Articles 155 and 157 of the Constitution respectively and explicitly provides that the state, in order to promote social welfare, shall establish a social insurance system; and in order to improve national health, shall establish extensive services for sanitation and health protection. Article 10, Paragraph 5 of the Amendments to the Constitution further stipulates: “The State shall promote the national health insurance.” As the foundation of fairness to the national health insurance, the National Health Insurance Act adopts the compulsory insurance, imposes the insured the obligation to pay premium under the public law, and charges different premiums on individuals with different income, so as to meet the fairness of burden-sharing based on affordability. Yet the relevant laws and regulations concerning the calculation of and the criteria for the amount of the premium, given that it has the effect of restricting people’s property right, shall certainly comply with the principles of statutory reservation and clarity of authorization of law, as repetitively stated under J.Y. Interpretation Nos. 472, 473, and 524.
Article 8 of the National Health Insurance Act places “those who join occupational unions but with no fixed employment or are self-employed” as the Second Category Insured. The level of premium for personnel at this level is regulated under Article 41, Paragraph 1, Subparagraph 7 of the Enforcement Rules of the National Health Insurance Act, amended as of August 2, 1995: “ For those… who join occupational unions but with no fixed employment or are self-employed, they shall file insurance from Level Six in accordance with the Table of Premium Levels[,]” and the same provision, amended as of November 18, 1999: “For those who join occupational unions but with no fixed employment or are self-employed, they shall file insurance from Level Six in accordance with the Table of Premium Levels.” (Amended and re-designated as Subparagraph 4 on November 29, 2002, hereinafter disputed provision). The level of the insurance premium is for a critical element in determining the premium and the burden of ability to pay. Given that the application of the disputed provision concerns the public interest of government’s finance and restrictions on people’s property right, it is not merely a technical or detailed issue and, therefore, should in principle be stipulated explicitly by statute. If the legislative body should authorize the administrative agency to promulgate supplemental regulations, the contents, objectives and scope of such authorization must be specific and unambiguous, and the content of the regulations must also comply with the meanings and objectives of the authorization. With regard to the degree of specificity of the authorization provision, it shall not be confined by the language of the statutory provision, rather shall be determined by the totality of statutory interpretation or the relevant meaning from the statute as a whole (see J.Y. Interpretation Nos. 426 and 538).
Article 86 of the National Health Insurance Act stipulates: “The enforcement rules of this Act shall be drafted by the governing agency and be submitted for approval by the Executive Yuan for its promulgation.” While the disputed provision was based on this Article, yet from the perspective of the relevant meanings of the National Health Insurance Act as a whole, it actually connects to Article 21, Paragraph 1 of the Act, “[t]he premium amount for Categories One to Three of the insured shall be stipulated in a Table of Premium Levels by the governing agency and be approved by the Executive Yuan.” (Amended as of January 30, 2001, which changed the original language “from First to Fourth Categories”) and Article 22, Paragraph 2 of the same Act: “For the insured under the First and Second Category who have no fixed income, they shall declare pro se the insurance premium in accordance with the Table of Premium Levels, and be subjected to the audit of the insurer. The insurer may summarily adjust [the premium] if it is inaccurate.” (Originally with the language but designated as Paragraph 3 before the amendment on January 30, 2001). These provisions carry the objective to effectively implement the national health insurance program, and a rather clear authorization to calculate the amount of premium based on categorization methods as its contents and scope. It is with this authorization that the governing agency established the Table of Premium Levels as the basis for the calculation of premium the insured should undertake. In light of the fact that all the insured maintain certain independence in their working style and their income from work-hours is diverse, taking into account the administrative efficiency and the insured’s income status, the disputed provision designated Level Six of the Table of the Premium Levels as the minimum for submission can hardly be deemed to have violated the meanings and purposes of the authorization statute, and consequently, contravened the provision to protect people’s property rights under Article 15 of the Constitution. Thus, the disputed provision does not contravene either the protection of people’s property rights under Article 15 of the Constitution, or the principles of statutory reservation and clarity of authorization of law under Article 23 of the Constitution.
The National Health Insurance Act used the regular income of the insured as the basis of premium calculation, with the insured undertakes diverse financial responsibility that hinge on income level. Under this affordability test, a security system that entails both the common sharing of health risks and social assistance can be formed; therefore, the pre-designation on the level of individual premium should match the actual income as closely as possible. However, given that the insured under the disputed provision involve various occupations and their income levels constantly fluctuate due to social or personal factors, that they must still declare [insurance premium] as Level Six even though their actual income does not reached that level has resulted in excessive premium charge to those who belong to the low income [category]. The relevant agencies should certainly consider the establishment of an appropriate mechanism to reasonably reduce the premium so as to meet the fairness of burden-sharing based on affordability and the mutual assistance for low income individuals in the social insurance system, and to realize the constitutional mandate for the promotion of a national health insurance. Thus, it is also pointed out that the above-stated provision should be reexamined and reformed accordingly.
Translated by Professor Tze-Shiou Chien.