As China’s economy continues to decline and medical insurance costs keep rising, a wave of “defaults” has emerged in rural areas. Following the exposure of compulsory medical insurance payments by villagers in Hunan Province, the local government in Shanxi Province has also been exposed for using various coercive means to force villagers to pay insurance premiums, sparking concerns.
On November 26th, a screenshot circulating online showed a notification posted by village officials in Poli Village, Longxing Town, Xinjiang County, Yuncheng City, Shanxi Province in a chat group named “Poli Village Service Group.” The notification stated that villagers who do not cooperate with the village committee’s work or actively pay the new rural cooperative medical care would not have scholarships for their children who are admitted to universities the following year, nor would they receive gift boxes. Furthermore, elderly people over the age of 70 in their families would not receive benefits for the Double Ninth Festival. The “notification” was signed by the Poli Village People’s Committee and dated November 23, 2024.
A villager from Poli Village told Huashang Daily that village committee officials issued a notification in the group urging the payment of medical insurance, requiring everyone to sign up for insurance.
The villager mentioned, “Everyone must sign up. If you don’t, they won’t reimburse you for medical expenses, and won’t provide pension for the elderly in your family.” The villager added, “It was the village party secretary who sent the message, and all village committee and village organization cadres posted in the group. Most of the 1,000 plus villagers in the village have already signed up, and now the notification is just a reminder to sign up quickly.”
Some villagers are puzzled by the urgency of the medical insurance payment, questioning, “Isn’t it supposed to be voluntary? Why are there consequences for not paying?”
When interviewed by the media, staff members from Longxing Town Government mentioned that they had criticized and educated the village committee members; however, they emphasized that their intention was positive, aiming to encourage villagers to actively participate in insurance schemes since some villagers had not enrolled in the past.
Regarding the insurance situation in Poli Village, whether the county town assigned insurance tasks to the village, and whether similar instances of forced insurance enrollment occurred in other villages, the staff member stated, “I am not very clear about this.”
The Shanxi Provincial Medical Security Bureau had issued a notice on August 30 based on the joint issuance of the “Notice on Doing Well in the Basic Medical Insurance for Urban and Rural Residents in 2024” by the CCP Health Insurance Bureau, and other departments.
Yuncheng City, where Poli Village is located, commenced the enrollment and fee collection of urban and rural residents’ medical insurance starting from September 1 this year, with a centralized collection period from September 1, 2024, to February 25, 2025.
The notification issued by the Poli Village committee has caused a stir on mainland social media platforms after being reported by local media.
Many netizens commented that enrolling in the new rural cooperative program should be voluntary, and coercing individuals otherwise is an abuse of power by the administrative organs.
“The village officials act like local tyrants, prohibiting coal burning, banquets, and burning straw. These village cadres should be executed directly; they are simply tyrants!” “To collect medical insurance, village officials are driven crazy.”
“The medical insurance should be voluntary; if it is mandatory, there is a problem behind it.” “This situation is very common at the grassroots level, where there are strict KPI assessments at each level.”
“This is nothing; in some places, if you don’t pay medical insurance, your children are not allowed to attend school, or teachers are not allowed to teach. They mobilize teachers and students to collect medical insurance from their families, fully implementing the work policy of mobilizing the masses.”
In fact, the forcible collection of medical insurance premiums as described above is not an isolated case.
Just a week ago, a notification issued by the Maotian Town Babao Village People’s Committee in Yueyang County, Hunan Province, regarding the collection of medical insurance fees spread online.
According to the notification: in order to implement the spirit of the superior party committees and governments, and to successfully complete the phased tasks assigned by superiors, after consultation by the village committee of Babao Village, it was decided that the following resolutions would be made for the collection of rural cooperative medical care fees for the year 2025: 1. Those who have not paid for medical insurance will not have any official seals or related procedures handled by the village office. 2. Those who have not paid for medical insurance will not be considered for end-of-year difficulties. 3. Party members who have not paid for personal and family medical insurance will be expelled from the party.
Furthermore, a notice issued by the Yueyang County Health Insurance Bureau on October 8 mentioned linking the collection of resident medical insurance with the performance evaluation of local officials. Those who perform poorly in the insurance fee collection would face accountability.
In 2017, Chinese Communist Party leader Xi Jinping called for the comprehensive implementation of a universal healthcare plan in his 19th National Congress report. Former Chinese Premier Li Keqiang revealed at the 2020 National People’s Congress that there are “600 million people in China with low to medium income, averaging only about 1,000 yuan per month,” sparking discussions both at home and abroad.
With three years of pandemic lockdowns and a continuing economic downturn, many industries in China are facing closures and rising unemployment rates, making it difficult for grassroots citizens to afford the increasing medical insurance costs.
According to previous reports by “Caijing Big Health,” the number of participants in the national basic medical insurance program in 2022 decreased by 17.05 million compared to 2021. Even more concerning, the number of participants in residents’ medical insurance declined by 25.17 million. This decline is a combination of natural attrition and a significant factor of residents voluntarily opting out due to continuously rising premiums.
In addition to the “defaults” in rural areas due to increased insurance fees, in urban areas, a large number of retired workers are facing substantially reduced medical insurance benefits due to healthcare reforms, leading to a high number of elderly individuals taking to the streets to protest.
The Chinese authorities introduced medical insurance reforms in 2023 to make up for the deficits in local employees’ insurance programs, causing significant controversy. Subsequently, the related reform policies sparked large-scale protests in Wuhan and several other cities, termed as the “White Hair Revolution.”