Proposition 52K0406

Projet de loi modifiant la loi du 26 mars 2007 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 ¶

Authors

CD&V Luc Goutry
LE Melchior Wathelet
MR Pierre-Yves Jeholet, Florence Reuter
Open Vld Yolande Avontroodt

Submission date

Nov. 21, 2007

Official page

Visit

Status

Adopted

Requirement

Simple

Subjects

health costs social security self-employed person health insurance

Voting ¶

Voted to adopt

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

Abstained from voting

Vooruit

Party dissidents ¶

• Alexandra Colen (VB) abstained from voting.

Contact form ¶

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Discussion ¶

Dec. 13, 2007 | Plenary session (Chamber of representatives)

Full source

Mr. Speaker, dear colleagues, it is my responsibility, in my name and in the name of my colleague Maggie De Block, to give you the reports of our work.

At the joint meeting of November 28, the Social Affairs Committee and the Committee on Economy, Scientific Policy, Education, National Scientific and Cultural Institutions, Middle Class and Agriculture examined this bill.

This bill was submitted at the initiative of our colleague Jeholet, with the contribution of Ms Avontroodt and Reuter and MM. Wathelet and Goutry.

The discussions began with a long procedural debate. Bonte requesting that, pursuant to Article 79 of our Rules, the bill be submitted to the Court of Auditors for the purpose of calculating its budgetary implications. We will have the opportunity to go back further. This request was ultimately rejected by 22 votes against 2 and 1 abstinence.

He then returned to the authors of the proposal and in particular to Mr. I would like to present this one. It is in fact a matter of increasing the social protection of self-employed persons and their families, in particular those of small self-employed persons who, due to the integration of small risks in the mandatory health insurance, will be able to benefit from the same social coverage as other workers and this, from 1 January 2008.

There are therefore, through this bill, two objectives: on the one hand, to determine the amount of costs related to the integration of small risks that will be borne by INASTI and, on the other hand, to adjust the contributions due by the self-employed in such a way as to finance the cost of the reform.

The author also notes that 80% of self-employed people have already voluntarily subscribed to a “small risks” insurance. Those people will therefore not need to contribute more to benefit from this access to health care. The remaining 20% who did not have this type of coverage will benefit from the integration of small risks into the compulsory health care insurance. It is also recalled that those who find it difficult to pay the amounts in question will always be able to apply for an exemption from the exemption commission.

It concludes by clarifying, on the one hand, that this proposal was drawn up in perfect consultation with the organisations representing the middle classes, both on the Dutch-speaking and French-speaking side (Unizo, UCM, SNI, the Wallon Federation of Agriculture, the Boerenbond) and, on the other hand, that it is a major step in improving the social status of independent workers.

He then returned to the members of the committees gathered to speak, in the continuation of a brief speech by Ms. Laruelle, Minister in charge of the Middle Class and of Agriculture and Development Cooperation.

The latter emphasized the following three points.

1 of 1. The Government does not have a unanimous position on the proposal under consideration.

2 of 2. The proposal meets the unanimous opinion of the self-employed defence organizations and, importantly, of the General Committee for the Management of the Social Status of Self-employed.

3 of 3. The urgent nature of a vote by Parliament on this bill and this, before 1 January 2008, date of opening of the right to the inclusion of small risks in the compulsory health insurance.

To various questions that were asked about the need to take a royal decree in the extension of the adoption of this law to ensure its effective implementation, the minister specified that at this stage, a royal decree was not necessary and that she would be able to send a letter to the independent social insurance funds to inform them usefully.

The discussions and exchanges between the Commissioners will then focus primarily on two points. First, the problem of budgetary impact already discussed at the beginning of the meeting regarding the need to submit this bill to the opinion of the Court of Auditors, some pointing out that it is likely to cause a significant budgetary effect at the level of public finances. Mrs Laruelle will respond to various stakeholders that, in the event that the budget objective set would not be achieved, it would result in a debt of INASTI to INAMI and not a deficit to be borne by the public finances.

Furthermore, a fund for the well-being of self-employed persons has been established within the framework of the social status of self-employed persons, which will total at the end of 2007 an amount of 341 million euros, which is equivalent to approximately one year of revenues from the "small risks" insurance in health care.

Secondly, if everyone is delighted with the inclusion of small risks in the mandatory health care insurance, and this for various reasons exposed by the respondents and on which they will probably have the opportunity to return to this tribune in a few moments, divergences have, on the other hand, appeared on the way of calculating contributions. For some, mr. Delizée, Bonte and Gilkinet – the arrangements adopted for the minimum package, the increase in the rate of contribution on the first tranche and the fact that no additional contribution is offered on the upper tranches of income are likely to disadvantage small self-employed. They announce the filing of amendments with a view to proposing a much more solidary modulation, in their opinion, of the grid of contributions included in the proposal, in other words to provide for a better progressivity.

For others - Ms. De Block, MM. Jeholet, Wathelet and George – the logic of the proposal is to link the amount of contributions to be paid to the amount of income, in such a way that the self-employed whose income is above a certain amount will contribute a little more than the current average and that those whose income is below that amount will contribute a little less than this average. This approach is inspired by the current system of calculation of the social contributions of the self-employed and has received a favorable welcome from all the associations and organizations for the defence of the self-employed.

Many exchanges followed on the arguments put forward by one and the other. Finally, after the general discussion there was the discussion of the articles of the bill and the amendments deposited, then the vote on the amendments and articles to result in the adoption of the proposal by 22 votes and 5 abstentions.

Je vous félicite pour votre première intervention à la tribune du Parlement: it was your "maiden speech". (Applause of Applause)

A number of people have signed up for the discussion of this bill. First, I give the word to Mrs. De Block.

The integration of small risks into the mandatory health insurance for self-employed was approved during the last legislature. This eliminated one of the main differences in the social status between employees and self-employed persons. The actual integration will also end the unpaid healthcare bills for a lot of people. Over the years, the term small risks no longer corresponded to reality. Some small risks meanwhile cost pieces of people and pieces of an income. As a doctor, I have witnessed this several times.

This integration of small risks was carried out in two terms. From 1 July 2006, they became mandatory, but also free insurance for beneficiaries of an income guarantee for the elderly and also for the start-up self-employed. Starting self-employed will only contribute from the seventh quarter of their activities. This operation is now completed. In the second operation from 1 January 2008, which we are currently undertaking, all other self-employed would be compulsory insurance for the small risks, however with contributions.

The present draft law adapts the existing contribution ceilings and contribution rates of social security contributions for self-employed persons in order to provide the necessary financing for integration. The total cost of this operation, which should not be underestimated, is estimated at EUR 439.900.000, of which EUR 342.570.000 should be financed by increases in contributions or by increases in ceiling. At the end of the previous legislature, the organizations of self-employed persons discussed how they would account for these additional costs in the social contributions and in the contribution ceilings. They made their own proposal. The proposal presented here embraces this integrally.

In the last legislature, a lot of improvements were made to the status of the self-employed. We can say that under the impulse of Minister Laruelle in this legislature pioneering work was carried out.

This operation was also the first to rely on the independent contribution of the self-employed.

Given the significant additional costs of this operation, it is important that an agreement could be reached with the self-employed organisations on how the funding would be made and how the costs would be distributed according to the respective income categories.

Under normal circumstances, these adjustments of the contribution ceilings and contribution rates, in implementation of the Act of 26 March 2007, would have been the subject of a royal decree. However, with the current government of ongoing affairs, one has been obliged to come to Parliament.

We have therefore taken our responsibility in the committee and the result is here in this bill. From 1 January 2008, the self-employed will be compulsory insured against small risks and the social insurance funds will be able to adjust their computer technology to the adjusted contribution and contribution ceilings. This regulation is called urgent.

The increase of the contribution ceilings and of the contribution percentages may at first glance not seem to be a popular message or a sympathetic measure. However, we must not lose sight of the benefits of this decision.

Self-employed individuals whose risk was overestimated by health funds and insurance companies to be insured were no longer accepted and fell out of the boat. Self-employed persons who had to finance inexpensive medicines after heavy, expensive procedures or sometimes after accidents also fell out of the boat and had to collect their income for this. Self-employed persons who are no longer insured after the age of fifty will also benefit.

I would like to emphasize in particular that small self-employed will now also be able to enjoy the maximum invoice and that for the first time in all that time a maximum invoice for self-employed will also be introduced. The children of self-employed workers will now also for the first time be entitled to the special fund.

Colleagues, I think this is an important day for the self-employed, although apparently you are not all so interested and you are busy with your own business.

Mr Dedecker, thank you for your attention. At least you react. I see that you listen.

I too .

In other words, the caste system in healthcare has been abolished from 1 January 2008. The small self-employed will no longer be the paria of Belgian health care.

Mr. Speaker, dear colleagues, this proposal is obviously going in the right direction to further increase the social protection of independent workers and their social status. And this is the continuation of all the work of Mrs. Laruelle since she has already done so much to improve this status.

From 1 January 2008, all self-employed workers must benefit from the coverage of small risks in health care; when it comes to small risks, it is about things as important as medical visits, nursing care, kiné care, medicines.

This bill, supported by the CDH, CD&V, Open Vld and MR, complements the law of 26 March 2007 of the "violet", which had already incorporated these small risks into the mandatory health care insurance for self-employed workers. It should be noted that today, 80% of independent workers have subscribed to a voluntary coverage.

As Ms. De Block said, this will avoid individual dramas. It is true that the debate in the committee focused on those 20% of small independent workers who, today, have not subscribed to this voluntary coverage. “They may be in trouble,” as I could hear from some as if it was a step back and not an extraordinary advance for them. However, this will prevent in the future those individual dramas that we know.

The widespread coverage of small risks will also open up for self-employed workers the maximum access to billing that limits individual expenses in case of serious or chronic illness.

What were the two main objectives of this proposal that complements the acquisition of principle of this measure, thus the law of 26 March 2007?

First, it is primarily the mode of financing: it allows to determine accurately and definitively the amount of costs related to the integration of small risks that will be borne by INASTI. The option that has been chosen in this bill is to take into account the Pact of Solidarity between Generations, thus limiting the cost that will be borne by INASTI as for other healthcare expenses.

Second, it is also to adjust the contributions due by self-employed persons in such a way as to finance the inclusion of small risks in the mandatory health care insurance.

A few comments, if you allow me.

1 of 1. This proposal guarantees self-employed workers a health care coverage finally identical to that of all other workers in our country.

2 of 2. This bill was drafted in perfect collaboration and in perfect coordination with the organizations of the middle and agricultural classes, whether it is the Unizo, the Union of the middle classes, the National Syndicate of Independents, the Boerenbond or the Walloon Federation of Agriculture.

3 of 3. This proposal is a victory. It takes into account the evolution of medicine, the expectations of the population on health care, the extension of life expectancy, in short, the small risks that, I repeat, are becoming less and less small.

4 of 4. Considering the 80% of small self-employed, who already subscribed to non-obligatory coverage, the premium they will have to pay will be lower or equivalent to what they pay today to insurance companies or mutualities.

5 of 5. They also benefit from greater solidarity, as the cost to be borne will no longer be dependent on the risk they present based on their age or their dependents, as was the case in the context of free insurance.

6 of 6. For self-employed persons, who cannot afford to bear an additional burden related to this new coverage, a solution exists in the current regulatory framework. In fact, they will be able to claim an exemption from social contribution for all contributions due and therefore also for those corresponding to small risks, which was not the case for the premiums paid under a free insurance.

In short, this bill, if it confirms the principle of the March 2007 law, also contributes to further improving the social status of independent workers, which has been accomplished by Ms. Laruelle for four years.

We are proud that this bill has been adopted as a parliamentary initiative. I apologize for not being able to attend the meeting of the committee due to personal circumstances, but with the greater zeal I would like to engage here today on the speaker’s floor for the bill I have submitted with.

It is very important to look at the history of social security. It is characterized by two things. First, there is the mandatory nature of social security: one must contribute in order to be able to exercise rights. We also have the obligation to contribute to the employees from the beginning of the system, so that solidarity could also be guaranteed. On the other hand, there is the insurance aspect: it is not only a system of solidarity and redistribution, which is abundantly present in our unique system of social security, but it is and remains also an insurance. You pay premiums and you also receive the associated legal benefits or risk coverage.

A significant group was lacking in healthcare, specifically in terms of small risks. About 700,000 people in our country have the status of self-employed or belong to the social status of self-employed. That is about 16% of the active population. Many of those people had long understood that the solidary insurance through social security was the best guarantee for achieving good risk coverage in healthcare. Many self-employed persons have been paying the so-called voluntary contribution for years, allowing them to be fully insured even for the small risks. For the great risks, this was already the case, because the legislature in 1963 had decided so immediately.

The proposal is in line with the recent trend of increasingly expanding social security and at the same time making it more uniform, less complex and less difficult. Let us think of our efforts to eliminate the distinction between employees and employees and to harmonise the minimum pensions as much as possible, or of the creation of an income-related pension for self-employed since 1987, in which they can also build up their own pensions, or of the proposals circulating to equalize the child benefit for the first child among employees and self-employed. This is, by the way, the only benefit in the child allowance that varies depending on the statute.

Instead of fragmenting the social security, we are thus strengthening it, because we are expanding the target group and increasing the critical mass. The first law of any good insurer is: strive for as many affiliates as possible to cover the risks as best as possible with a large premium. In that sense, we fully support the principle – we have been defending it for years – that for self-employed persons even the small risks would be included in the mandatory solidary health insurance, which has long existed for wage-takers.

Then, of course, the discussion can begin. Of course we need to ensure the financing. We need to provide income for the system. I have been following the topic for a while. As a result of this proposal, I have, of course, put myself again hard at studying. One could say that there will have to be a certain collection operation from the social status of the self-employed. Even if we make things uniform, we must still maintain the link with the sender, the premium provider. Hence it is good that every social statute – in our country there is a division, for there is, on the one hand, a social statute for the self-employed and, on the other hand, a social statute for the salaried – is in power to pay its own benefits, to pay its own insurance. Therefore, we are ⁇ asking party not to simply shift things to the general resources. In the long run, one gets confused in financing, because one no longer knows who funds what.

In recent times, this is increasingly the case, with, among other things, alternative financing, including in the general arrangement. The share of alternative financing is currently more than 30 percent. That amount usually comes from indirect and direct taxes and which are paid by everyone, including by non-employed. Thus they contribute to the system of the wage-takers.

On the contrary, I also find it legitimate that a state subsidy is given to the social status of the self-employed, but they must be sufficient in power to cough it up themselves. When I analyze the numbers, I find that this is not a problem today, also because some buffers have been built in for caution. For the risk calculation, for example, the small risks for the non-affiliates were equated with the risks of the already affiliated. Now, however, it turns out that the non-members are the "good risks", because in many cases - as the statistics show - it is young, start-up entrepreneurs who do not see the need for a joining and often postpone such insurance, because they think they still have time for it.

If one takes those risks and insures them as well as the average of the other risks, then one builds an important buffer for financing. In addition, for the calculation of expenditure, it is based on those for 2005. The growth rate of 4.5% has been applied three times. I think that is the maximum that could be done. The growth rate limits us to 4.5%. It has been applied three times in 2005, 2006 and 2007. I think that is a second buffer, especially since the most recent year – I have looked at the spending for the small risks – is a much smaller growth.

The benefits for small risks, including in the supplementary free insurance, remained roughly stable. In other words, one can expect that a certain overwhelming has occurred. My initial concern – because I have naturally started talking about it with the social partners and with the people who have supported it – turns out to be unjustified. Through this buffer, they have been able to convince me that we have sufficient guarantees in terms of financing that things can go well.

They have been forward-looking for a few years. The bonuses that could be realized through the social status of the self-employed in recent years were stored in what they call a kind of welfare fund. This reserve can also be used for the social status of self-employed persons.

The contribution to that reserve fund currently amounts to approximately 150 million euros. It is also expected, given the good performance in the social statute, that some 250 million euros could be added. In other words, the reserve in the fund can reach approximately 450 million euros.

Well, the cost of integrating small risks is roughly calculated, with the administrative costs included, approximately 470 to 480 million euros. This means that from that welfare fund only the funding could be provided. However, since the state intervention keys, which also exist in the system of the general arrangement, are used here, there is actually no need for them. Therefore, we do not have to worry much: on the basis of the numbers received, we have been able to determine that the necessary guarantees are available.

You might argue, colleagues, that there may be an additional effort needed by the self-employed. Well, when one looks at the mass paid by the wage-takers in global governance, one comes to about 66%. The number of self-employed is approximately 59%. So there is indeed a smaller participation due to the self-employed when you look at the percentage.

The share is growing and that is more important. We are still behind, but the convergence is increasing. A collection movement is underway. This leads me to the following decisions. Self-employed – let us be honest – have for a long time alone for the sake of their profession had to act more individualistically and therefore have a slightly less developed sense of solidarity than people who are together in the same work situation on the workplace. Despite this mentality, self-employed people understand that they need to be adequately insured. Look at the number of bankruptcies, the risks, the huge investments that people have to make when they start a business. All this requires them to be extremely careful and to ensure that they are covered, that they are insured. Let us be honest. Most self-employed do not leave it with compulsory insurance like this here that is linked to social security. Most self-employed also have private insurance that they use to ensure that they can at least keep their head above water when an accident occurs.

That the self-employed understand that this solidarity needs to be expanded rather than limited, and that they also make an effort to bring solidarity to each other and not to flee away in private insurance is an important signal. They are willing to contribute to the social security system.

What Mrs. De Block said, I think is important. Like Mr Jeholet, she talked about the interventions. Be careful to compare these contributions with each other. Per ⁇ the people of the SPA will argue that we make the small pay too much while the big pay too little. In this regard, I believe that the rules of social security must be taken into account, namely that the person who earns the most always pays the most for social security, since the contributions are deducted proportionally to the income. But not only do they pay the most, they also get the least because with the refund there are all sorts of income-related selection systems that ensure that those with the lowest income get the most back on health benefits.

Colleagues of the Sp.A., we must be careful that we do not exaggerate, that we are going to refer to the people we need to feed the system, the strongholders, those who make a lot of money, in the long run, to a kind of aid scheme in which we tell them to pay as many contributions as possible, not ceiling on the full wage, while when paying out benefits we tell them that they are strong enough to bear them themselves. In this way we have a system of assistance and there is no social security anymore. The insurance element is then gone and then we are only left with an income-related system, an assistance system. This is good as a correction on a social security system. However, it is not good if this assistance system remains alone because everyone knows that this is unpaid because everyone then flies away in the private sphere where everyone pays a private insurance for themselves and then only the fools remain in the assistance system.

Therefore, we must pay attention to the desolation. We must ensure that the system remains attractive enough.

I can continue to discuss this contribution. That is very complicated. This is explained in the law. There is a minimum threshold, there are maximum thresholds and intermediate thresholds. All of this can be calculated. This has also happened. A certain contribution has been linked to this. We can continue to discuss this.

However, I am quite reassured. In fact, it is the social partners themselves, i.e. the representatives of the self-employed, who have drawn up the system. That is also good. You must not think that the legislator himself, we as the draft legislators, who calculated contributions. We cannot do that. This involves study services. This involves contact with the back. That presupposes that one can make simulations and that one can see if this is socially portable for the professional group. Now it turns out that this can be. It is a joint proposal that comes from the social partners representing the self-employed. They have come to the conclusion that this is a fair, fair way to be able to secure that contribution payment in the future.

My colleagues, I am quite reassured. I have been critical about it. I have been very informed about these things. I find it a good thing in principle that these risks are included in the mandatory insurance, that they do not escape us, that the social security is thus strengthened, that also self-employed people, and especially those who are in difficulty, can thus enjoy solidarity. They may not be able to contract private insurance. Therefore, I think it is good that we have been able to get into this system.

From that enthusiasm—it is in the logic of things—we will join it. We are now, of course, in a different situation. Finally, I have to say that this should have already been arranged, colleagues. For a long time, there were KBs for approval. It is because one was suddenly affected by the electoral fever, around the middle of this year, that one did not dare to cross the cold water and that one has remained on the side and that we have had to act from the Parliament itself.

After all, if this law is not passed today, the first quarterly contribution for the self-employed in 2008 will be in trouble and people will have to pay their contribution for the health insurance separately later, which would not be acceptable.

This happened because of the hesitation in the purple. I do not give an analysis of what was the reason. I have my own ideas about it. One puts it on the other, as always. Whoever is right will be nobody and everyone. One puts it on the other. It comes down to the following. Unfortunately, before the elections, we were unable to show the courage to approve and approve the KBs that were prepared so that this statute had been in place for a long time and we should not have made this intervention quickly in December through Parliament.

Nevertheless, I feel honored to be able to participate in the draft law. As a very notorious and well-known ACW supporter, I am also very concerned about the people, for the self-employed, for the people who sometimes have more difficulty in that group. From my knowledge of social security, I would like to do my best to fully guarantee these people too that they would get everything they need.

Mr. Speaker, I would like to thank Mr. Goutry for his very deep reflections. I only regret that, as he said at the beginning, during any of the discussions in the committee he has not really been able to contribute to the debate and that he now expresses his great concern. I have not been too pathetic about it, but I have been present at the discussions when it was necessary.

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