Twists and turns by the administration of Prime Minister Shigeru Ishiba over a hike in medical copayment caps is expected to pave the way for an unprecedented scenario in Japan's history — a second revision of the fiscal budget.
The minority government formally initiated parliamentary procedures on Tuesday to enact a second revision of the 2025 budget in the Upper House. The first budget — submitted in late January — was approved in the Lower Chamber last week after it was amended following negotiations between the coalition and opposition parties.
On Wednesday morning, Lower House Budget Committee Jun Azumi met with his Upper House counterpart Yosuke Tsuruho to organize additional Lower House debates over the new changes and discuss the upcoming parliamentary schedule.
“If the government had listened to the opinions of other parties and changed its stance while the budget was still under discussion at the Lower House, this wouldn’t have happened,” Azumi told reporters after the meeting.
While there have been cases of bills returning to the Lower House after amendments in the Upper House, it has never happened with the budget, approval of which often decides the fate of governments.
Fumbling over the budget has been seen as symptomatic of the government’s minority standing in the Lower House and Ishiba’s weak grip on the Liberal Democratic Party.
His turnaround over high-cost medical expense benefits — a system that caps medical fees at a certain threshold — has stunned observers and raised questions over the reporting lines between the government and the party.
It also adds to the Ishiba administration's existing woes — a recent NHK opinion poll found only 36% approve of the administration and internal discontent over policy concessions to the opposition is mounting.
Ishiba is expected to explain the reasoning behind his policy shift during questioning in a meeting of the Lower House Budget Committee on Thursday.
The debate over the planned hike in the medical copayment system erupted late last month after strong pressure from the opposition Constitutional Democratic Party of Japan.
The government had included increasing the current cap on out-of-pocket expenses by approximately 10% from August in its initial budget proposal, sparking protests from the opposition as well as patients associations.
Following the uproar, Ishiba initially announced that the government would consider a revision of the proposal, without adding further details.
However, after the budget passed the Lower House on March 4, pressure on Ishiba peaked in the Upper House, with lawmakers from his own LDP-Komeito coalition questioning the government’s move.
On March 5, representatives from a patients’ group were called in for unsworn testimony at the Upper House Budget Committee.
Two days later, on Friday, Ishiba announced he had decided to postpone the hike this year, while leaving the door open to a revision later. He then went on to meet with the patients' group on Friday evening.
”I am fully aware that a more thorough discussion on this topic is necessary and that these measures shouldn’t be implemented unless the patients are fully convinced,” Ishiba told the Upper House Budget Committee on Monday.
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