China’s New Health Insurance Law Mandates Coverage but Leaves Key Protections Unspecified

China has passed a new law requiring residents who are not covered by employee health insurance or other state medical programs to enroll in the country’s basic health insurance plan, prompting criticism that the regime is imposing an obligation on citizens without guaranteeing affordable coverage.

The Healthcare Security Law was approved by the standing committee of the Chinese Communist Party’s (CCP’s) rubber-stamp congress on Aug. 28, which will take effect on Jan. 1, 2027.

The law did not establish a minimum reimbursement rate for medical expenses, a ceiling on individual premiums, or a minimum level of government subsidies.

Two legal academics who spoke to The Epoch Times about the matter, on condition of anonymity out of fear of reprisal, said the law places a clear obligation on individuals while leaving the regime’s financial and coverage commitments largely to local authorities.

“This clearly forces ordinary people to enroll in insurance. This is a trick by the CCP to get money from the people,” a law professor in Hunan Province told the publication. “This horrible law does not mention a minimum reimbursement rate or an upper limit on individual contributions. It leaves it to local governments to decide what kind of protection they will provide.”

Under the new law, the basic health insurance plan will be financed through a combination of individual contributions and government subsidies, leaving provincial medical insurance and finance authorities to set individual contribution and government subsidy levels.

Related Stories

The law professor said that approach could produce significant disparities across China.

“I believe the authorities have given local governments too much discretion. This will artificially create a regional welfare gap in which richer provinces provide better protection while poorer provinces impose heavier burdens,” he said. “Medical insurance contributions are rising year after year, and ordinary people may eventually be unable to afford them.”

The law does provide assistance for some of China’s poorest residents. People classified as extremely poor and certain people at risk of falling back into poverty are eligible for financial assistance toward their individual medical insurance contributions.

However, the law does not specify the minimum amount of that assistance, nor does it establish the detailed criteria for determining eligibility.

Potential for Administrative Enforcement

The new law makes health insurance coverage mandatory. While it does not specify a fine for those who refuse to enroll, its language could give the regime room to introduce enforcement measures later.

Article 20 of the law requires tax authorities to collect basic medical insurance premiums, including maternity insurance premiums, in accordance with regulations.

At the same time, Article 44 establishes a credit-management system that includes insured individuals. The law does not specify what credit-related penalties could be imposed on people who refuse to enroll or whether such individuals could face restrictions on access to public services.

A legal scholar in Guangdong Province told The Epoch Times that the absence of an explicit fine does not necessarily eliminate the possibility of future enforcement.

Although the legal-liability provisions do not directly impose a monetary penalty on ordinary residents who refuse to enroll, the designation that residents “shall participate” in the system gives administrative authorities room to enforce the requirement, he said.

“The CCP may very likely imitate the previous ‘one-child policy’ model in the future, using local implementation rules or administrative documents to introduce administrative measures such as recovering unpaid premiums, compulsory tax collection, credit management, or restrictions on public services to force collection,” the legal scholar said.

Zhou Yu contributed to this report.