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The Diet has passed a law to rescue some 33,000 children of middle school age or younger who are not covered by health insurance because their parents defaulted on premium payments to the National Health Insurance system (Kokumin Kenko Hoken) administered by municipalities. The new law, however, fails to cover high school students without health insurance and adults who cannot afford to pay premiums.

If people fail to pay insurance premiums for one year or longer, municipalities take away their health insurance certificates and issue them “entitlement certificates.” These require the holders to pay medical fees in total — not just the 30 percent that insured people pay — then wait several months for 70 percent of their costs to be refunded. About 330,000 households have been issued “entitlement certificates.”

Some teachers, though, have reported cases in which sick students refuse to go to doctors, saying that doing so would put their parents in financial trouble.

Under the new law, health insurance certificates good for six months will be issued from April 2009 to children of middle school age or younger and whose parents hold entitlement certificates due to premium defaults. The certificates can be renewed if municipalities deem necessary.

Many of those participating in the National Health Insurance system have low incomes. Self-employed people, independent professionals, pensioners and the unemployed mainly take part in the system, although high-income independent professionals, such as doctors and lawyers, have established their own health insurance plans. The health and welfare ministry says that as of Sept. 30, 2007, about 3.846 million households, or 18.5 percent of National Health Insurance system households, had defaulted on their insurance premium payments.

A December 2007 survey by the Osaka social welfare promotion association shows that about 80 percent of households taking part in the National Health Insurance system in Osaka Prefecture earn less than ¥2 million a year. The government should seriously consider using more tax money to help people who cannot afford to pay health insurance premiums.

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