New “Medical Security Law” Issued: Solidifying Class in the Name of Law, Squeezing the Survival Rights of the Lower Class

On August 28, 2026, the 24th session of the Standing Committee of the 14th National People’s Congress passed the “Medical Security Law of the People’s Republic of China.” The official press release lauded it as a milestone in “improving a multi-tiered universal medical security system.” However, when we cross-reference it with current macroeconomic data, unemployment status, and the detailed provisions of the law, what emerges is a law that explicitly prices the right to life and legalizes systemic injustice.

This law not only fails to break the much-criticized “dual-track medical insurance system” but, in an era of economic downturn and stagnant public income, it institutionalizes the harvesting of resources from the lower strata through legal obligations, punitive measures, and welfare thresholds.

I. Rights Transformed into “Mandatory Obligations,” Punitive Measures Target the Public

The most alarming aspects of this new law are the redefinition of insurance participation and the implementation of punitive clauses.

• Insurance Participation Defined as a Mandatory Obligation: Article 4 clearly states, “Citizens have the right and obligation to participate in basic medical insurance according to law.” This transforms medical security from a public welfare that the government should provide into a statutory “obligation” that citizens must fulfill.
• “Carrot and Stick” Approach to Prevent a “Withdrawal Tide”: In response to the widespread phenomenon of payment lapses in recent years, Article 12 explicitly proposes “establishing and improving a long-term mechanism for participation… improving incentive and restraint measures to promote continuous participation.” The so-called “restraint measures” essentially restrict the freedom to withdraw from insurance through administrative means, forcing the lower strata to continuously inject funds into the financially strained medical insurance pool.
• Severe Personal Accountability and Penalties: Articles 48 and 49 stipulate that individuals engaging in fraudulent or deceptive insurance practices will not only be ordered to repay the fraudulently obtained amounts and face a fine of two to five times the amount but will also directly face penalties such as “suspension of their medical expense network settlement for three to twelve months” and “restriction of the scope of designated medical institutions where they can receive services.” In an environment where public medical resources are highly concentrated, suspending network settlement and restricting access to medical care is tantamount to directly depriving the lower strata of their right to medical treatment.

II. Legalization of the “Dual-Track System”: Identity Determines the Value of Life

Article 9 of the law stipulates: “Basic medical insurance includes basic medical insurance for employees and basic medical insurance for urban and rural residents.” This signifies the formal establishment of China’s long-standing “medical class stratification” into national law.

Under China’s current system:

1. Public Sector Employees and Enterprise Employees (Employee Medical Insurance): Have personal accounts for daily outpatient visits and medication purchases, with reimbursement rates for hospitalization typically ranging from 80% to 90%.
2. Vast Majority of Farmers and Grassroots Masses (Resident Medical Insurance): Have no personal accounts, high deductibles, and actual comprehensive reimbursement rates often hovering around 50%, with many high-cost self-paid drugs and targeted therapies excluded.

The same life, simply due to differences in household registration and occupational status, receives several times less state assistance when facing life-or-death situations such as cancer or serious illness. The law, which should be a tool for promoting social equality, has now become a shield for confirming identity privileges.

III. Shifting the Burden to 200 Million Flexible Workers, Premiums Severely Out of Sync with Income

Amidst economic downturn, a large number of unemployed individuals have entered the gig economy. However, the “Medical Security Law” not only fails to provide a safety net for the unemployed but also transfers the fundraising pressure to the most vulnerable groups.

• A Heavy Burden for 200 Million People: According to public data from the National Bureau of Statistics, the scale of flexible employment in China has reached 200 million people. Article 10 of the law stipulates: “Encourage self-employed individuals without employers, part-time workers not covered by basic medical insurance for employees in their employing units, and other flexible employment personnel to participate in basic medical insurance for employees.” Without employer contributions, flexible workers who wish to enjoy normal reimbursement rates must personally bear the entire pooled cost, which is about 8% to 10% of the average social wage, costing nearly a thousand yuan per month. For delivery drivers and ride-hailing drivers struggling to make ends meet, this so-called “encouragement” is forcing them to spend their current food money.
• A 40-Fold Increase in Premiums: A Plunder: Article 11 claims that the payment standards are “linked to the level of disposable income per capita.” However, according to historical data from the National Healthcare Security Administration, individual payments for resident medical insurance (formerly rural cooperative medical system) have surged from the initial 10 yuan/year in 2003 to 380-400 yuan/year in recent years, an increase of nearly 40 times.
• Cruel Income Comparison: According to the National Bureau of Statistics’ “Statistical Communiqué on National Economic and Social Development in 2023”, the per capita disposable income of rural residents nationwide was only 21,691 yuan, averaging about 1,807 yuan per month; the per capita disposable income of rural residents in poverty-stricken counties was only 16,396 yuan (averaging about 1,366 yuan per month). For a family of four or five, the annual resident medical insurance payments alone would require nearly 2,000 yuan, accounting for more than a month’s total income for a poor family.

IV. Maternity Insurance Sets a Class Barrier, the Poor Are Not Entitled to Free Childbirth

Against the backdrop of frequent official calls to increase the birth rate, the provisions of Article 14 are even more glaring: “Employees shall participate in maternity insurance. Maternity insurance premiums shall be paid by the employing unit, and employees shall not pay.”

This means that only “employees” in formal systems and enterprises and institutions can enjoy maternity medical expenses and high maternity allowances fully paid by the state and the unit. Rural women, full-time housewives, and 200 million flexible female workers, who truly face high childbirth costs and lack income sources, are completely excluded from this free welfare. The group most in need of maternity support is precisely forgotten at the legal level.

The core logic of the entire “Medical Security Law” is, as stated in Article 22: “Expenditure is determined by income, and income and expenditure are balanced.” Its ultimate goal is to ensure the financial security of the medical insurance fund pool, not to protect the dignity of life of every citizen. When the law chooses to collect premiums through mandatory obligations, allocate resources through a dual-track system, and suppress withdrawals through administrative penalties, it is no longer protecting the people but the privileges themselves.