A September survey by the health and welfare ministry has found that about 32,900 children throughout the country were not covered by health insurance because their parents had failed to pay premiums to the National Health Insurance system (Kokumin Kenko Hoken). Irregularly employed workers, unemployed people and pensioners now make up a large portion of those covered under this system. Premium payment defaults for this group have increased.

In late October, the ministry told municipalities to issue short-term health insurance certificates to middle school students and younger children whose parents asked for help after having defaulted. Since the instruction is not binding, municipalities may adopt different ways of handling this.

Under the ministry’s 2000 notice, municipalities suspend health insurance certificates for people whose defaults have lasted for a year or longer without sufficient reason. Defaulters are then issued “entitlement certificates” — which require that they pay the entire medical cost, instead of the normal 30 percent, to medical institutions. Several months later, 70 percent of the cost is supposed to be refunded to them, but in many cases, municipalities use the money paid by the holders of entitlement certificates to make up for unpaid premiums.

The number of households that cannot afford to pay premiums has apparently risen. Six years ago, some 225,000 households had to use “entitlement certificates.” Now an estimated 330,000 households use them.

A survey of 50 major cities by Kyodo News in mid-November shows that 29 had issued or planned to issue normal or short-term health insurance certificates to affected children. The eligibility age of children differs from city to city.

The Liberal Democratic Party and the Democratic Party of Japan agreed to write a bill to issue six-month health insurance certificates to all affected children at middle school or younger. The Diet is urged to pass the bill soon. At the same time, the government should consider ways to prevent defaults by people who have enough income to pay premiums.

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