No.141 Issues in the medical expenses subsidy project for high school students

Up until now, there have been two subsidy programs for medical expenses for children: a system for preschoolers (Marunyuu) and a system for children attending compulsory education (Maruko). These subsidy projects are subsidized by the Tokyo Metropolitan Government and implemented by municipalities, but from the launch of the Marunyuu system to the present day when the target was expanded to include Maruko, the content of Tokyo's subsidies has been limited to Marunyuu. has a system with ``income restrictions and no co-payments,'' and Maruko has a system with ``income restrictions and some co-payments.''
　
Therefore, the subsidy program for children's medical expenses under the Tokyo metropolitan government system is not "free," and for those who are ineligible due to exceeding the income limit, the city, ward, town, or village may decide to It is being subsidized with financial resources. As a result, disparities arise due to differences in the financial strength of local governments.
　
Regarding Marunyuu, all special wards have ``no income restrictions and no co-payments,'' but when the system was launched, many cities in the Tama area had ``income restrictions and no co-payments'' in accordance with the Tokyo system. ”. The Tama district has weaker financial strength compared to the special wards, and this has long been an issue as a symbol of the "San-Tama disparity." Although it took some time after that, income restrictions were gradually abolished through the management efforts of each city, and now all cities including Inagi City have ``no income restrictions and no copayments'' for Marunyu.
　
On the other hand, for Maruko, all special wards have ``no income restrictions and no copayments,'' but in the Tama area, many cities still have ``income restrictions.''
　
Under these circumstances, without any prior consultation with municipalities, in January 2020, when the budget formulation for 2020 was completed, a medical expense subsidy system for children up to 18 years old was suddenly announced. It has been announced that the company will be founding Maru-Ao. From the perspective of Tokyo residents, it is clear that it is better to have subsidies than none, but half of the project costs will be borne by the municipality, and if a system is created with income restrictions like Marunyuu and Maruko. , the Santama gap will further widen.
　
When introducing the new system, the special ward immediately announced a policy of eliminating income restrictions for Maruo, as well as Marunyu and Maruko, at the ward's expense, but this is not so easy in the Tama district.
　
In response to strong requests from the Tokyo Metropolitan Assembly, it was decided that the Tokyo Metropolitan Government would pay the burden of municipalities for the three years up to FY2020, but this only applies to people within the income limit; The city will not cover any excess costs.
　
The Tokyo Mayor's Association, of which I am a member, has expressed strong concerns and has decided to set up a forum for discussion between the Tokyo Metropolitan Government and the Mayor's Association to resolve these issues. We will discuss not only the handling of financial resources, income limits, and self-payments from FY2020 onwards, but also a review of the system that includes not only Maru-Ao but also Maru-Nyuu and Maruko.
　
There has been a strong demand in Inagi City for some time for the removal of income restrictions on medical expenses subsidies for children. While we are closely monitoring the outcome of financial negotiations with the Tokyo Metropolitan Government, we are in a situation where we cannot wait for their conclusion.
　
Therefore, at the second regular meeting of the city council held in June of this year, Inagi City proposed and approved its own proposal to abolish the income restrictions for Maruko and Maruo. We have decided to subsidize medical expenses for all children.
　
Although our financial resources are limited, we will continue to strive to allocate them toward the healthy development of the children who will carry our future.