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- You can't cure it without difficulty: will the unemployed have to pay for a compulsory health insurance policy
You can't cure it without difficulty: will the unemployed have to pay for a compulsory health insurance policy
Federation Council Speaker Valentina Matvienko said that unemployed but able-bodied citizens should pay annual contributions to the compulsory health insurance fund in the amount of 45 thousand rubles per year. The experts interviewed by Izvestia acknowledged the existence of this problem, but urged caution in implementing the proposed solution.
What is the essence of the proposal
At parliamentary hearings on the draft federal budget for 2026 and the planned period 2027-2028, Valentina Matvienko noted that there are "many people of working age" in Russia who "allegedly do not work" and do not pay for their medical care. She called for correcting approaches to this issue without violating the constitutional rights of citizens.
Parliamentary hearings in the Federation Council on the topic "On the parameters of the draft federal budget for 2026 and the planning period of 2027 and 2028"
As Matvienko noted, it is possible to optimize government spending on compulsory medical insurance if unemployed able—bodied citizens are required to pay annual health insurance contributions in the amount of 45 thousand rubles per year on their own - this is the average employer's payment for their employee to the compulsory medical insurance fund.
According to her, if an able-bodied citizen is not employed anywhere, it most likely means that either he works in the shadow economy, or "simply does not want to work." She made a reservation that she was not referring to minors, pensioners and people who cannot work due to health problems.
She called the problem with payments to the compulsory medical insurance for unemployed citizens "overdue and even overripe."
What kind of unemployed are we talking about
It should be noted that, according to Rosstat, unemployment in Russia in August 2025 updated the historical minimum for the entire observation period since 1991, reaching 2.1% according to the methodology of the International Labor Organization (ILO). The total number of unemployed in the country is estimated at 1 million 592 thousand people. At the same time, 400 thousand people were registered with the employment service, of which 300 thousand were officially recognized as unemployed.
Anton Kotyakov, the head of the Ministry of Labor, recalled in a recent interview that the ministry, together with the Compulsory Health Insurance Fund and the Federal Tax Service, analyzes the number of unemployed Russians of working age. This is done, among other things, in the context of problems with health insurance. In particular, Moscow Mayor Sergei Sobyanin spoke about them in September. According to him, the authorities of the capital pay 180 billion rubles to the Federal Migration Service for unemployed citizens, and the regions as a whole — about 1 trillion rubles annually. This amount consists of payments for mothers with many children, people with disabilities, and students, but Sergei Sobyanin also pointed to about 10 million residents of the country who "are not burdened with any restrictions, do not work, and have not even submitted applications for social support or to the Federal Migration Service to be insured."
Last year, the Federal Health Insurance Fund's budget was calculated based on the fact that health insurance covers 143.8 million people, of which 79.9 million are unemployed.
According to the ILO methodology, an unemployed person is considered to be a person who, firstly, does not have a job, secondly, he is looking for it, and thirdly, he is ready to start it almost immediately. If a person does not have a job, he does not necessarily fall into the category of unemployed. Some of them relate to potential labor, the second to those who want to work but are not looking for work, and the third to those who do not want to work.
In June 2025, according to Rosstat, about 14.5 million people were of working age, but not part of the workforce. 11.5 million of them did not express a desire to work.: These are 6 million full-time students, 2 million pensioners, 1.6 million people who run a household, and 1.9 million who do not belong to any of these categories. 768,000 people out of 14.5 million people were considered a potential workforce.
Another 2.1 million people from Rosstat statistics are people who want to work, but are not looking for work and are not ready to start it. Anton Kotyakov noted in the aforementioned interview that if an adult able-bodied person does not work, then "the state has the right to ask the question: "Why?". At the same time, he opposed the "parasitism tax."
The sources of income of the unemployed are not reflected in Rosstat statistics.
An officially registered unemployed person has only one source of income, which is usually unemployment benefits, Alexander Safonov, a professor at the Financial University, told Izvestia.
— If an unemployed person has concealed some kind of employment, for example, temporary, then he will be removed from the register and will have to return the paid amounts of benefits. There are also unemployed people who have not been registered with the employment service and continue to search for work on their own. In this case, their source of income is family.
It should be noted that in August 2025, only 200 thousand people received unemployment benefits in the country.
How to implement the idea of payments for compulsory medical insurance
Sergey Dorofeev, Vice President of the National Medical Chamber, agrees with Valentina Matvienko's idea.
"Once upon a time, in Soviet times, they even persecuted people for parasitism," he remarked in an interview with Izvestia. — It's a fair decision, I think. Why do those who work deduct a certain amount from their salaries for the operation of the compulsory health insurance system, but everyone uses it?
Alexander Safonov refused to compare the idea of payments of the unemployed to the compulsory health insurance fund with the "parasitism tax," but he also agreed with the initiative itself, calling it a completely reasonable decision.
— The risk of turning this measure into a "tax on parasitism" can be realized only if it is not clearly defined who exactly belongs to the category of "unemployed with income," Natalia Kurbatova, Director General of Ingosstrakh—M IC, told Izvestia. — We are definitely not talking about people who have temporarily lost their jobs or are in a vulnerable position, for example, caring for children or the elderly. We are talking about those who receive informal income, but deliberately avoid paying contributions.
According to her, the effectiveness and fairness of this measure will depend on the accuracy of the criteria and administrative mechanisms.
Muslim Muslimov, Chairman of the National Association of Healthcare Managers and a member of the Civic Chamber of the Russian Federation, emphasizes that it is really important to analyze the burden on medical institutions from non-working citizens. However, he called for taking into account "several fundamental aspects."
"In our country, according to Article 41 of the Constitution, medical care is provided free of charge and is guaranteed to everyone regardless of their employment status," the source told Izvestia. — Any change in this fundamental principle will require extremely serious public and expert discussion, and possibly an adjustment of the legislative framework.
In addition, he emphasizes, a thorough analysis of the target group is necessary.
— These may not be abstract "unemployed" people, but, for example, the self-employed, people of pre-retirement age, young mothers. For many of them, the amount of 45 thousand rubles for an MHI policy may be unaffordable," Muslim Muslimov believes. — Before talking about the introduction of such a norm, it is necessary to conduct a thorough study, segment this audience, analyze its real capabilities and the incidence rate.
Yuri Zhulev, co-chairman of the All-Russian Union of Patients, calls the idea of strengthening the financial stability of the compulsory medical insurance system understandable, but urges caution in its solution by introducing mandatory contributions for the unemployed, since "it is unclear how to distinguish those who are consciously unemployed from those who are forced out of work." He stressed that the measures should not be a blow to "the most vulnerable."
Andrey Shatov, co-founder of insurance brokers SokolikGroup LLC and Corpmed, believes that if tools appear that will allow tracking people's shadow earnings, then this idea "sounds quite reasonable." And lawyer Yaroslav Kleimenov notes that there are already precedents when representatives of the tax service indirectly detected the shadow income of citizens — such cases are analyzed in the letter of the Federal Tax Service of Russia dated May 7, 2019, No. CA-4-7/8614.
Natalia Kurbatova notes that an interdepartmental mechanism based on data from the tax service, the Social Fund, and employment agencies could help.
"A combined analysis of these sources will allow us to objectively determine who really has no income and needs support, and who actually works outside the official field," she said. — In this case, the reform will be stimulating, aimed at expanding official employment and strengthening the sustainability of the compulsory health insurance system.
Alexey Starchenko, a member of the council of public organizations for the protection of patients' rights at Roszdravnadzor, however, called Valentina Matvienko's proposal "a simple solution to complex problems that is almost impossible to implement." He believes that it is very difficult to identify parasites living on shadow incomes, and it will probably cost more than they can potentially bring to the compulsory health insurance system.
— But how to identify them? And how much money will be needed to identify them? Much more than their potential payment, I suppose. Other measures are needed to combat them, but it is difficult," the Izvestia interlocutor is sure.
According to Alexey Starchenko, to solve the problem of filling the compulsory health insurance system, difficult decisions need to be made: for example, to adopt a law on combining compulsory health insurance with voluntary, offering citizens the services they need and need, for which they will be willing to pay.
— What will the initiative lead to — when applying to a medical organization for help, they will require a certificate from work or tax? — Or will we refuse the "parasites" to visit a therapist, cardiologist, neurologist, or hospitalization?
Lawyer Yaroslav Kleimenov also calls the measure unacceptable, since the collection of insurance premiums from non—working citizens is, in fact, a tax in the absence of a taxable object.
— This directly contradicts the norms of Article 3 of the Tax Code of the Russian Federation, which prescribe to take into account the actual ability of a citizen to pay taxes and do not allow discrimination based on social criteria, — said the interlocutor of Izvestia.
At the same time, collecting payments from people who do not have financial means will cause a series of bankruptcies, Yaroslav Kleimenov believes.
Sergey Dorofeev notes that, in general, the compulsory medical insurance system needs to be reviewed, which now resembles "quasi-budgetary financing": the system itself should be either insurance or budgetary. And even if the insurance model remains, then certain serious changes must be made to it, he is sure.
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