MediShield Life Scheme
Madam, I rise in strong support of the White Paper on MediShield Life. I would like to especially focus on a very significant feature of the Review Committee's recommendations – that of universal coverage.
During the Our Singapore Conversations conducted with 47,000 Singaporeans, healthcare has emerged as one of the top three concerns for them. Many people worry that as the population ages and life expectancy increases, healthcare would not be affordable. It is clear that access to affordable healthcare throughout life is an important basic need of all Singaporeans.
Yet, 7% or 270,000 Singaporeans and PRs are uninsured under the MediShield, which is our basic public insurance scheme. Out of these uninsured, 60,000 of them have pre-existing conditions of varying severity. Amongst those who are insured, another 65,000 are estimated to have exclusions. In total, I would say more than 100,000 Singaporeans and PRs have been uninsured for years
For many years since I joined this House, I had asked for health insurance to be a "must-provide" service by Government, for all. Health insurance and affordable healthcare are basic essential services that must not be denied to anyone in our Singapore family, whatever health conditions they are born with, or acquired during their lifetime either through accidents, old age or other reasons.
I often wondered, and had articulated in this House, why, for instance, a person with Down's Syndrome would be deprived of health insurance-paid hospitalisation if he should meet with an accident through no fault of his? Or why a person who acquired a heart condition or diabetes should be denied basic health insurance or other medical benefits that other citizens have access to? I had asked for Government and other key insurance providers to look into addressing this big gap for several years I have been in Parliament.
To be fair, the attention and support given to the special needs community especially, by the Government has been remarkable in the last decade. This is thanks to the clear signal sent by the Prime Minister since his inauguration. The call to consider the special needs community, those who are disabled, was also supported by the active leadership and good work of several Ministries such as the Ministry of Social and Family Development, Ministry of Education and, more recently, Ministry of Transport.
But one important missing piece has always been health insurance. It is not an easy piece to fix. Inclusion has a price. Even as Singaporeans call for an inclusive society and to ensure that everyone has access to public health insurance and healthcare, not all the calls share the same degree of conviction. Many people do not mind sharing the cost of insurance for all, only if it means they are made to pay just "a little bit more". Many, of course, want the Government to pay the bulk of any premium increase. In my less optimistic moments, in the last year when MediShield was being considered, I had thought that the MediShield Life Review Committee and the Government will continue to leave the uninsured behind; citing cost as an obstacle.
While all this is happening, baby steps, indeed, had been taken. Ministry of Health had cautiously introduced the policy of ensuring all children born after 1 March 2013 to be covered under MediShield, whatever their condition; leaving out only those who were born before March 2013. Another encouraging baby step that was taken last year was when I was able to work with NTUC Income – thanks to then CEO Tan Suee Chieh and his team – they piloted and launched their first disability-specific insurance product for the autism community. So that was really encouraging.
But the real deal has now come in a reformed MediShield Life that features universal coverage – for life, for all; albeit with a recommended 30% loading for those with pre-existing conditions but with Government agreeing to foot 75% of the cost of inclusion.
I am extremely encouraged by this show of moral courage of the Government in supporting this particular recommendation of the Review Committee to cover everyone. It is a move that has so far earned the support of most MPs, regardless of the party colour that they don; not to mention the many special-needs persons who previously were being denied health insurance. I have spoken to them and they are very, very supportive and grateful. Good leaders do the right thing despite challenges, despite difficulties. Including every Singaporean in a basic healthcare scheme – regardless of their age, condition, ability to contribute economically or other perceived liability – is the right thing to do. I therefore thank and salute the Minister and his team for strongly endorsing the universal coverage recommendation by the Committee. Thank you for putting your money where it matters – to pay for bulk of the cost to bring the previously uninsured into MediShield Life.
I have five suggestions to make, for Minister's consideration.
Suggestion One: Universal Permanent Subsidy. On the recommendation to apply permanent subsidies only for two-thirds of the population, I wish to ask the Minister to consider a subsidy formula that is currently used in Government-sponsored, for example, Early Intervention Programmes in MSF. This model applies a universal flat subsidy to All Singaporeans, whatever their income is; and then add a second component of means-testing to those of lower income. Considering that health insurance is a very basic essential service, I urge the Ministry to consider applying a universal flat permanent subsidy to all Singaporeans first, regardless of income; and then apply another layer of subsidy that is means-tested.
Suggestion Two is regarding the premium loading for those with pre-existing conditions. On the recommendation of an additional 30% loading on the standard premiums for the first 10 years to be paid by individuals with pre-existing conditions, I would like to seek Minister's clarification on: (1) how this additional loading of 30% is computed; (2) how the duration of 10 years is derived at; and (3) the criteria by which individuals with disabilities are evaluated for this additional loading. Because as most of us know disabilities come in varying degree of severity – some are mild, some are moderate and some are more severe. Just because someone has been to a special school, just because he has a form of mild or moderate autism or just because someone meets a technical definition of intellectual impairment, for example, an IQ of below 70, does not mean that that person is automatically a high-risk profile, subject to the loading.
Suggestion 3 relates to the IP, Integrated Shield Plan option for all. On the recommendation that the Government works with the insurance industry for a Standard Integrated Shield Plan (IP) at Class B1 level coverage, Madam, I fully agree with this recommendation. But I would also like to ask the Minister to play a regulatory role so that key IP providers adopt fair and consistent practices so that persons with pre-existing conditions will not be at the mercy or be totally left out by the for-profit providers. IPs, as the Committee pointed out, are of significant public interest, with 60% of Singaporeans having bought IPs of various forms. Persons with pre-existing conditions should not be denied and deprived of the choice of upgrading to Class B1 because of either unfair risk-loading practices or private insurers' lack of interest to cover this target group. I ask the Ministry to consider working out to offer a standard IP for all, regardless of health conditions, using the same principles of standard loading if need be, as the basic MediShield Life.
My Suggestion 4 concerns employer plans. At the job front for persons with pre-existing conditions, I urge the Government to ensure that persons and their existing pre-existing conditions are not excluded from plans that cover, that provides some basic employment benefits such as the Workman's Compensation, Group Hospitalisation and Surgical Plans and Term Life Insurance Plans. I think these plans need to be aligned so that people with pre-existing conditions or congenital conditions will not be left out.
My last suggestion refers to Small Enterprises and Voluntary Welfare Organisations (VWOs). For small enterprises and the not-for-profit voluntary welfare organisations, I urge Government to consider a Rebate of sorts. These are set-ups that can scarcely afford a further increase in operational costs and the mandatory additional 1% Medisave contribution to pay for the MediShield review will certainly impact them. I ask Minister, Ministry, the Government, the relevant ministries to consider how these Small Enterprises and VWOs could be supported.
So these are the five suggestions.
In conclusion, Madam, it has been said that "where your treasure is, that's where your heart is also". This Government has committed a hefty treasure of close to $4 billion over the next five years to provide every Singaporean with lifetime basic protection against medical costs so that they can have greater peace of mind. This move tells me that the Government's heart is in the right place -- with the People. Thank you for agreeing to deploy the country's treasure to where it should rightly be – basic protection for every Singaporean, regardless of their health status.
I thank the Review Committee and the Secretariat for its excellent work. A very well-written and reader-friendly White Paper. Thank you, very much. I thank the Government for strongly endorsing the Committee's recommendations. And I strongly support the White Paper on MediShield Life.