WP’s Full Motion on the Cost of Living Crisis—speech by Dennis Tan

Mr Speaker, as MPs, feedback from residents about rising cost of living is not uncommon. However, in the last half a year, the frequency of such feedback has really increased tremendously. I received such feedback not merely from residents who are in the lower income brackets. I also received feedback from across the different income tiers. Recently I attended a feedback session with some condo residents in Hougang and concerns arising from rising cost of living were raised by many with whom I spoke to. Mr Speaker, I believe I am not alone in receiving such concerns and feedback. I therefore support the Workers’ Party motion today calling on the Government to review its policies with a view to lower cost of living pressures on Singaporeans and their families. 

Mr Speaker, there are different issues of rising cost of living which affect Singaporeans. My colleagues in the Workers’ Party will be focusing on different aspects of the rising cost pressures.  I will be speaking on the need to relook certain aspects of our means-testing criteria in public healthcare and for more help for adults with special needs or disabilities and their caregiving families. 

Healthcare costs and means testing

Mr Speaker, with a growing ageing population, healthcare costs are the concerns of many, including especially many of our seniors and those with no income and yet facing health issues and find themselves struggling to afford essential healthcare. The current means testing method based on Per Capita Household Income (PCHI) presents some challenges for certain Singaporeans. The current economic indicators applied to the healthcare means testing criteria may have their limitations.  The PCHI formula looks at household income broadly; it overlooks or de-prioritizes two important issues: 

(1) The formula looks baldly at rigid household incomes and does not look at differing or specific needs of specific members of each household when evaluating help which should be given. 

While it’s true that both the young, such as children, and the elderly may not have earning power or contribute directly to the Per Capita Household Income (PCHI), the elderly are more likely to require nursing care due to the onset of various chronic illnesses associated with ageing. 

According to the National Population Health Survey conducted in 2020, over 20% of respondents aged 60 to 74 years had diabetes, approximately 75% of those aged 70-74 years had hypertension, and 60% in the same age group had high cholesterol. These chronic illnesses often result in increased healthcare spending, including expenses related to complications. For instance, diabetes and high cholesterol are commonly associated with cardiovascular diseases like coronary heart disease In fact, in 2019, approximately 75% of heart attack patients were aged 60 and above.

Furthermore, most corporate medical insurance plans typically allow employees to include two family dependents, usually a spouse and offspring, but do not permit the inclusion of elderly dependents. This exclusion is often reflected in corporate insurance plans, such as those offered by Raffles Medical Group, a major corporate insurance provider in Singapore. These plans specify that eligible dependents must be either a spouse or unmarried or unemployed children. As a result, some households with elderly dependents may experience higher out-of-pocket medical expenses compared to households with children, even when their PCHI is the same. It is crucial that we consider such disparities in means testing.

One might argue that the seniors in Singapore already have access to a wide range of subsidy schemes aimed at addressing their needs, such as the Merdeka Generation Package (MG) and Pioneer Generation (PG) Package. However, a closer examination of the healthcare subsidies offered by these packages reveals room for improvement. For instance, the subsidies entitlement for MG and PG cardholders covers chronic conditions and dental services but are not as extensive in coverage when compared with the coverage of critical illnesses in commonly available medical insurance policies and subsidies for chronic conditions are capped annually.

(2) It does not look at whether family members actually do receive help from family members for the medical fees and expenses of a family member. 

The choice of residence for retired elderly individuals, whether they decide to stay with their working adult children or live independently, has little impact on the family’s financial dynamics. Financial support from working adult children is a personal decision made independently of the elderly person’s choice of living arrangement. As a result, the retired elderly may appear to have a high PCHI on paper, but they may not receive financial assistance from their children.

While the Government expects family members to pay for the living and medical expenses of family members, in reality this may be easier said than done. Many residents have told me that they do not wish to impose on their children and they try to make do with what they have. Many have tried unsuccessfully to get   public financial assistance when they do not receive money or sufficient money from their children as their children have told them they do not have enough to contribute to their parents including those who live with their children in the same households. How can such people receive further subsidy or assistance if help is not forthcoming from family members and without having to request from family members?  

I see the same problem with some of my residents seeking financial assistance but were not eligible because of household income. An elderly male resident saw me a few times, crying with frustration due to the lack of financial support as he is not eligible for more support due to his son’s and daughter-in-law’s incomes and his son said that he is unable to provide more support. 

Furthermore, for healthcare means testing, beyond cases of elderly parents living with working children, there may also be other categories of co-occupiers in the household who may not be currently sharing or co-funding medical expenses of other occupiers of the property. By way of an example, Mr A is in his early 60s and working part time due to his health condition. He lives with two other higher earning siblings. They share  common household expenses but not  individual medical expenses. The household income would be a key consideration for the amount of subsidy he is entitled under the present PCHI formuIa. In a case like this, does the Government expect Mr A to reach out to his sibling to ask them to share his medical expenses? Will Mr A get help if he applies to the authorities for further subsidy?

Removal of the Annual Value as a method of means testing when the household income is zero

Mr Speaker, currently when the per capita household income of a particular household ie PCHI, is zero, the Government will look at the Annual Value of the property that the household is living in.

In July this year, the honourable member for Aljunied GRC, Mr Gerald Giam, urged the Ministry of Health to consider removing the AV component for households with no income. Senior Parliamentary Secretary Ms Rahayu Mahzam said in response and I quote “..on the Member’s point of considering to remove this, this is a broader point we are looking at.” I hope the Government will remove this.

Mr Speaker, households with zero PCHI but higher Annual Values often comprise of retirees who are in their twilight years and may have a family member who is seriously unwell and seeking medical treatment. 

The Minister of Health himself had acknowledged, in a written answer to a parliamentary question in February this year, that Annual Value is an imperfect proxy for determining financial need, especially for those who are asset-rich but cash-poor. 

There may be a variety of reasons why such individual owners are unable to monetize their property. As we age, we may grow more attached to our homes, the neighbourhoods we are familiar with, and the communities we have built over the years and that these may not even be the reasons for some among us for not being able to move out to a lower priced property for whatever reasons. Monetizing, right-sizing, or downsizing may not always be feasible or desirable. In addition, we have been encouraged to age in place. 

But owners living in their own properties are not the only people who are affected by the Annual Value. There are also family members who are caught by the rule. Besides non-owner spouses, siblings, children, aunts, uncles and cousins living in the same property may be caught by the rule. Such family may not be able to get their relatives in the same household to pay for their medical expenses. They may not be able to afford a place of their own just to qualify for more state subsidies. 

There are also cases of family members being co-owners of a family property or co-inheriting such property after a parent has passed on. I have known of a few of such cases where residents inherited a family property together with fellow family members. They continue to live in their own property. The family property is kept for use by other family members and this could be a residential or even commercial property and there is no near term prospect of the property being sold and proceeds to be distributed. These non-occupier ‘owners’ are caught by the Annual Value issue when it comes to medical subsidies and also for other packages and schemes from other ministries. Such people have to appeal every time against their non access for subsidies and benefits and the outcome may not always be consistent.  

Before I leave this point, I would also say that whether a person is an owner or a non-owner, it would not be right to expect a person living in a property with higher Annual Value and battling a serious disease to have to make arrangements to move out of his or her home or to sell his or her home to raise funds for medical treatment.    

Different needs – Singaporeans who have to care for their family members who may be special needs adults or are grappling with severe mental health and other health issues. 

Next, I would like to discuss the needs of families who have family members with special needs or with mental health issues and requiring care from family members.  The burden placed upon these families is immense, and I hope that the state can extend more help to affected families.

While the number of such families may not be large, their plight is significant and warrants our attention. According to SgEnable, 3.4% of people aged 18 to 49 in our country are disabled. These numbers are not negligible, and we must recognize the challenges faced by these families. Moreover, data from the Ministry of Social and Family Development (MSF) estimated that in 2022 there were approximately 32,000 persons with disabilities (PWDs) aged 15 to 64, with about 1,000 of them unemployed and 22,000 outside the labour force. These figures underscore the urgency of addressing their needs. Moreover, for families where such adults with special needs or with mental issues require their ageing parents to continue to care for them, the burden of caregiving, both financially and physically can be tremendous.

I have some suggestions to provide better assistance to these families:

  1. We should create a list of non-critical illnesses that necessitate long-term care and force individuals out of employment. This list would include conditions such as early onset dementia, severe autism, Down syndrome, schizophrenia, and Parkinson’s disease. Such conditions can be financially burdensome for families, and access to social support for these individuals and their families is currently limited.

For example, eligibility for claims under CareShield Life remains limited to individuals who are unable to perform at least 3 Activities of Daily Living (ADLs). However, the above-mentioned ailments, while detrimental enough to put one out of employment, do not always impact one’s ability to perform ADLs. Many insurance plans cover critical illnesses, and the insurance products available on the market that cover non-critical illnesses remain limited. Besides, some of these non-critical illnesses are congenital, making afflicted individuals excluded from medical insurance schemes which require that one must be free of pre-existing medical conditions before they are onboarded. 

The eligibility criteria for CareShield Life can be expanded to include consideration of those who can still perform Activities of Daily Living (ADLs) but are unable to earn a stable income due to non-critical illnesses. This aligns with the original intentions of CareShield Life, which is targeted at individuals with long-term care needs. 

  1. For such individuals with non-critical illnesses, we should offer more subsidies for medical supplies, consultations, treatment, rehabilitation, and day care services. Medical expenses for such individuals are not limited to specialist outpatient care or inpatient care but also include other essential areas like medical supplies and rehabilitation.
  1. Increased subsidies for inpatient and outpatient specialist treatment for both individuals with non-critical illnesses and their caregivers should be made available.

While there are existing subsidies for long-term residential care, day care, and rehabilitation, many families do not meet the eligibility criteria due to the ceiling limits set by PCHI or even the Annual Value of their property.

For example, the PCHI upper limit to qualify for day care subsidies is set at $2,800. This can make it challenging for working adults taking care of their disabled children, as their income may exceed this limit. Should the working adult take care of his or her disabled child because the child is not capable of independent living, and let’s say he or she earns about $7000 per month (taking the median monthly salary of someone in 40-44 years old age group), and the spouse is a full time caregiver without any income, this works out to a PCHI of $2333 per month ($7000 divided by 3), the family only marginally qualify for 30% subsidies entitlement for day care services.

Furthermore, the Senior Mobility Fund is targeted at seniors aged 60 and above, leaving out younger persons with disabilities who also require nursing and rehabilitation support. The younger PWDs, in spite of their nursing and rehabilitation needs, will not be able to access the fund. Even if the age criteria is extended to include younger PWDs, they do not qualify if the PCHI is more than $2000 and the Annual Value of their property is more than $13000.

In short, I am concerned that those affected are not getting enough support. There are PWDs in the working age-group with rehabilitation needs, and I hope the Senior Mobility Fund is extended to include PWDs. I also hope PWDs in the working adult age group qualify for subsidies in day care and residential care. Besides the opportunity cost of lost income, they should not be penalised just because they live with a working family member out of necessity. 

  1. More support should be given to caregivers of adults with special needs or disabilities. While we do have existing grants and concessions, such as the Caregivers Training Grant, Home Caregiving Grant, and Migrant Domestic Levy Concession, some of these are limited to households where the care recipient is elderly and exclude families where elderly parents are caregivers to disabled children. This disparity must be addressed.

Can caregiving grants such as the Home CareGiving Grant and the Migrant Domestic Worker Levy Concession for Aged Persons with Disabilities be extended to households where the care recipients are not seniors and may have no issues with ADLs but are involuntarily unemployed? After all, the conditions that threaten employment (e.g. early onset dementia, severe autism, down syndrome, schizophrenia, Parkinson’s disease) are neurological or psychiatric conditions that affect soft skills like cognitive and communication skills, and may not always affect one’s ability to perform ADLs. To use only ADLs as an indicator in eligibility determination for grants is not comprehensive.

Mr Speaker, I hope that more help can be given to support caregivers especially caregivers who had to give up their full-time jobs to care for their family members and do not have an income or may need more financial support. For a start, I hope that the Home CareGiving Grant can be increased beyond the current $400 for deserving cases.

In closing, Mr Speaker, I hope the current means testing can be further improved upon to take into account the specifics of an individual’s financial situation, particularly his or her cash flow, and health condition and make healthcare more affordable and accessible for all. More help should also be extended to adults with special needs or other forms of disability who are in the working adult age group but are unable to work and requires part or full time care from family members especially families where the parents are getting on in age.

Mr Speaker, I support the motion.