Local governments crack down on health insurance scofflaws By Philip Brasor and Masako Tsubuku 11 September

 According to an article in the August 29 Asahi Shimbun, the number of asset seizures initiated by local governments in an attempt to recoup delinquent national health insurance payments has increased startlingly in the past four years. Asahi asked the pertinent sections of all 23 wards in Tokyo, as well as those in 19 major cities about seizures. They received responses from 37 local governments in all, and the data indicates that between fiscal 2006 and fiscal 2010, the number of delinquent payments that led to actual seizures of assets increased by almost sixfold.

Enough to make you sick: monthly Kokuho payment schedule

 In this case, we’re talking about Kokumin Kenko Hoken, or National Health Insurance, which is paid by anyone who is not a member of the Shakai Kenko Hoken system, which is paid for by contributions from employers. Traditionally, National Health Insurance, known as Kokuho for short, was carried by people who are self-employed. And that’s still true. However, the ranks of Kokuho carriers has increased greatly over the past two decades as the employment situation has changed. With more people out of work and even more changing over from so-called lifetime employment to so-called non-regular employment, the number of people who are compelled to pay into the Kokuho system gets larger and larger. Kokuho is administered by local governments, and national insurance, whether paid for by the individual or by his/her employer, is mandatory in Japan. If the individual is too poor to pay the premiums, he or she should go to the local government office and tell an official. The only real way to get out of the system and still have insurance is to qualify for welfare. Other than that, in principle everyone has to pay. Some local governments have a system wherein someone who has not paid because of financial difficulties but needs medical care can pay the full amount of that care up front and receive at least partial reimbursement later, but those are exceptional cases.

 As society ages, medical costs are rising dramatically; and now Kokuho also includes nursing care insurance (kaigo hoken) if you’re over 40 and “support money” (shienkin) to pay the insurance of citizens over the age of 75. Moreover, because of the ongoing recession and the resulting injection of the marginally employed and unemployed into the Kokuho roles, the percentage who pay their due premiums is going down — about 88 percent nationwide in 2009 — so local governments are cracking down on health insurance scofflaws. The local goverments who answered Asahi’s survey reported 3,429 cases of property seizures for failure to pay premiums in 2006. This number rose to 17,020 in 2010. The reason is to “maintain the system” and “equalize the burden.” The top ten cities in terms of seizures were Yokohama with 2,913, Fukuoka with 1,745, and Nagoya with 1,254. Among the assets seized, 50 percent were savings accounts of some type, 22 percent insurance policies, and 15 percent real estate. The total amounts seized by 36 of the local governments in 2010 was ¥9.13 billion, an increase over the amount seized in 2006 by a factor of 4.6.

 It isn’t as if a local government goon suddenly appears at your house and asks for you bank book. Local governments typically send a number of notices by mail and if no response is forthcoming they send an officer to the address of the non-payer to discuss options. Seizure of assets is a last resort. Some local governments, however, have resisted the trend. Tokyo’s Chuo Ward, for instance, has not carried out any property seizures, saying that doing so would only make the financial situation of the scofflaw that much worse. Some local governments draw the line on seizures at certain assets. For instance, they may avoid seizing special “insurance” accounts for children’s education purposes.

 Many local governments are asking the central government to contribute more tax money to their Kokuho coffers, the idea being that health care is guaranteed by the central government and people at the bottom are being asked to pay a larger burden relative to their ability to do so. A 64-year-old taxi driver in Osaka had some of his savings seized because he hadn’t paid his ¥130,000 yearly premium. His annual income, which includes a small pension, is ¥800,000, with which he supports two other people. Since he is a diabetic, he needs his insurance, but the main point is that even if you never use your national health insurance you still have to pay for it. In that regard, “insurance” is an imprecise term for the system. It is basically a tax: You cannot opt out.

 This aspect was brought home to us after our recent move. The local government of the city we now live in charges more for Kokuho than did Arakawa Ward in Tokyo, where we used to live. The reasons are demographic: A smaller population and thus smaller tax base combined with a higher percentage of older people. As it turns out we will have to pay in 2011 almost 20 percent of our adjusted 2010 income for national health insurance, after paying 10 percent of that income in national income tax and another 20 percent in local income tax. It’s not as if we made a lot of money last year, either. Our income has been dropping steadily since 2008. But except for semi-annual dental checkups, we haven’t used our health insurance for any medical purpose since 2006. In Japan, it doesn’t pay to be healthy.

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