Prisoners domiciled abroad: no LAMal obligation (cross-border guide)

Context

In brief

• No LAMal obligation for prisoners domiciled abroad
• The National Council voted with no votes in favour
• Around 2.000 people in prison without AOMS in 2021
• The costs remain the responsibility of the cantons

Key facts

• Location → Bern
• National Council vote → no votes in favour
• Outcome → consideration rejected
• Previous vote → Council of States, June
• Estimate → around 2.000 people without AOMS in 2021
• Statistics → FHE of the Federal Statistical Office (UST/BFS)
• Law → amendment to LAMal
• Current funding → cantonal taxes

In Bern, after the vote of the Council of States in June, the National Council rejected, with no votes in favour, consideration of the relevant amendment to the Health Insurance Act. The result rules out introducing an obligation for prisoners in Switzerland who are domiciled abroad to take out insurance with a health insurance fund.

The process stopped at the consideration stage: Parliament did not proceed to a detailed examination of the proposed amendment. A new federal obligation is therefore ruled out for the group concerned.

The federal vote

The proposal sought to shift the healthcare costs of foreign prisoners from the public purse to health insurance funds. The Federal Council's bill had a stated objective: to ensure equal medical treatment during detention, as provided for by the Federal Constitution. To achieve this, the reform would have enrolled the persons concerned in health insurance and required them to pay the premium.

The framework described by the source is different. The healthcare costs of prisoners not domiciled in Switzerland are currently borne by the cantons and financed through cantonal taxes. The National Council's decision therefore maintains the existing framework for the group concerned. The legislative reference was LAMal/KVG; guida LAMal can be consulted for guidance on the topic.

Figures and reasons for the rejection

The Deprivation of Liberty Statistics, identified by the acronym FHE, from the Federal Statistical Office (UST/BFS), estimated that in 2021 around 2.000 people were in prison without compulsory health insurance for medical care (AOMS). This figure is the statistical basis cited in the dossier.

Parliament opposed the transfer almost unanimously. According to the reasons given, it would have been inappropriate to shift the costs from the cantons to compulsory insurance, also because many of those concerned would have benefited from premium reductions. The reform would also have created a disproportionate administrative burden: as a rule, those concerned would have been enrolled in health insurance for only a few months. The matter was deemed to fall under cantonal jurisdiction. With the votes of the Council of States and the National Council, the dossier has been definitively buried.

Operational details

What changes, and what does not

The practical point of the rejection is the failure to transfer the costs. For the audience described by the source, funding remains in the channel already indicated: the Cantons bear the healthcare expenses of non-domiciled prisoners and cover them through cantonal taxes. On the other hand, the mechanism that would have required the individuals concerned to pay a health insurance premium is not created.

Before, proposal, outcome

The comparison also clarifies the scope of the decision. The proposal did not concern a general revision of premiums for those living in Switzerland, but a specific audience of detained individuals domiciled abroad. The source does not announce a new obligation for other insured persons nor a general amount to be applied to families. Therefore, the vote should not be read as a decision on the premiums of the general population. Its subject remains the funding of medical care during detention for the individuals indicated in the proposal.

For the administrations, the reported problem was the limited duration of the insurance relationship: those concerned would normally have been affiliated for only a few months. Parliament considered the administrative burden associated with such a short affiliation to be disproportionate. Added to this was the issue of premium reductions, which would have involved many of those concerned according to the reported reasoning.

The choice therefore has a precise effect on the institutional level: a new federal step is not created to shift the health bill towards compulsory insurance. The issue has remained associated with cantonal jurisdiction. For those looking at the cost of living, the consequence should not be broadened beyond the dossier: the source speaks of healthcare costs of non-domiciled prisoners and cantonal taxes, not a revision of direct federal tax. The expenditure framework can be explored in greater depth under cost of living in Switzerland, without confusing this decision with a general change in premiums.

Recommended tools

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Key points

How to read the decision

The decision does not require turning a parliamentary news item into a new compliance obligation. For anyone who has to assess a case related to detention, the useful sequence is as follows:

1. Define the scope. The text concerns detainees in Switzerland who are domiciled abroad and the proposal concerning foreign detainees; it should not automatically be extended to all detainees. 2. Separate the data from the decision. Approximately 2.000 is an estimate referring to 2021 in the FHE of the UST/BFS, not the numerical result of the parliamentary vote. 3. Distinguish the current regime from the reform. For prisoners who are not domiciled in Switzerland, the source indicates cantonal financing through cantonal taxes; the premium paid by individuals was the proposed mechanism. 4. Check the status. The Council of States had rejected it in June; the National Council then refused to consider it, with no votes in favor. The dossier has been definitively shelved. 5. Keep the level of jurisdiction clear. Parliament considered the matter cantonal, so the decision does not trigger a federal procedure.

What follows from the vote

Once these steps have been completed, there is no new federal compliance obligation to derive from the vote. The insurance obligation for the indicated group was not introduced, and the transfer of costs to health insurers was not approved. The correct interpretation is therefore institutional, not a request for immediate enrollment.

The same caution applies to the numbers. The FHE estimate from 2021 is the statistical data cited in the dossier; the reference to a few months instead describes the duration normally expected for the affiliation envisaged by the reform. These are two different elements: the first quantifies the people without compulsory health insurance, while the second supports Parliament's administrative objection.

For a general review of the Swiss budget, after distinguishing this dossier from the other costs, use calcolatore stipendio e imposte.

Source: tio.ch