A notice regarding the national health insurance payment exemption from a municipal government in Niigata Prefecture that an inn owner has received is seen in this partially modified photo provided by the individual. The reason for rejection states, "the amount of exemption could not be calculated."

       TOKYO -- Flaws have emerged in COVID-19 relief measures for families paying into Japan's national health insurance system.

       It has emerged that some families expecting zero income are being told to pay national health insurance premiums while others who have seen a 30% or more income loss due to the spread of coronavirus infections are exempt -- a finding that has sparked inquiries with local governments.

       As the outbreak drags on, this confusing situation has developed as the Japanese government's COVID-19 relief measures cannot cover crisis-induced losses based on simple year-to-year comparisons alone.

       The national health insurance in Japan is a public medical insurance system run by municipal governments while its finances are managed by prefectural governments. Policyholders are mainly among self-employed residents under the age of 75. The insurance premium that the head of a household must pay is the sum of payments including premiums per policyholder in the family and fees depending on their income from the previous year.

       A special relief measure was introduced in fiscal 2020 for those who saw their income drop due to the effects of the coronavirus crisis. Those who meet certain criteria, such as an expected annual income decrease of 30% or more compared to the previous year and 10 million yen (about $90,600) or less in annual income in the previous year, are eligible for the insurance payment exemption.

       Municipal governments have been showered with inquiries regarding the aid program. For example, if a person made 3 million yen (roughly $27,200) in income in 2020 and is expecting to make 30% less in 2021, they will be exempted from paying for national insurance premiums entirely, provided no one else in the household earns money. Out of consideration for low-income households, the smaller the previous year's income, the higher the rate of exemption.

       However, if an individual filed zero income in 2020 and expects to see the same zero earnings in 2021, they will not be eligible for the relief measure as the income hasn't dropped from the previous year. As an insurance premium is calculated by multiplying income, how much reduction each person gets for a payment cannot be calculated using zeros and negatives. In a case of zero income for two consecutive years, the person would not have to pay for premiums that change depending on the previous year's income, but would still be required to pay for each policyholder in the household.

       A man in his 40s who runs an inn in Niigata Prefecture saw a huge fall in the number of guests due to the pandemic. The running costs including fixed expenses and utilities exceeded sales and he made no income in 2020. He was expecting to see zero income this year again, but has received a payment notice for the national health insurance premium for 190,000 yen (around $1,700) for the year from his municipality. He applied for an exemption with the municipal government but was declined. The notice of disapproval said his application was denied as "the amount of exemption could not be calculated."

       The man told the Mainichi Shimbun, "There must be many business owners whose income dipped into negative last year because of the coronavirus. They should base (the exemption) not on the previous year's income but on the income before the coronavirus crisis in 2019."

       However, the Health, Labor and Welfare Ministry maintains that it has no intention of reforming the relief measure for the time being, with one official commenting, "The program is designed for those who saw an income decrease from the previous year. 'Zero' or 'negative' income cannot be considered as 'a decrease,' and is therefore not subject for relief."

       An official from the Shinjuku Ward Office in Tokyo told the Mainichi Shimbun that some residents remain unconvinced even after they explain the program to them, while in the city of Kumamoto and elsewhere residents are visiting the city hall to file for the relief program not knowing that they are not eligible.

       Kazuhiko Nishizawa, chief senior economist at The Japan Research Institute Ltd., points out that the program "feels unfair" for those who have lost income due to COVID-19. He said, "Especially for the national health insurance, premiums become higher when the person has children. It would have been better if the comparison could be made with income from two years prior, before the coronavirus hit, but that might have been difficult in terms of designing a relief program. The effect of the prolonged pandemic is showing."

       (Japanese original by Natsuko Ishida, Lifestyle and Medical News Department)

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