Billions of health insurance discounts on the brink: confrontation in the premium dispute

Up to ten percent of income

With the premium reduction initiative, the SP demands that the health care premium may not exceed ten percent of disposable income. Cost point: 4.5 billion francs per year. The federal government should bear two-thirds of this, the cantons the rest.

The Bundesrat thinks that is too much. He has formulated a counterproposal costing 500 million francs. The cantons should do more. After all, they are responsible for the rising healthcare costs, according to the national government.

In fact, costs are rising continuously: by 2.6 percent in 2022 and by 3.4 percent in the first quarter of 2023. This drives up premiums. Current calculations by the SGB show that in 2022 the premium volume in Switzerland was CHF 32.9 billion, this year it will be CHF 35.3 billion. Federal Councilor Alain Berset (51) has already announced an “above average increase” for 2024. If the premiums rise by another 6 percent – ​​a conservative estimate – the premium volume next year will amount to 37.7 billion.

An increase of CHF 2.4 billion per year – this figure is close to the amount the National Council plans to spend on premium reductions. Unlike the Bundesrat, which considers 500 million to be sufficient, the Grand Chamber wants to make 2.2 billion available per year.

Council of States undercuts Federal Council

The Council of States will decide on Tuesday. There, a strong wind is blowing against the counter-proposal of the National Council. Last fall, the small Chamber did not even want to get involved. Now the Health Committee of the State Council has come up with its own proposal, undermining the Federal Council: according to the committee, 350 million is sufficient to solve the premium problem.

That drives SP co-chair Mattea Meyer (35) up the wall. “Given a premium increase of more than two billion francs per year, an exemption of 500 or even only 350 million francs is a travesty. This does not change the unfair principle of simply passing on the increasing costs to the insured. »

Central council member Pirmin Bischof (64), member of the Health Commission, disagrees: “Social assistance and benefits automatically increase if the eligible premiums increase. This protects the weakest.” On the other hand, it is worrying that the premium pressure is affecting a growing section of small and medium-sized enterprises. “The Commission’s proposal would lead to targeted aid for this section of the population.”

However, cutbacks are only the second best solution, says Bischof. “We need to get cost growth under control.” That’s where the center’s cost brake initiative comes into play. It obliges the federal government and the cantons to intervene if healthcare costs rise too much compared to wage developments.

The bourgeois majority decides

She has absolutely no objection to cost savings, says Mattea Meyer. “We could start with drug prices, which account for a quarter of healthcare costs. The pharmaceutical industry makes billions every year from this.” The problem is the enormous lobbying forces in parliament. “The influence of pharmaceuticals and insurance companies regularly prevents improvements in favor of the insured.” As an example, Meyer refers to federal councilor Berset’s attempt to introduce generic to make medicines cheaper. “The common people have sunk the project.”

Now the bourgeois majority in the Council of States decides on the premium reductions. The proposal from the Health Commission of 350 million has the best chance: it comes from the middle bracket, which has 14 members of the small chamber. But another Council of States non-appearance is at stake: SVP State Councilor Hannes Germann (66) will file a corresponding application.

However, that would increase the chance that the people would eventually vote for the SP initiative and thus more than 4.5 billion francs. Because a withdrawal is only an option for the Social Democrats if parliament accepts the National Council’s counter-proposal.

“There’s nothing wrong with voting,” says Germann. But he also says: “Both the initiative and the counter-proposals are a paternalism of the cantons. Admittedly, not all of them have done their homework. But that’s no reason to change the whole system.”