Proposition 52K2450

Projet de loi instaurant une exemption de la taxe annuelle sur les opérations d'assurance au bénéfice des assurances soins de santé offrant un niveau de protection élevé.

General information ¶

Submitted by

CD&V Leterme Ⅱ

Submission date

Feb. 26, 2010

Official page

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Status

Adopted

Requirement

Simple

Subjects

tax mutual assistance scheme insurance insurance company tax-free allowance health insurance

Voting ¶

Voted to adopt

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

Abstained from voting

Groen Ecolo FN

Contact form ¶

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Discussion ¶

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

Full source

The reporter, Mr. Jenne De Potter, told me that he refers to his written report.

The speakers list includes Mrs Partyka, Mr Gikinet and Mrs Plasman.

First, I give the word to Mrs. Partyka.

Mr. Speaker, this draft is linked to the draft that we will discuss as soon as possible. This is about taxation and the exemption from the tax of 9.25 % imposed on insurance premiums of insurers. The Government provides for an exemption for certain high-quality insurance. In this way, the government seeks to provide, through a tax incentive, an equivalent protection, similar to that in the former Hospital Fund Act or the Demotte Act, namely for insurance that is accessible up to 65 years, for insurance that is accessible despite medical antecedents, for existing conditions or chronic diseases. Furthermore, such insurance should also not give rise to higher premiums or exemptions in interventions.

Products that meet these conditions will be exempt from this tax. We were a really demanding party for that. I find it extremely positive that the government has linked those two projects, because that was important.

CD&V is also satisfied with the amendment submitted by the majority, which aims to introduce the tax exemption for insurance, including in double rooms. We are very satisfied with this because we hope that in this way the supplementary insurance of the health fund can also remain an affordable alternative. We will support and approve this with full conviction.

What amendment are you talking about? Which we adopted in the committee? (Assent) I thought there was a new amendment that made the text a little less bad!

The project that we are going to adopt is not anonymous. I am glad that you are so many to share some thoughts on the subject. It is not anodine since it concerns the ability of our seriously ill fellow citizens to take care of themselves and to assume the cost of hospitalization.

I will address all the texts at the same time and I will begin again, if necessary, tomorrow with Mrs. Onkelinx. It is a pity that she is not there!

It is observed that more and more hospitalization bills are not paid, that more and more medical care is transferred by fellow citizens who have no means to pay them, and this despite a system of reimbursement of health care, a social security that we all want and that must be preserved. By the way, if we look a little further than in our country, the main fight in domestic policy of the new President of the United States since his inauguration is the establishment of a mandatory and generalized health insurance.

Mr. Speaker, Mr. Gilkinet, I think you are a little wrong, we are now dealing with the fiscal part. There is a tax section and a part dealt with in the Social Affairs Committee. The protests are now about the fiscal part, of course in the presence of the Minister of Finance. You do, I will also stay for the other part, but it may be a little weird in the discussion. I have that impression, but as someone else doesn’t like it.

My argument also concerns both, because they are connected. The first draft had actually been better after coming on the agenda, then that would not have happened. However, I think there is no problem.

We will store all that, all that is said. It will be answered at an appropriate time, but you are, of course, right, the first draft implies exclusively the competence of Minister Reynders.

Mr. Speaker, it is not for nothing that I requested, here 20 minutes ago, the resumption of this discussion tomorrow after the topical questions. Thus, she will be joined to the discussion of the bill that Ms. Onkelinx defended in the Social Affairs Committee. It was agreed that the two texts would be considered jointly. I would prefer a single discussion of these texts that are actually linked. I also understand that my colleagues from the PS and the CDH are not present because they must be quite embarrassed by the tax provisions adopted and which are not without consequences on the state budgets. Mrs. De Block, you will allow me to consider that we are here facing a whole. The two texts are clearly linked.

Mrs. Onkelinx, texts of such importance ⁇ deserve a more provided audience. What I have to say deserves even more a large assembly! I pointed out the issues of social security and the ability to take care in case of serious illness or hospitalization. In fact, more and more of our fellow citizens struggle to take care of themselves. Hospitalization bills remain unpaid. Care is postponed despite a reimbursement of health care that many of us envy, including the President of the United States. It has just taken steps but it is still far from a system like ours, which we can congratulate.

I think that if we share this concern of equality, of solidarity, of the effectiveness of public policies, all political action must tend to strengthen this solidarity.

Madame Onkelinx, you will agree with me that the ideal in terms of hospitalization and hospitalization insurance would be to have a system integrated into our social security. In terms of costs for insured persons, this would guarantee the most limited amount possible, which would ensure everyone’s ability to take care of themselves regardless of their health, fortune or level of income. This could eventually develop a more efficient overall cost management of social security than it is today.

I think this is the ideal to be achieved.

It can be said, even if it does not interest many people, Madam the Minister of Social Affairs, Mr. the Minister of Finance, that the present texts are distant from this ideal. The two texts that the colleagues of the majority will vote tomorrow will not improve the situation of patients, nor that of chronically ill patients. On the contrary, they will make health insurance, which they had and have access to as part of mutualties, less interesting, because they will lose competitive advantages.

What is the current situation? There are two types of health insurance companies on the market. First, private insurance, often offered by employers as an extra-legal benefit in connection with a job, is absolutely respectable. If a person occupies a job, it means that he enjoys a very good health status. In addition, these insurance companies seek to evacuate bad risks, in particular by submitting them prior questionnaires. Bad risks are not profitable. Sometimes they are expensive in hospitalization. The balance sheet is negative. Therefore, attempts are made to avoid coverage of such risks through pre-medical questionnaires or premium increases.

This debate often takes place in the Committee on Finance or Economy. Some insurers increase premiums according to age. As a result, it becomes increasingly difficult for older persons, who benefit from private insurance, to continue to benefit from it if they do not have comfortable financial means. I am regularly questioned about this.

Moreover, the system has a deregulatory effect on healthcare spending and hospital spending, as for such subjects the overall healthcare spending costs expensive to social security. It is well known that hospital institutions, when they see an arrival of a patient with a solid health insurance, tend to multiply the examinations and operations resulting in an increase in the bill.

Private insurance exists in many areas. This is perfectly respectable. It is normal that they try to increase their profits. That is life.

And then, there are mutual insurance, which are not all perfect either. A mutuality is an organization defined by law as non-profit. It collectively organizes the reimbursement of health care. For most of the insurance offered, it does not select the risks. Sometimes it even tries to develop mechanisms for regulation and cost control, sometimes through agreements with hospitals. Currently, mutual insurance companies can – not automatically –, depending on the characteristics of the insurance they offer, escape the tax on the insurance premium which is of 9.25% and the INAMI contribution, so-called “Busquin tax”, which is 10%.

But what happened? Private insurance companies have opposed this situation. They appealed to the Belgian court, which, in first and second instances, dismissed them, considering that this difference was justified, given the role and functioning of mutualities in the field of health insurance.

They decided to go further. I will not prevent them from using all possible legal routes. The European Commission, after being questioned, issued an opinion in May 2008 which estimated, on the basis of information provided by the government – in this case, by Mr. Donfut – that mutual insurance does not meet five conditions set by the “non-life” directives. I am sorry, of course, but I have no power over the European Commission.

The government was facing a choice: either to go further or to bend by adapting the legislation. This was discussed in the Social Affairs Committee. You told me that by addressing the Court of Justice of the European Union, we could also lose everything and result in an even more damaging situation for the patients you say you want to defend.

If I look at the case-law of the Court of Justice of the European Union (CJEU), whether it is on occupational accident insurance or, more recently, on small risk insurance, it is sometimes more progressive than the Commission. “A Member State is entitled to reserve the coverage of a risk to a public body specified by law if such restrictive practice finds justification in European law and does not violate the principle of proportionality.”

Regarding the task of general interest which belongs to certain bodies, it considered that “the fact of allowing certain private insurers to intervene in the market in question – in this case, it was mandatory health insurance – would result in entrusting an increasing share of bad risks to these bodies – mutualities –, which could jeopardize their financial balance and, consequently, the continuation of their mission”.

There is thus jurisprudence that I found in the General Review of Insurance and Liability (RGAR); they tell me that if we had been more combatative at this level, we would have been able to defend a model that seems to me more solidary. This is not what we are offered today.

Indeed, there has been this discussion between Assuralia and the Intermutuellist College, which resulted in this famous agreement that is translated into three bills that seem to me to go further, negatively, than what this agreement included.

Fortunately, we were able to get an amendment. I had one and the majority members also. We have been able to agree on a formula that, in the text as such, reaffirms that the services offered by mutualities are services of general interest, that they escape the Services Directive.

For the rest, I have to see some retreats that we regret. We can live with the new administrative arrangements – everything changes – because they have been negotiated with mutualities. Nevertheless, on the fiscal part, we have this loss of progressiveness and the disappearance of the possibility of exemption from INAMI tax for the most solidary products. Today, we have a system either without any possibility of deductibility, or ...

Not only do I listen to you, but you have already said it in the committee. That reminds me of everything. So it is normal that I can listen to you and listen to you elsewhere.

I will soon have to look at it again. He’s a beautiful guy, I’m not saying the opposite.

You will make me red!

Either there was no deductibility at all, or there was the possibility of having both deductibilities, or, having only one with a certain progressivity and a differential advantage for the most solidary products, that is, those who accept all risk profiles, all ages and organize solidarity as one would like to see it organized within the framework of social security. And then, I discovered with astonishment and some disgust that the tax text we are discussing introduced a new possibility of deductibility for so-called continuity insurance, that is, if one was insured under a labour contract and that one is no longer insured, for one or another reason (end of career, dismissal, decision of the employer). The Minister of Finance replied to me in a committee that the two types of insurance are identical and that it is therefore normal to treat them in the same way.

Let me challenge this view of things. There is de facto a selection of risks since not everyone has the opportunity to work. When you work, you are in good health and the risk profile of workers is thus statistically less problematic than that of the sick person or the elderly person hosted under the insurance offered by mutualities. In addition, private insurance companies in particular develop strategies to get people insured by uncontrolled tariff increases out as soon as they become less profitable, less economically interesting because more often sick.

When the number of private hospital insurance contracts is known, the introduction of this new possibility of tax deductibility also has a very significant potential budgetary impact. For this impact, potentially affected persons, the exact conditions to be fulfilled to continue to benefit from this contract as part of its continuity, things do not seem clear to me. Can one be affiliated for three months by his employer and then continue his insurance contract on an individual basis while benefiting from this possibility of tax deductibility under a contract ultimately comparable to any contract offered by a private insurance?

Beyond tending towards a less solidary model, this disposition seems to me imprudent. Although the two texts prepared by Ms. Onkelinx have been largely coordinated with the different sectors, we cannot support them, as they represent a downturn in the capacity of citizens to receive treatment at acceptable costs.

It is an advance! If you have well understood the project, Mr. Gilkinet, you will have noticed that we are protecting the ability for mutualities to offer hospital insurance. All the mutualities thought like us. Without this project, many people would not have hospital insurance. It is really about protecting the hospital coverage.

Furthermore, thanks to the mechanism set up, we also protect the chronically ill, since the mutualist society will no longer be able to distinguish between a chronically ill and another. The tax bill, of course, provides for a small exception for some interventions in a private chamber but, so far, the exception was much wider.

In other words, as a general rule, the population is protected through the ability for mutuals to offer hospital insurance. This was extremely important for mutual societies, which have the specificity of not making a distinction between members and not looking at the pre-existing health status. Furthermore, the chronically ill person, as such, who more and more needs hospitalization insurance, will be better protected by mutualist societies.

Three things, Madam the Minister.

The first is a hypothesis: did it actually have to [...]

The [...]

In this case, the cause of more solidary mutual insurance seemed to me quite plausible at the level of the European Court of Justice. There is a jurisprudence that seems to indicate – but it is a hypothesis and I can admit it to you – that this system was quite defendable at a higher level. The opinion of the Commission is one thing, the opinion of the Court of Justice is another.

Second, you will not deny that the possibility of exemption from INAMI tax no longer exists. Following the instructions and recommendations...

In the current situation, a mutuality may, in the same service, for example, provide for those persons, chronically ill, a flat-rate intervention per day instead of the intervention calculated on the basis of the costs actually incurred that is granted to the other members. This will no longer be possible so chronic patients are better protected.

It is not about this that I was talking to you. The possibility of exemption from INAMI tax no longer exists for the most solidary products and in the end, I confess that I do not understand what continuity insurance comes to do in this system because they do not have the solidarity characteristics of other products that need to be protected, to allow these sick, of which you just spoke with a lot of conviction, to continue to treat themselves. This will have a significant budgetary impact and that says budgetary impact, say a little later, austerity measures that have consequences on the capacity to cure themselves. We believe that this is not the best way the government has chosen.

Mr. Speaker, Mrs. Minister, Mr. Minister, colleagues, as I just said, my discussion will include the three drafts. So I will no longer intervene tomorrow and my name may be removed from the speaker list.

As described in the report on supplementary health insurance — the report we will hear tomorrow — our group is very engaged with this dossier. We would, of course, have preferred to leave things to the old, as that provided the best assurance regarding the protection of patients. The arrangement in the Demotte Act, which obliged mutualities to conclude an affordable hospitalization insurance for persons with a chronic disease or disability and thus intervene in the costs of a pre-existing condition, was the best we could offer. Therefore, the fear of degradation as a result of the complaint of the private insurers and then the bankruptcy order by the European Commission was high.

The current drafts, with the exception of the draft on tax exemption, were discussed extensively in the Social Affairs Committee. Our group also realizes that there is no other choice possible. The creative pathway to enable the health funds to continue to offer the same protection through the society of mutual assistance, we find a good arrangement, although provided that the link to the tax exemption and above is linked to a number of very important conditions relating to the high level of protection, no distinction in treatment, and so on.

In the press, especially in the Flemish press, we read comments today on the events in America regarding health insurance. There was nevertheless the critical comment that fortunately we have the mutualities, which will still make an offer. If it is left entirely to the private sector, it will not happen.

Contrary to the possibility of an extensive discussion in the Social Affairs Committee, this has not happened in the Finance Committee. I found that it was a lack of respect for the opposition to address the point at 19 am 00, when some members were not present, in part because we in the Committee for Business, given the urgent treatment, would not give advice, although in the understanding that there would be no overlapping. I felt sorry.

We wanted to submit an amendment. It is now on the table so I hope you look at it now. It concerns the incorporation of an important additional security, a new article 2bis on the supplement to article 138bis, 6 of the law of 25 June 1992 on the land insurance contract. The explanation goes well with the amendment itself. We consider it very important because in the Land Insurance Contract Act the right of chronically ill and disabled persons to additional insurance may be terminated after 30 June 2011. This is a possible legal impasse. In the draft on the insurance tax it is always possible but in the law on the land insurance contract there is a timing, namely 30 June 2011. Until then, an evaluation must be made. If that assessment is negative, then we still have a problem. I do not think this is the goal of the government. We hope that everyone will support this amendment. Per ⁇ Minister Reynders says that the amendment is not correct but then I would have liked to get a clear explanation in that regard.

I have two or three comments. As regards the examination of the draft in the committee, it was normal to proceed with the examination of the various drafts in the Committee on Finance. We try to do that even to 19 u. It is the same reasoning as before the plenary session. We will address three key drafts related to the financial crisis and then proceed with the fiscal draft, also in the plenary session.

Second, your amendment is not necessary. The draft can enter into force on 1 July 2011 without any problems. The same treatment applies to the other designs. If there were a real problem in 2011, we could decide something else. There is no need for such an amendment.

Third, in response to Mrs Partyka’s question, I believe that a very useful amendment has been submitted in the committee for a specific treatment of the different performances. It was useful, so I supported it, just like the members of the majority.

Mr. Gilkinet, I tried to answer you and explain the situation in the commission. I will not try to do it again in the plenary session. This is a lost pain because you probably have a fundamental hostility for everything that comes from private sector insurance companies. It is a choice. I simply find that on the fiscal level, we must treat the same legal structures that will present the same products. That is why we come to a text like this.

You get into a whole series of remarks on what could be different depending on whether it is a mutual company or a company from an insurance group. In the tax text, it is obvious that products with the same characteristics should be treated in the same way. But I think I will never be able to convince you.

Mr. Minister, my colleague Gilkinet bases his argument on the fact that it is not the same product and that the conditions of insurance and tariff setting will be different. What do you think?

Madam, it is very simple. We are in a tax text that provides for an insurance tax and, provided that a product corresponds to a number of characteristics, there is an exemption. These characteristics will therefore have to be fulfilled, whether it is a product from a company that the mutualities will create, because they will have to go through corporate structures or whether it is a product from a private insurance company.

But I understand your question. I tried, like others, to explain to Mr. Gilkinet said that from the moment when the products are similar and must meet the same characteristics, one comes to the same exemption. But obviously, it emits a sort of systematic rejection of any product from a private insurance company. I cannot prevent it.

I have heard him talk many times about the great progress made in the United States. There is only the first pillar, which uses exclusively private insurance companies. I can hear a lot of things because there are other interesting countries in the world. But in Belgium, we are not at all in the mechanics of the first pillar covered by insurance companies, as is the case in the United States.

With regard to the United States, I said it was a first step. It is better to have a private insurance than nothing at all. I am also insured with private firms in fire, for car accidents, etc.

Let’s read the text again to see the difference. The text sets out four conditions that an insurance must meet in order to have access to this deductible.

1 of 1. It must be accessible to any insured candidate who has not yet reached the age of 65.

2 of 2. It shall bear the costs of damages covered by it, even if they result from a pre-existing disease, condition or situation.

3 of 3. The presence of a disease may not result in an increase in premiums or a restriction in the level of intervention.

4 of 4. Insurance contracts may not provide for a waiting period of more than 12 months.

This is a type of conditionality and the other type of conditionality is to be in the continuity of an insurance concluded as part of an advantage offered by a company. This continuity is accessible only if one has been engaged in this company and it is impossible, if one has not been employed, to have access to it. The conditions of access are different.

This has nothing to do with depending on a private insurance company or mutuality! You constantly confuse the concepts. You just read the conditions, it is very nice, but if you had come to debate in committee, we would have read them together.

I was there.

Obviously, you did not perceive them in a concrete way.

One of my professors at the university called this a false mind: you are constantly moving from one dialectic to another.

You are explaining to me that it is necessary to be very careful not to let private companies intervene while mutualities offer a wider service. Then you tell me about the second pillar in opposition with a third, but that’s not what we’re dealing with. We are dealing here with a precise matter and in this precise matter, all corporate structures – mutualities will have to transition into corporate structures – that will offer products with the same characteristics will benefit from the same exemption. This is not a deductibility, it is a tax exemption.

Once I answer this, you tell me that some have had a professional activity and others do not. It has nothing to do!

Did the teacher say this to you?

No, he explained this in a general way and I have at least two fellow disciples who have recognized this teacher and who know the circumstances.

Let us be clear! If a private insurance company meets these four conditions, I see no objection to that it benefits from this exemption. Similarly, if an insurance offered by a company dependent on a mutuality does not fulfill them, it seems to me quite logical that it does not benefit from it.

What I’m trying to tell you, in a ⁇ messy way, is that it is different to offer the ever-coming an insurance product and to assume the continuity of this insurance obtained under a labor contract, because the selection of risks is different.

If I understand you well, you are asking for the same exemption if it is an individual contract that is not linked to a work contract!

This is not true! As part of a contract of employment, there is not this 12-month stage!

We had this discussion in the committee. Your questions from the beginning clearly indicate that you missed the ball a little. The Minister explained it clearly. Should we now have a technical discussion about which products are and which are not, about collective contracts and individual contracts? I want to, but we should have done that in the committee, I really think it is no longer the time to start talking about it.

Madame Partyka, I was actually in the commission. For me, this is not a technical problem, but a fundamental issue. I believe that these two products that are placed on an equal footing – the continuity of an advantage obtained under a labour contract and a contract that starts at any time for anyone meeting positive accessibility criteria – are two different realities. But the minister claims that they are identical.

No, he said the opposite! Fortunately, otherwise I would not agree with him.

We may have to invite Mr. Gilkinet came to a liberal congress to try to convince them to go as far as he did. I know that he is likely to be badly received in other congresses, but some of us will listen to his reasoning. I try to understand it. We are talking about individual insurance contracts that should benefit from the same exemptions as a solidary and collective contract, with precise conditions to be respected.

I say to you: Come! I can introduce you to some liberals who may join you. I do not guarantee you that they will go as far as you in the will to exempt from individual contracts. There will probably be a floating.

I must remain neutral, but if I find, Mr. Gilkinet, that Parliament is beginning to defend Minister Reynders, that may indicate that you may be exaggerating! This is a reflection of the Parliament that is not normal!

I am joking. At this time it is allowed.

We assist at a debate particulièrement riche et animé, mais vos voudrais rassurer Mme Onkelinx et M. The Reynders. My propos is exactly the opposite of what you have understood. Peut-être me suis-je mal exprimé. There is no question of proposing an exemption from individual contracts. It seems to me justly that the disposition inscribed in the second paragraph of the first paragraph indicates that you are moving in this direction. And c'est bien ce que vous dénonce!

Mr. Gilkinet, I would like to explain to you why you make the wrong proposition, but I will not do it here. We will talk about it soon, but I think you are really wrong.