Canton of Ticino agrees to the abolition of black lists

DEBT

For the government, individuals who fail to pay their health insurance premiums should not end up on a black list and be treated only in case of emergency.

 Canton of Ticino agrees to the abolition of black lists
Ticino says yes to the abolition of «black lists».

Canton of Ticino agrees to the abolition of black lists

Ticino says yes to the abolition of «black lists».

Ticino backtracks on the black lists of defaulters of health insurance premiums and says it is ready to align itself with what is proposed by the Commission of Social Security and Health of the States (CSSS-S). The Commission which, in essence, proposes to remove the paragraph of the Federal Law on Health Insurance (LAMal) according to which those who do not pay their health insurance premiums must end up on a black list and, as a result, will only be treated in an emergency.

The Cantonal Government has expressed its position in its reply dated October 1st to the federal consultation on the project of modification of the LAMal (Federal Health Insurance Law) and, in brief, considers that «apart from the far from negligible administrative cost that the maintenance of such a list entails», its abolishment could put an end «to possible unequal treatment in relation to the affordability of services paid for by the obligatory health care insurance». At the same time, the proposal of the minority of the CSSS-S to maintain the black lists and to define what is meant by «emergency treatment» was considered «impracticable» because «the policyholder’s perception of the seriousness of his illness is subjective». If one really wanted to maintain this instrument, the Government believes that it is necessary to «anchor in the LAMal the competence of the treating doctor or the emergency service to determine seriousness, without the insurer being able to question it».

The government’s stated position is an entirely new development. Only two years ago, on May 2, the then director of the DSS, Paolo Beltraminelli, declared at RSI that « Ticino is still convinced» of the black list system. Beltraminalli had, however, made an important clarification: «The Canton only suspends those insured persons, a little more than 3,000 out of a total of more than 25,000 who are in default, and who do not contribute what they are obligated to despite being able to do so».

The Council of State also expressed its opinion on the non-prosecution of minors for failure to pay premiums, aligning itself with the proposed amendment which indicates parents as the only parties liable to pay premiums and cost-sharing for their children until they reach the age of majority. This is so as not to «adversely affect their future.»

Suspended for coronavirus

It should be remembered that last April the Canton had declared the lifting of the suspension of insurance coverage for citizens included in the notorious «black lists» of health insurance debtors until the end of the state of need due to the coronavirus emergency. The issue of black lists of insured persons in arrears has also been the subject of much debate in cantonal politics. Nine deputies (socialists Ivo Durisch, Gianrico Corti, Milena Garobbio, Carlo Lepori and Tatiana Lurati, the independent Jacques Ducry, the ecologist Michela Delcò Petralli and the liberal radicals Natalia Ferrara and Nicola Pini) had called for their abolition in June 2018 and had proposed, by means of a parliamentary initiative, to «remove» this possibility from the cantonal regulations applying the LAMal/KVG.

Even the Conference of Cantonal Health Directors (GDK) is in favour of abandoning blacklists. In a statement published on Monday, the CDS agrees that citizens who do not pay the premium or the deductible should be offered a model with a limited choice of service providers. However, exceptions that particularly affect the chronically ill should be examined. The cantonal health officials are in favor of abolishing blacklists in which the names of people in debt appear. Furthermore, access to adequate health care must be guaranteed for all.

This would, amongst other things, avoid further disputes over the definition of medical emergency treatment. According to the proposal of the commission, which in June put a preliminary draft amendment to the KVG up for consultation through to tomorrow, the cantons are to be given more options for collecting debts arising from non-payment of premiums. Those that assume 90% of the claims of insurers will be able to have their certificates of non-payment transferred to them and manage them directly. The CDS considers the financial outlay of 90% to be too high and calls for a solution in which the cantons take over 85% of the claims, as is currently the case. Finally, it accepts without objection the idea of CSSS-S with regard to young adults, who in future will no longer be able to be pursued for premiums and cost sharing not paid before reaching the age of majority. In other words, as long as they are minors their children have no responsibility in this matter, which instead falls solely on their parents. The draft bill aims to improve the procedure in the event of non-payment of health insurance premiums and follows an initiative filed by the canton of Thurgau. The draft implements two motions passed by Parliament. In the background are the high costs borne by the cantons, which in 2018 incurred charges of more than 385 million francs.

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