Health Tax: Unions Demand Withdrawal

Context

In brief

• Cross-border worker health tax: unions demand definitive withdrawal.
• Violation of 2020 treaty and double taxation.
• Risk of blocking revenue sharing for border municipalities.

• What: Demand for the definitive withdrawal of the "health tax" for cross-border workers.
• When: June 15, 2026 (date of union communication).
• Who: CGIL, CISL, UIL, UNIA, OCST, SYNA, VPOD, and SYNDICOM.
• Where: Italy and Switzerland (with reference to the Canton of Ticino).
• Why: The tax would violate the 2020 international treaty between Italy and Switzerland, introducing double taxation.

The unions CGIL, CISL, UIL, UNIA, OCST, SYNA, VPOD, and SYNDICOM have once again called for the definitive withdrawal of the so-called "health tax," introduced by the Italian Government with the 2024 budget law but never applied. This stance comes two and a half years after the theoretical entry into force of the measure and is based on a new opinion commissioned by the Canton of Ticino from a professor at the University of Fribourg. According to the trade union organizations, this opinion confirms the theses long held: the tax would not be a contribution, but rather a tax, and as such would violate the 2020 international treaty between Italy and Switzerland, creating a situation of double taxation for cross-border workers. This new element is added to a series of already known critical issues, including strong union opposition from both sides, implementation uncertainties, the reluctance of three of the four Italian regions bordering Switzerland (excluding Lombardy), and doubts about constitutionality raised by legal opinions commissioned by the trade union organizations themselves. The argument for the legitimacy and usefulness of the health tax, presented as a tool to discourage the migration of healthcare personnel to Switzerland, therefore appears increasingly weak. The regulation, in fact, remains without implementing decrees more than thirty months after its introduction, and the Lombardy region seems to be the only one to stubbornly support this measure. The trade union organizations reiterate their determination to appeal to the Constitutional Court should the tax be effectively applied, with the aim of demonstrating its illegitimacy. At the same time, they hope for the definitive abandonment of the measure and the initiation of a constructive discussion on the problems that this dispute has generated in the world of cross-border work, starting with the full operationalization of the interministerial committee established by law 83/23 but never truly made effective. The issue of the health tax, therefore, continues to represent a critical point in relations between Italy and Switzerland regarding cross-border workers.

Operational details

The consequences of over two years of dispute over the health tax have raised serious concerns among Italian and Swiss trade unions. The prolonged controversy has created significant interpretative chaos regarding the tax obligations of cross-border workers, fueling uncertainties that also affect the daily lives of commuters. Furthermore, the situation has led to a hardening of the Swiss interpretation of the so-called 'omnibus decree' related to cross-cantonal work. This decree, which affects those who reside in a province different from the one bordering the Canton where their work is carried out, now sees a stricter application of its options. Additionally concerning is the real risk that Italy, by introducing a measure deemed detrimental to the tax agreement, could cause the suspension or non-payment of tax refunds. These fund transfers are vital for over 365 border municipalities, which use them to finance both current expenditures and important investments for their communities. The loss of these resources would produce a real economic and social earthquake in these areas, compromising essential services and development projects. For these reasons, the unions strongly reiterate the call to resume dialogue, prioritizing common sense and respect for the rules agreed upon over years of negotiations. The goal is to restore a climate of cooperation that has allowed the unanimous approval of treaties and implementing laws by the Italian and Swiss Parliaments in the past. The request is clear: from the Italian side, the withdrawal of a tax considered useless for deterring the migration of healthcare personnel and effectively unenforceable; from the Swiss side, the recognition of the option provided by the omnibus decree for cross-cantonal cross-border workers and the guarantee of the transfer of refunds until 2033, in line with the 2020 international treaty and the implementing laws. The current situation highlights the fragility of the balances achieved and the need for a collaborative approach to resolve cross-border work issues.

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Key points

Trade unions CGIL, CISL, UIL, UNIA, OCST, SYNA, VPOD, and SYNDICOM have outlined a clear strategy to address the 'health tax' issue and its implications for cross-border workers. Their primary demand is the definitive withdrawal of the measure by Italy. Concurrently, they are urging the opening of a serious and constructive discussion forum to tackle the problems that have emerged during this dispute phase. A crucial point concerns the interministerial committee, established by law 83/23 but never fully operational, which should become the appropriate venue for addressing these matters. On the Swiss side, the unions are calling for full recognition of the option provided by the 'omnibus decree' for cross-cantonal cross-border workers. This recognition is fundamental to ensure the continuity of fiscal equalization payments until 2033, as stipulated by the 2020 international treaty and subsequent implementing laws. Should the tax be effectively applied, the trade unions do not rule out recourse to the Constitutional Court to challenge its illegitimacy. This demonstrates their firm determination to protect the rights of cross-border workers. The current situation requires coordinated action and respect for bilateral agreements to avoid further tensions and ensure the economic stability of border communities. To better understand the fiscal and salary implications of cross-border work, our online tools can be utilized. Specifically, our net salary calculator can provide a detailed estimate of your salary based on current regulations, helping cross-border commuters navigate the complexity of the Italian-Swiss tax system. It is also advisable to be informed about the specific regulations regarding equalization payments and withholding taxes to ensure compliance with both countries.

Source: cgil.lombardia.it

Article 1(237–238) of Italian Law No. 213/2023 does not apply indiscriminately to all cross-border workers. It covers: (a) Italian residents who work and stay in Switzerland and use the Italian SSN; (b) frontier workers under Article 9(1) of the Italy–Switzerland Agreement whose income is taxable only in Switzerland and who exercised the legal right to choose health insurance; and (c) dependants of those two categories. Paragraph 238 sets a progressive 3–6% share of net Swiss salary, with a €30 minimum and an ordinary €200 maximum for each month worked from 2024. The cap may be doubled in cases of omitted payment or omitted communication specified in Article 1(100) of Law No. 207/2024. The Region of residence sets the rates and procedure each year.