No.141 Issues of the Medical Expenses Subsidy Program for High School Students

So far, the medical expense subsidy program for children has included two subsidy programs: one for preschool children (Maru-nyu) and one for children in compulsory education (Maru-ko). These subsidy programs are funded by Tokyo Metropolis and implemented by municipalities. Since the establishment of the Maru-nyu program and the subsequent expansion of eligibility to include Maru-ko, the subsidy structure from Tokyo has consistently been that Maru-nyu has "income restrictions and no out-of-pocket expenses," while Maru-ko has "income restrictions and some out-of-pocket expenses."

Therefore, the child medical expenses subsidy program under the metropolitan system has not been made "free of charge," and those who are excluded due to exceeding income limits are being subsidized by the general funds of the municipalities based on their own judgment. As a result, disparities arise due to differences in the financial capacity of the municipalities.

Regarding the Maru Milk, all special wards have "no income restrictions and no out-of-pocket expenses," but at the time the system was established, many cities in the Tama area had "income restrictions and no out-of-pocket expenses" in accordance with the Tokyo Metropolitan system. The Tama area has weaker financial capacity compared to the special wards, and this has long been a challenge symbolizing the "San-Tama disparity." Although it took time, due to the management efforts of each city, income restrictions have been gradually abolished, and now, regarding Maru Milk, all cities, including Inagi City, have achieved "no income restrictions and no out-of-pocket expenses."

On the other hand, for Maruko, there are no income restrictions and no personal burden in all special wards, but in the Tama area, many cities still have income restrictions.

In this situation, without any prior consultation with municipalities, it was suddenly announced in January 2022, after the budget formulation for the fiscal year 2022 was completed, that a medical expense assistance system (Maru-Ao) for those up to 18 years old would be established. From the perspective of Tokyo residents, having assistance is certainly better than not having it, but since half of the project costs will be borne by the municipalities, and a system with income restrictions similar to Maru-Nyuu and Maru-Ko will be established, the disparity in the San-Tama area will further widen.

With the introduction of the new system, the special wards quickly announced a policy to eliminate income restrictions for Maru-Aoi, similar to Maru-Nyu and Maru-Ko, at the expense of the ward. However, it is not so simple in the Tama area.

Due to strong requests in the Tokyo Metropolitan Assembly, it has been decided that the Tokyo Metropolitan Government will cover the municipal burden for three years until fiscal year 2025. However, this only applies to those within the income limit, and the Tokyo Metropolitan Government will not bear any costs for those exceeding the income limit.

From the Tokyo Mayors' Association, in which I also participate, we have conveyed strong concerns, and it has been decided to establish a "discussion forum" between Tokyo and the Mayors' Association to address these issues. We will discuss not only the financial resources for fiscal year 2028 and beyond, the handling of income restrictions and self-burden, but also a review of the system that includes not only the Maru-Ao but also Maru-Nyu and Maru-Ko.

The removal of income restrictions regarding medical expenses assistance for children has been a strong request in Inagi City for some time. While we are closely monitoring the outcome of negotiations with Tokyo Metropolitan Government regarding funding sources, we are in a situation where we cannot wait for that conclusion.

Therefore, at the second Regular Session of the City Council held in June of this year, we proposed and received approval to abolish the income restrictions for Maruko and Marua, and decided to provide Medical Expenses assistance for all children aged 0 to 18 starting in April next year.

In the future, although our financial resources are limited, we will strive to allocate them in a way that supports the healthy development of the children who will lead us into the future.