self-employed should pay less contributions. At the moment, it is known that this is not possible given that low incomes cost as much in pensions, disability and disability, while relating less to the financing of the social security scheme of self-employed.

The challenges, in the months and years to come – hoping in the months – will be to dare to approach this system of contributions with the same concern as you, Madame the Minister, not to escape the system of solidarity those who enjoy significant incomes. Curiously, they remain informed in the status of self-employed and pay taxes in the corporate tax regime rather than resort to the corporate regime. Thus, people with significant income from self-employed have agreed to remain under this regime, but benefit from the sort of exemptions from contributions on the highest income. We should be able to analyze the reasons for this and look at how to make this solidarity functional and equitable in the future.

I will keep myself from saying what should be done. I would, however, find it very positive to hold debates in our parliament to discuss it with researchers who have already analyzed the issue, representatives of the independent and us, political actors.

It remains that the step taken here for the integration of small risks constitutes a favorable, long-awaited element, which we will gladly support.

Madame Laruelle, before closing the debate, would you like to intervene?

There was really no question. I would like to thank the speakers and the work that has been done in the committee.

The project was approved unanimously. This shows how much he responds to a real expectation on the ground. This also proves that we were able to find a balance between the demands and expectations of each, an objective that was however difficult.

As several speakers have mentioned, we are currently working with middle-class organizations on how to replicate this cost to the level of the self-employed, through social contributions. So far, no response has been given on this subject.

Mr. Speaker, I would like to emphasize the fact that today we are experiencing an important moment in the evolution of our social law and the status of people since by granting the small risks to self-employed workers, we are actually making a fundamental adjustment to give equal rights to individuals.

Knowing that health is the most precious good of workers, whether they are self-employed or employed, he was subject to the injustice that we have not yet been able to give a concrete response to the despair, sometimes, of those who were plunged into the disease without having the faculty to have a full coverage, while knowing that the concept of small risks no longer corresponded to reality. Today, one can be covered for small risks and have the feeling that these are just health blossoms. This is completely false! There are, the rapporteur recalled, basic health benefits, including access to certain medicines, linked to this refund for small risks.

So, Minister Laruelle and myself think that this is not at all a text like any other. We believe that this marks a turning point in the evolution of social law, in the logic of approaching the statutes. We have made other efforts, especially in the ways of financing social security management, which go in the same direction.

Mr. Speaker, I simply wanted to emphasize this important moment – the House sometimes knows it – which will probably be remembered in the future, in terms of the evolution and convergence of the statutes.