The National People’s Congress of the Chinese Communist Party recently passed the “Healthcare Security Law”, which stipulates that citizens who are not covered by basic employee medical insurance and do not enjoy other national healthcare security must participate in the basic medical insurance for urban and rural residents. While this law makes participation in health insurance a civic duty, it does not specify the minimum reimbursement ratio, personal payment limit, and government minimum subsidy, leading netizens to criticize it as a “malevolent law.”
The “Healthcare Security Law,” consisting of 7 chapters and 56 articles, was passed on August 28 and will come into effect on January 1, 2027. Article 4 stipulates that citizens have the right and obligation to participate in basic medical insurance according to the law, with Article 10 stating that employees should participate in basic employee medical insurance. Furthermore, Article 11 specifies that citizens who do not participate in employee medical insurance and do not enjoy other national healthcare security must participate in the basic medical insurance for urban and rural residents.
Regarding the law making insurance participation a civic duty, Wang Tong, a law professor in Hunan (pseudonym), expressed to a media outlet, “This is clearly forcing people to participate in insurance, it’s the Chinese Communist Party tricking money out of the people. This malevolent law does not set a minimum reimbursement ratio, personal payment limit, or a standardized government subsidy. With ‘should’ on the left and ‘should’ on the right, but without unified hard numerical requirements, it is left to local governments to decide what kind of protection to provide.”
The law specifies that the healthcare insurance for urban and rural residents combines individual payments with government subsidies, with payment standards aligned with economic and social development levels and residents’ per capita disposable income levels. The standards for individual payment and government subsidy are to be determined by the healthcare and finance departments of provinces, autonomous regions, and municipalities directly under the central government, or by their guiding local departments.
Wang Tong remarked, “This provision appears tailored to local conditions, but it uses per capita income as a cover, not considering whether the lower-income vulnerable groups can afford it. I believe that giving local governments such broad discretion is problematic, as it may artificially create a regional welfare gap of ‘rich provinces with good security and poor provinces with heavy burdens.’ Healthcare insurance payments may rise annually, and the people may eventually be unable to afford it.”
A netizen, “OldCatsLikeGoodTeeth,” posted on the social platform X on August 29, stating: “What is a ‘malevolent law’? The newly introduced ‘Healthcare Security Law’ is the latest spokesperson for malevolent laws. It mandates ‘you must be insured,’ but does not promise ‘how I will protect you.’ It also bullies the poor: the poorer you are, the less you can afford; the less you can afford, the less protection you have.”
The law also stipulates that destitute individuals, members of households receiving minimum living allowances, and those meeting the criteria to prevent falling back into poverty shall participate in resident medical insurance, with the individual payment part to be “subsidized as required.” However, the specific subsidy ratio, minimum standards, and criteria for determining individuals are not explicitly stated in the law.
Article 12 of the “Healthcare Security Law” stipulates the establishment of a long-term mechanism for insurance participation, improving “incentive and restraint measures” to encourage continuous insurance participation. This article does not directly mention waiting periods for discontinuing insurance or standard for retroactive payments.
The current resident healthcare insurance policy has had a discontinuation waiting period since 2025. Individuals who did not participate or interrupted their resident healthcare insurance during the centralized payment period will have a fixed waiting period of 3 months after re-enrolling. For each additional year of discontinuation, another month is added to the waiting period. Individuals who have discontinued insurance can reduce part of the variable waiting period by paying, with each additional year of payment shortening the waiting period by one month, although the fixed waiting period cannot be shortened. Those who discontinue insurance for four years or more will have a fixed and variable waiting period totaling no less than 6 months after restoration, and medical expenses incurred during the waiting period will not be reimbursed retroactively.
Mr. Fang, a human rights activist from Sichuan, stated, “I see this set of regulations as most harmful to the unemployed and low-income groups, as they are being pushed to find employment when suitable jobs are hard to come by. This results in a vicious cycle of ‘the poorer you are, the less protection you have.'”
Article 20 of the “Healthcare Security Law” mandates that tax authorities “shall collect basic medical insurance fees (including maternity insurance fees) as required.” The chapter on legal responsibilities mainly targets healthcare departments, operating agencies, designated medical institutions, insurance fraud, and illegal use of insurance funds, without specifying the amount of fines for ordinary citizens who refuse to participate in resident medical insurance.
Article 44 of the “Healthcare Security Law” has established a credit management system including insured individuals, but does not mention the specific credit penalties faced by those who refuse to participate, nor does it prescribe measures such as restricting access to public services.
Zhou Hanmin, a legal scholar from Guangdong (pseudonym), stated that while the legal responsibility chapter does not directly outline fines for ordinary residents who refuse to participate, the legal characterization of “must participate” leaves room for the executive branch to enforce it.
He said, “The Chinese Communist Party may likely mimic the past ‘family planning’ model in the future, introducing administrative measures such as retrieving insurance premiums, strong taxation, credit management, or limiting access to public services through local implementation details or administrative documents to enforce compulsory payments. This is quite scary.”