"Any healthy person can pay"

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The authorities propose to oblige all unemployed Russians to pay 45 thousand rubles annually to the Compulsory Health Insurance Fund - this should help “fairly distribute the load” and reduce the fund’s deficit. Инициатива, озвученная Валентиной Матвиенко, подается как способ «справедливо распределить нагрузку» и сократить дефицит фонда, который в 2025 году оценивается примерно в 130 миллиардов рублей.

Let's figure out who this measure will affect and why it will only increase social inequality in Russia.

• Author

  

  Author

  Никита Герасимов

• Editor

  Editor

  Denis Leven

• Illustrator

  Illustrator

  Vitya Ershov

• Publication

  October 9, 2025

On October 6, Speaker of the Federation Council Valentina Matvienko stated that Russians who are not officially working must pay contributions to the Compulsory Health Insurance Fund. According to the official, on average 45 thousand rubles should be collected from people per year. Matvienko added that this is exactly how much the employer pays for one employee in the Compulsory Medical Insurance Fund.

“Young, healthy people of working age do not work anywhere,” she said, addressing the head of the Ministry of Finance Anton Siluanov, adding that the Russian economy incurs “huge costs for the non-working population.”

Матвиенко считает, что 45 тысяч рублей может заплатить «любой здоровый человек» , поскольку это «не колоссальные средства». По словам спикерки Совфеда, комитет по социальной политике направит эту инициативу в комитет по бюджету, Минфин и Минтруд.

“The state seeks to bring freelancers, self-employed, platform workers, whose income is not visible to the tax system, out of the “shadow”

Earlier, a similar proposal was voiced by Moscow Mayor Sergei Sobyanin. В сентябре 2025 года на Московском финансовом форуме он заявил, что только Москва платит в ФОМС 180 миллиардов рублей за неработающих людей, а все регионы России — около триллиона рублей в год.

По словам Собянина, около десяти миллионов человек по всей стране «не обременены никакими ограничениями, не работают и даже заявления не написали о социальной поддержке или в ФОМС, чтобы их застраховали».

“The reasons for the emergence of such ideas are now clear. ФОМС в последние годы балансирует между растущими расходами и ограниченными доходами: дефицит фонда на 2025 год оценивается примерно в 130 миллиардов. At the same time, there is a fight against shadow employment, the state is trying to bring freelancers, self-employed, platform workers, whose income is not visible to the tax system, out of the “shadow”. In this context, Matvienko’s proposal is another attempt to expand the tax and insurance base,” notes economist and editor of the Politeconomics channel Khazbi Budunov in a commentary to Replica.

Фонд обязательного медицинского страхования — государственный небюджетный фонд, который отвечает за сбор и распределение средств, направляемых на обязательную медицинскую страховку работников. Он следит за тем, чтобы у каждого работающего в России был медицинский полис и доступ к бесплатной помощи.

Фонд также оплачивает услуги медицинских учреждений — больниц, поликлиник и других — за оказанную людям помощь. Кроме того, ФОМС формально должен защищать права застрахованных, выравнивать расходы между регионами, контролировать качество помощи и разрабатывать тарифы для медучреждений.

Thus, the MHIF acts as a “common purse” that makes treatment free for people and paid for by hospitals, while simultaneously acting as a regulator for health insurance.

Who may be affected by this measure?

“If we put aside emotions, the idea is directed against people of working age who are neither in employment nor in the status of unemployed, students, pensioners or other preferential categories. На практике это фрилансер:ки без регистрации, самозанятые, подрабатывающие, сезонницы, женщины, ухаживающие за близкими, а также те, кто просто выпал из системы», — говорит Будунов.

The macroeconomic effect of such a measure will be minimal, the expert notes: unemployment in Russia is now at a record low, and even if all potential “unemployed” are taxed, we are talking about small revenues against the backdrop of the MHIF budget, where turnover is measured in trillions of rubles.

На уровне домохозяйств это решение может сократить и без того ограниченное потребление и усилить социальное расслоение. Фиксированная плата в 45 тысяч рублей, не зависящая от дохода, по сути, является регрессивным налогом: чем беднее человек, тем большую часть своего дохода он отдаёт.

For the compulsory health insurance system itself, this initiative is likely to create additional difficulties rather than solve existing ones. Придётся определять, кто «здоровый», кто «неработающий», администрировать сбор, контролировать оплату — расходы на администрирование могут съесть значительную часть поступлений.

“Finally, the question remains: what will happen to those who do not pay? It is impossible to deprive of medical care - this is a constitutional right. Значит, государство всё равно вынуждено будет финансировать их лечение, только уже в форме экстренных расходов», — отмечает Будунов в комментарии «Реплике».

Precarity in modern Russia

In modern Russia, it is not entirely clear who can be considered “non-working,” notes Budunov.

“Labor relations are blurred, new forms of employment - freelancing, self-employment, daily wage contracts - create a huge layer of precariat, people with unstable work, without social guarantees and insurance rights. They are the ones who will find themselves between a rock and a hard place: formally unemployed, but actually providing an income for themselves. They will bear the brunt of such a measure,” says the economist.

The precariat is a class or social stratum of people who work but do not have stable employment. К прекариату можно отнести курьер:ок, работников служб доставки, самозанятых и стажёр:ок в разных учреждениях.

It is traditionally believed that the precariat is one of the most unstable and unprotected classes of modern society. Precarious workers lack long-term job security and social benefits, leaving them unable to budget for expenses and under constant stress, forced to look for a new job.

Precarious employment is widespread in Russia. Doctor of Economic Sciences Ekaterina Litau notes that the collapse of the USSR, the rapid formation of a capitalist economy and the weakening of trade unions led to the spread of precarity.

“In Russia, the precariat sometimes looks like the norm of life in general: you didn’t expect stability. What they have in common is existential vulnerability. Today you are in demand, tomorrow the platform algorithm will decide that you are not. And this is equally frightening for both the Russian courier and the London delivery man,” explains Litau.

According to conservative estimates, about 12 million people in Russia can be classified as precariat. Many of them work in the IT field, transport goods, or provide repair and cosmetic services.

Formally, these people are not constantly employed, but rather are interrupted by various orders or projects. In theory, the measures proposed by Matvienko could also affect them, since the status of their work is unstable, and many of the precaries are not officially registered.