Proposition 52K2293

Projet de loi portant des dispositions diverses en matière de l'organisation de l'assurance maladie complémentaire (II).

General information ¶

Submitted by

CD&V Leterme Ⅱ

Submission date

Dec. 2, 2009

Official page

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Status

Adopted

Requirement

Simple

Subjects

EC Directive administrative court civil procedure appeal mutual assistance scheme insurance insurance company health insurance

Voting ¶

Voted to adopt

CD&V Vooruit LE PS | SP Open Vld MR

Abstained from voting

Groen Ecolo LDD FN VB

Party dissidents ¶

• Gerolf Annemans (VB) voted to reject.
• Peter Luykx (CD&V) abstained from voting.

Contact form ¶

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Discussion ¶

March 24, 2010 | Plenary session (Chamber of representatives)

Full source

Let me allow this ⁇ interested public to briefly report on the discussion of the important draft in the committee.

The discussion took place in the Joint Committee on Business and Social Affairs, which we had decided. In the Social Affairs Committee, the Minister also explained, on behalf of Minister Reynders, the background and intentions of the draft. The drafts were drawn up following the infringement procedure by the European Commission on the basis of the reasoned opinion.

Following a complaint by Assuralia, the Commission was of the opinion that the supplementary health insurance offered by the health funds should indeed be regarded as a non-life insurance and, therefore, they must also comply with the same rules as the insurers.

The Minister made two important remarks. First, the draft proposals ensure the long-term protection of chronically ill persons, including through the tax exemption of the tax of 9.25 % for the insurance we have just discussed. The draft laws are also the implementation of the agreement of September 2008 between Assuralia and the health funds. For legal reasons, two drafts were submitted.

The drafts provide that the health funds, separate legal entities, establish the mutual assistance societies, which can then offer the supplementary health insurance. In order to make this possible, Belgium requested an adaptation of the new European insurance directive, the Solvency II directive. These legal entities will then be subject to the same rules as those applicable to private insurers.

In the general discussion, Sp.a. showed, at Mrs. Plasman’s mouth, an understanding of the way the legislative change is implemented, but was concerned about the protection of the patient, especially with regard to the amount of insurance premiums and the consequences for a possible impairment of the statutory health insurance.

On behalf of the CD&V group, I myself have emphasized the importance of a regulation of the “second pillar”, which this supplementary health insurance is gradually becoming. They are increasingly an indispensable supplement to the statutory health insurance.

CD&V considers very important, among other things, that there is no two-speed system in which people with low incomes cannot afford additional insurance for these supplementary health insurance. We therefore found it important that the protection could be achieved in a different way, through the tax exemption for high-quality insurance.

Mr. Gilkinet of Ecolo-Groen! regretted the fact that Europe is undermining solidarity through the mutuality’s supplementary health insurance. He preferred to include the supplementary health insurance in the statutory health insurance and regretted that the draft law on tax exemption for the supplementary health insurance was not yet available.

Mr Bultinck of the Flemish Interest was concerned about the absence during the discussion of the draft law on tax exemption and also concerned about the affordability of premiums, the deadlines on which the law would come into force and the reason why a legally mandatory supplementary insurance was not chosen.

The MR, on behalf of Ms. Carine Lecomte, stated that the design makes it almost possible for health funds to offer additional insurance. Without intervention, Europe would have distorted competition with insurance companies.

The protection of chronically ill persons will continue to be ⁇ ined by the exemption from the tax of 9.25 % on premiums from insurance companies that offer good guarantees.

Ms. De Block of Open Vld wanted to see the draft laws discussed together with the draft tax exemption. Given the diversity of legislation and control mechanisms, the Commission emphasized the importance of cooperation between the Health Fund Control Service, the CBFA and the planned evaluation. She also emphasized that the patient’s interest should be placed first.

CdH, through Ms. Fonck, was concerned about the possible reduction in patient protection, for example through segmentation. She hopes that the tax exemption will provide sufficient incentives and safeguards to keep access to supplementary health insurance.

Mr Mayeur emphasized the importance of statutory health insurance and considered the fact that we must adapt our system under pressure from Europe a defeat for our social security.

In addition, some colleagues had a number of previous technical questions.

The Minister has responded to this. In addition to a number of technical explanations, she addressed the main remarks. She noted that paying all expenses through the legal insurance is currently impossible and that a distinction is made in the design between the services, operations and insurance.

In addition, the Minister also believed that the draft would allow the health funds to continue to offer high-quality insurance, inter alia by preventing them from having to pay a tax of 9.25 % on those insurance. However, she is aware of the risk that chronically ill people could not get insurance and also believed that the three bills should be discussed together and that the three bills should be voted together.

Thank you, Mrs. the reporter. First, I give the word to Mrs. De Block.

Mr. Speaker, Mrs. Minister, and the six colleagues who are so brave to discuss this very important draft, this draft on the supplementary insurance is very important for us. This draft will eliminate inequalities within the organization of the supplementary health insurance. It has been a bit of a dry matter to discuss and I thank the reporter, Mrs Partyka, who has been able to present this yet quite juicy and concise.

The benefits for the insured cannot be underestimated. As stated above, the bill came under pressure from the European Commission. That threatened with a sanction because the health funds and the private insurers could not treat the patient on an equal footing when offering an additional health insurance. A legislative framework had to be created and this legislative framework was, as I mentioned it in the committee, a so-called Belgian compromise. Since the health funds could not be completely equalised with the private insurers, they had to create a so-called society of mutual assistance, which would allow them to be legally equalised.

Through a number of technical interventions, the inequalities have been eliminated and this is especially beneficial to the patient. From now on, access to additional health insurance is equal for everyone.

Being rejected because of a congenital early deviation or an early detected disease is now no longer possible. The phenomenon of risk selection is from now on. For example, even 65-year-olds could not go everywhere for an additional insurance. This evil was also corrected.

The importance of the fact that people with chronic diseases should be able to take additional insurance has been emphasized in the committee several times. The discrimination of chronic patients, precisely those who have more medical expenses and are very vulnerable because they also have less income, has been emphasized several times by several colleagues.

On behalf of Open Vld, I would like to say that we are very pleased with this draft. I have two other questions aimed at closely monitoring the implementing decisions.

First, access to the supplementary insurance is optional. So she is not compulsory. Patients will be adequately informed about this.

Second, we would like to have the possibility for patients to mutate between health insurance. I am not saying that this is always necessary or often occurs, but it is still a free choice. Sometimes one is out of home with a certain mutuality. In the course of one’s life, one can change to another mutuality.

two things. In fact, this is not in the lot of compulsory insurance, you are quite right to emphasize it. Secondly, I think it is still necessary to clarify, since this is one of the specificities of the mutual sector, that mutual companies will only be able to offer their insurance to members of affiliated or related mutualities. This is a general principle that already exists in the laws of 1964 and 1993. With, that said, two elements. The affiliation with the mutualist company will not be terminated if the person is affiliated with another mutuality that is also affiliated or linked to the mutualist company, this is the first particularity. The second is that, when a person has decided to become a member of a mutuality that is not affiliated or related to the mutualist company in question, the member must be informed that his decision implies that he will no longer be affiliated to the services of that mutualist company.

So, you are not obliged to have this product, it is not part of the mandatory package but you can not shop through mutual products.

Let me say, however, that by putting ourselves in line with this European regulation, we can provide a great added value for patients. We have two flies in one blow. The weakest in society are better protected. Open Vld considers this to be a very big step and a progress for the patients.

Ladies and gentlemen, it is 20 hours.

I consult with you.

It is registered M. Gilkinet and Mrs Partyka.

Mrs. Plasman has told me that I may remove her and Mrs. Fonck is not present. In fact, it comes down to two presentations. If you are short, Mr. Gilkinet, what your habit is, and if Mrs. Partyka is also short, we can finish this design. Is there consensus on this?

In this case, I give the floor to Mrs. Partyka, who is the second speaker on the list.

Mr. Speaker, we have already talked about the origin and basic idea of this draft.

In addition, I agree with the Minister when she says that this draft has the important merit that it allows the health funds to maintain a supplementary health insurance. I think this is a very important point that we should ⁇ not lose sight of. Insurance has an important social function. The health funds do not follow the commercial logic of the private insurers. With the design present, this remains possible, and that is very important.

I would like to take this opportunity to emphasize the importance of supplementary health insurance, as well as its alternative by the health fund insurance. OECD figures show that patients pay a considerable part of their costs themselves. It is not less than 28% while 72% is publicly funded.

It does not appear that the patient’s personal contribution will decrease. The study shows that the bill for a double room may have dropped, but the supplements for a single room have increased by 6% over the past year. They now make up no less than 55% of the invoice, which is sometimes difficult for the patient to carry.

I know that it is fashionable to refer to the American system, to which President Obama has now changed everything. I think, however, that we must be careful that we too do not let our private insurance go down to a more American system. Health insurance and supplementary insurance are increasingly a necessary evil. Anyone who cannot pay the insurance or is not accepted by the insurers falls out of the boat. This is a little like the American situation. 16% of the U.S. GDP goes to health care. Approximately 50 million people are not insured.

We are rightly very proud of our social security, but our supplementary health insurance is still beginning to show American traits. In the United States, private insurance is concluded in two ways, either individually or through the employer. Individually, it is a matter of wealthy citizens. Through the employers, it is mainly the large companies that finance the health insurance. In small ⁇ , the employee either pays with or must take care of his own insurance.

This is also increasingly the case in our own supplementary health insurance. People who are unemployed, low-income or in economically weak sectors are increasingly lacking additional insurance. Even low-income people cannot afford such insurance. Older people are often excluded too.

The insurance of the health funds offered and will offer an affordable alternative in the future. They must also accept everyone up to 65 years old, as the Flemish Patient Platform stipulates. The hospitalization insurance of the mutualities is, in contrast to the hospitalization insurance of private insurers, obliged to contribute to the costs of pre-existing diseases. Moreover, mutuality hospital insurance is cheaper than often expensive private hospital insurance.

The design had one disadvantage. We have talked about this a few times. Compulsory equality is detrimental to social protection. The Minister rightly says that it is extremely positive for the operations. There will also be greater protection for socially weaker groups. In terms of insurance, the equalization has a disadvantage. While there was previously protection by the law-Demotte, the obligation to join up to 65 years of age and also despite medical antecedents, those two obligations now fall away. The right of membership up to 65 years of age is eliminated and the right of insurance despite medical history or chronic diseases is also eliminated. Hospitals funds could, however, limit the benefit for existing diseases to a fixed fee and exclude supplements for single rooms.

However, this disadvantage has, in my opinion, been sufficiently corrected by the government by the taxation and the exemption of premiums for policies that continue to offer these guarantees, including for double rooms. I am very pleased that it is arranged in this way. I am also convinced that this gives the health funds the guarantee that they can continue to offer those insurance.

In addition, finally, I think it is important that an evaluation of the 2011 budget is provided. It was a bit of coffee watching. It was a European obligation. I think we have sought a solution in the best possible way. It is therefore important that we conduct this evaluation in 2011 to see what effect that design has had on the market.

I have spoken a long time about the tax bill.

I had requested the analysis of the two texts in a joint committee. I used the phrase “buy a cat in a bag”. As soon as we have made the choice, as the government and Mrs. Minister have done, to try to answer the commission rather than explain here, we should try to have a device that is less problematic in terms of the benefits of insurance proposed by mutualities.

You can see the bottle half empty or half full. I kept in mind that my colleague Mayeur had the same analysis as me in the conclusion, so that was rather a retreat. “Nederlaag” was mentioned in Mrs Partyka’s report.

This is a defeat for social security against an attack by the private sector.

In this case, all of this must be implemented. There are indeed the deadlines to be respected with the possibility of extending by six months for the arrangement to begin at the beginning of a calendar year. This will require an assessment, including in relation to the fiscal impact of the measures we have just discussed. I will be ⁇ attentive to this. Our concern is to allow as many people as possible to be able to get proper care as more and more of our fellow citizens give up the necessary health care and as more and more bills are unpaid.

I hope that the United States will evolve toward our social security model and that we will not evolve toward theirs. We cannot fully speak of social security in their head.

I will be brief. In fact, just recently I intervened thinking that we were looking at both projects at the same time!

That is what I noticed!

I can only repeat myself. Through this project, we protect the vast majority of the population who have already signed a complementary hospital insurance with a mutuality. And we support the very principle of mutualist solidary insurance, as tax deductions will go to mutualist companies that organize this mutual risk, which establish no difference between members, including those who are chronically ill, who do not make a difference according to their health status before the conclusion of the insurance contract.

On the contrary, our social system is becoming more efficient and we can be proud of it. Obviously, the ideal in my view would be to include compulsory hospital insurance in the compulsory insurance package. But maybe we will ⁇ it someday! In the meantime, this step seems to me essential for the protection of our fellow citizens.