Response to interpellations 2024/25:5 and 9 regarding proposals for changes to the health insurance
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
M assesses that the investigation's proposals do not meet current challenges within the sickness insurance 1. M announces a program to reduce sick leaves through increased coordination of rehabilitation efforts and work-oriented support 1. M emphasizes the importance of the work principle and that individuals should be able to return to work. The Government presents in the budget bill for 2025 measures such as work trials with maintained sickness benefit and a mandate to Försäkringskassan to strengthen the follow-up of the employer's plans 2. M considers that these measures are important to facilitate the return to work 2. M wants to develop cooperation and supervision of the employer's rehabilitation responsibility 2. M further wants to develop methods for those on long-term sick leave, develop grants for workplace-oriented rehabilitation support and consider partial sickness and activity compensation during studies 2. M invests 500 million kronor in primary care's work with mental health 2. M wants to raise compensation levels for persons with sickness and rehabilitation efforts 2. M considers that the investigated reforms do not meet current challenges and wants to implement a comprehensive program to reduce sick leaves 3.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Statsrådet Anna Tenje (M)
Madam Speaker! Åsa Eriksson has asked me whether I will not proceed with the proposals for changes to the sickness insurance that were suggested in the investigation *An evaluation of changes in the sickness insurance's regulatory framework during 2021 and 2022* (SOU 2024:26). Additionally, Märta Stenevi has asked me if the investigation's proposals are under preparation and if it is my opinion that the government should present them as a bill to the Riksdag.
Madam Speaker! Sweden has and shall have a health insurance that provides people with financial compensation in the event of loss of income due to illness and reduced capacity to work.
In recent years, sick leaves have become more frequent and longer. This is obviously a worrying development, not least for those individuals who are moving further and further away from work. A well-functioning sickness insurance must be based on research and the best possible available knowledge regarding what is most appropriate for people to be able to be on sick leave with compensation that provides financial security. At the same time, it is important to ensure accurate and effective rehabilitation measures that counteract unnecessarily many, and particularly long, sick leaves. Here, the investigation's analyses constitute one of several knowledge bases.
The Government assesses that the investigation's proposals do not meet the challenges that exist within the health insurance in the current situation.
Our approach instead is to now implement a comprehensive program to reduce sick leave and help people back to work as soon as possible. Therefore, the government announces in the budget bill for 2025 a number of different measures to strengthen the return to work through increased coordination of rehabilitation efforts, work-oriented rehabilitation support, and a review of increased opportunities for studies for those who receive sickness and activity compensation.
Åsa Eriksson (S)
Madam Speaker! I want to take the opportunity to congratulate the Minister. I heard that it is an anniversary today. Nice to be able to celebrate it in the chamber and debate that important health insurance!
It is interesting to listen to the government's silence after the consultation period for the investigation *An evaluation of changes in the sickness insurance rules during 2021 and 2022* expired. There was crushing criticism of the investigators' proposals to remove the improvements to the sickness insurance that we Social Democrats and the Green Party managed to push through in a government position.
The Minister does not seem particularly interested in discussing what should happen with the proposals; it was a long time ago that we submitted our interpellations and we have now had to wait for the debate. Perhaps it was the birthday we were supposed to wait for!
One can also reflect on which issues the government is trying to dodge. Crushing criticism from organizations that care about people's safety is not always something the right-wing parties care about. I believe, therefore, that there were more than just me who let out a sigh of relief when the proposals from the investigators were neither included in the budget bill nor on the list of bills for this parliamentary year.
Madam Speaker! The Minister and I probably agree that Sweden should have secure social security built on the idea of duty and right. That is what we have at least been until now. And those who are too ill to work should, of course, be able to rely on the sickness insurance. That is how we Social Democrats reason. But the question is how the Moderates view the sickness insurance. The policy that the Minister's party went to the election on in 2006 was, after all, to worsen the security systems and introduce a stumbling block in the sickness insurance. It is, as I have told before, one of the reasons why I became politically engaged in the first place.
The price for the deteriorations carried out by the Alliance government was paid by the sick. Cancer patients were denied insurance and were forced to live on their partner or on social welfare. The long-term sick lost their sickness benefit and were referred to the Public Employment Service (Arbetsförmedlingen), despite the fact that both the employers, they themselves, and the case officers at the Public Employment Service considered them far too sick to work. It is this moderate policy that the investigators Johansson and Hägglund propose should be reintroduced.
Madam Speaker! The background to my interpellation is, however, a statement that the Minister's coalition partner Jimmie Åkesson made from the chamber's rostrum during the party leader debate earlier this autumn, on September 11. He said: "We will not contribute to any deteriorations regarding health insurance." It is not often I agree with Jimmie Åkesson, but there he did, at least, say some very wise words.
We both know, Minister, that the Sweden Democrats are the largest party in the government support and that you three government parties do not have a majority here in the Riksdag without them. That is, everything that the Minister wants to push through in the Riksdag must be approved by the Sweden Democrats. My question to the Minister therefore becomes: What does the Minister think of the proposals from Johansson and Hägglund? Does she think they are bad, or is it simply that Jimmie Åkesson has decided that they should be thrown in the wastebasket, where many of us believe they belong?
Märta Stenevi (MP)
Madam Speaker! I also want to begin by heartily congratulating the Minister on this remarkable day. It is a privilege one has as a Minister to be able to hang out in the chamber both in time and out of time and answer interpellations. But we do not need to be here longer than necessary. I have a actually quite simple question.
The proposal that was submitted originated in an evaluation that the previous government wanted to conduct of the changes that the S-MP government implemented to facilitate for more people to return to their employment. Additional directives were also given with a very clear direction, and the investigators were replaced. It became a clear determination of that which was then also delivered in the investigation's report.
Is it the government that has stopped the preparation of these proposals, or is it actually the Sweden Democrats?
Statsrådet Anna Tenje (M)
Madam Speaker! I must, of course, thank you for the congratulations. It is a wonderfully fine privilege to be able to serve democracy even on one's birthday. It was very pleasant that so many could step up and debate six interpellations this fine evening.
I believe we can all be in complete agreement that the system that collectively catches those who cannot work as usual due to illness constitutes a very important component of our social insurance system. We must never hide, forget, and retire away people who have the capacity to work and have the possibility of returning to work. That there is a basic support when misfortune strikes or illness occurs creates both a security for the individual and a cohesive and more well-functioning society. Simply put, it constitutes an indispensable part of the Swedish social contract that we have a social insurance system and a sickness insurance that works.
At the other end of the same contract, there is also an obligation for every person who can work to also do so. That people work and pay taxes is the entire prerequisite for us to be able to continue to offer a good and well-functioning health insurance for those who do not have the same opportunities and cannot work. No public security can replace the security and the empowerment that follows from self-sufficiency through work. A job is so much more. We have several times in this chamber discussed the importance of re-establishing the work line and the importance of supporting the return to work. It is about community, colleagues, coffee breaks, and a sense of being able to contribute meaning in a larger context.
The absolute majority of all sick leaves that occur are very simple. One becomes ill. One gets the flu, a stomach bug, or a fever and is signed off work. After a few days, one recovers, and then one is back at work again. That is how it looks in the vast majority of cases.
For those affected by more prolonged illnesses, the journey looks very different. There, employers, healthcare, and relevant authorities must focus on accurate and effective rehabilitation measures that counteract unnecessarily many and also particularly long sick leaves. There, the individual obviously also has a very important part and an obligation to participate.
If the person who is able to maintain contact, go to their work, and have a coffee break and talk with colleagues, the possibilities for a faster recovery are often much greater. Therefore, the question of maintained work capacity and the possibility of returning to work is extremely important. Many doctors testify that in many cases it is more harmful for a person to completely break off from their workplace to recover than to stay. Perhaps one can stay part-time or with adjustments, possibly without a single work task.
The government recently presented the budget bill for 2025. It is a budget for a wealthier and stronger Sweden, where those who can support themselves do so, but where we also have a strong safety net for those who currently cannot. Among the proposals are those intended to facilitate a return to work, for example, that one shall be able to undergo work testing; one shall be able to come back and try working without requirements in order to lower the thresholds as much as possible.
Åsa Eriksson (S)
Madam Speaker! There were many fine words from the Minister, but everyone who heard the Minister's answer also heard that she completely avoided answering the question of what she considers regarding the investigators' proposals and why the government is not proceeding with them. That answer is unfortunately completely in line with the Moderates' policy. What the Minister thus acknowledges but does not want to say out loud is that it is the Sweden Democrats who are running the Tidö government. Thank you for the Minister making it so clear! There you have the explanation for why we refer to you as the SD government.
Madam Speaker! We Social Democrats think that the government has now given a number of assignments in the budget bill. Earlier assessments and interventions are super important. There, I agree with the Minister. It is crazy that so many people are left in their sick leave for a long time without anything happening. We cannot have that. We Social Democrats want to see stricter requirements on employers to present a plan for how employees can return to work. It simply must happen.
Försäkringskassan must, in all cases that are not self-evident, in all complex cases that are somewhat diffuse – when it concerns a broken bone that can heal perhaps it is not necessary – strive for coordination with employers, healthcare, and preferably trade unions, we Social Democrats mean, to ensure that there is a plan for what the State Councilor speaks about: how one can return to work as quickly as possible.
Madam Speaker! In order for this to be possible, we Social Democrats in our budget motion have 6 billion more than the government in reinforcements to municipalities and regions. We inflation-protect the state grants. The SD government does not. We also have an additional 3 billion for staffing reinforcements within healthcare so that healthcare, among other things, can enable earlier investigations, operations, treatments, and rehabilitation efforts. Thus, people can regain their capacity to work and return to work instead of being left passively on sick leave. It would enable more people to regain their capacity to work faster and be able to support themselves and their family.
How does the Minister intend for care to be provided earlier in the cases of illness when the government cuts the state grants to the regions?
Märta Stenevi (MP)
Madam Speaker! I thank the Minister again for the answer. I completely share the Minister's view on the importance of having a context, a greater meaning, a sense of belonging, and an opportunity to return to one's work. That the individual has an obligation to get well is a slightly more complicated picture, because it often requires quite a lot around it, not least when it concerns somatic illnesses, which one simply cannot recover from by will alone.
The changes implemented by the S-MP government aimed to reverse the previous alliance government's very destructive sickness insurance policy, which meant that people were in a state of enormous anxiety regarding the economy rather than being able to focus on rehabilitation.
We know that there is much left to do, not least in the actual implementation of how Försäkringskassan shall work with the coordination responsibility towards multiple parties so that one actually gets the interventions one needs, not only in the form of part-time work and workplace adaptation for the individual but also regarding the organizational and social work environment and other actors required for the person on sick leave to return.
Overall: Given what emerged in the answer and what I have otherwise heard in the chamber today, Madam Speaker, I wonder if the government agrees that the previous Alliance government's deteriorations of the sickness insurance were directly destructive. Is it the case that the policy for sickness insurance implemented by the S-MP government is now also the Moderates' and the government's policy?
Statsrådet Anna Tenje (M)
Madam Speaker! If it was perceived that I said there was an obligation to get well, I meant an obligation to participate in the process together with employers, healthcare, and relevant authorities - nothing else. If there had been an obligation to get well, it would have been simple, and I understand that it is not at all - if anyone misunderstood.
As I mentioned in my previous speech, the measures we can jointly implement are extremely important. Those who are ill must receive care and become healthy and restored as quickly as is possible. Rehabilitation efforts, adaptations of work tasks, and so on, enable a quick and efficient return to work, even for those who perhaps cannot be completely restored.
Let us dwell a little on the budget bill for 2025. There, the government presents a whole battery of measures specifically for return to work. In addition to reviewing the work trial, which I touched upon earlier, with maintained sickness benefit, it involves, among other things, a mandate to Försäkringskassan to strengthen the authorities' work in following up on the employer's plans for return to work as well as coordinating the rehabilitation.
A mandate to Försäkringskassan and Arbetsmiljöverket is to develop their cooperation and supervision of the employer's work environment and rehabilitation responsibility, and an additional mandate to Försäkringskassan is to develop the work of continuously investigating the conditions for work-preparatory or work-life-oriented interventions for persons with aktivitetsersättning and initiating such interventions when the conditions exist. Furthermore, Försäkringskassan shall, together with Arbetsförmedlingen, further develop methods for those on long-term sick leave to assess taking advantage of work capacity in gainful employment on the labor market. In order to facilitate for employers to take their rehabilitation responsibility and utilize the expert resources of public health care, the grant for workplace-oriented rehabilitation support needs to be developed.
We are also reviewing partial sickness and activity compensation during studies because we have seen that there is sometimes a strong desire not to study full-time, or even part-time, but on a part-time basis without risking one's compensation.
There is also a targeted investment of 500 million kronor in primary care and first-line work regarding mental health, given that we see it is precisely those diagnoses that are increasing in sick leave.
Last week, the government decided to strengthen the healthcare system's work with sick leave and rehabilitation through a mandate to Socialstyrelsen. At the same time, ISF and Myndigheten för vård- och omsorgsanalys were also tasked with evaluating the law on coordination measures for patients on sick leave.
I and the government will tirelessly continue to do our work to support people in returning to work and ensure that it happens as effectively as is possible, above all for the sake of the individual and so that this holds society together and finances everything that we agree is important in our country.
Another important aspect of making the social contract work is to truly prioritize and ensure that the groups with the greatest needs – persons with sickness and rehabilitation interventions in special cases, an economically vulnerable group – shall receive increased compensation levels. This has not occurred since 2012.
The social democratic government had all those opportunities, but they did not take them. We are doing so now.
Åsa Eriksson (S)
Madam Speaker! Once again, we received no answers on how the Minister intends for healthcare to be accessed faster in medical cases. It was 500 million kronor for primary care's first-line psychiatry, which in itself is good. But both the Minister and I know that it is not enough in the long run. Far more money was needed. We have, as mentioned, invested 6 + 3 billion more than the government, and I believe that even more than that will be needed in the future.
We also did not receive any answer from the Minister to my colleague Märta Stenevis question, which was highly relevant. Now that the Minister has stopped the preparation of the proposals from the investigation, is it the case that the Minister admits that the introduction of stupstock and make-believe work that Försäkringskassan is to refer to was incorrect policy by the Alliance government? Or is it the case that the Minister admits that it is the Sweden Democrats who are steering the government's policy?
Märta Stenevi (MP)
Madam Speaker! I thank the Minister for a long series of reforms. This interpellation, however, was about the health insurance and the proposals for deteriorations in the health insurance that the government commissioned.
Neither Åsa Eriksson nor I have received an answer as to what the government actually wanted to see. Perhaps it is simply a negotiating victory for the Sverigedemokraterna that has overridden the Moderaterna and the other parties in the government. What do I know?
Madam Speaker! I am sincerely glad that the Green Party's health insurance policy is now largely retained by the Moderates and that we will avoid seeing a return to the senseless Alliance policy that existed previously.
Statsrådet Anna Tenje (M)
Madam Speaker! I would like to begin by thanking both the interpellants for their pressing and important questions. The reason why this interpellation debate has not dealt with any proposals regarding the health insurance in accordance with the investigation that was conducted is precisely because there are no such proposals. I therefore intended to take the opportunity to instead account for the proposals and reforms that the government is putting forward.
Already in the opening statement, I noted - which one would have heard if one had listened carefully - that the government does not make the assessment that the investigation's proposals meet the challenges that exist within the health insurance in the current situation. Among other things, the referral bodies highlighted that several of the reforms have been in effect for a relatively short period and that more time is required to fully see the effects.
Our approach is now instead to carry out a comprehensive program to reduce sick leave and help people back to work as soon as possible. It is a program that I have, in large parts, accounted for here in the rostrum today. This occurs, of course, against the background of a very concerning situation and a non-positive development where individuals in the sickness insurance are getting further and further away from work.
I look forward to continuing the important work I have accounted for and indicated in the budget bill, and I will continue to closely monitor the development of sickness absence moving forward.
I thank you for the debate and for taking the time to celebrate my birthday with me.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.