Estonian politicians are divided over a proposal to require all residents to contribute to health insurance, as the country struggles with one of the highest proportions of uninsured people in Europe.

Around 90,000 people, or just over 7 percent of Estonia’s population, currently have no health insurance. Only Romania records a higher proportion of uninsured residents in the European Union.

The problem is particularly pronounced among people of working age who do not pay social tax. Employees receiving officially declared wages are automatically covered through payroll contributions, while the state finances healthcare for children, pensioners and several other protected groups. Nevertheless, approximately 10 percent of working-age women and 14 percent of working-age men remain outside the system.

Health economists Triin Habicht, Andres Võrk and Kaija Kasekamp have proposed making health insurance contributions genuinely compulsory and placing responsibility for payment directly on individuals who are not otherwise covered. Comparable arrangements already operate in countries including Lithuania and the Netherlands.

Under the proposal, uninsured residents would accumulate a debt to the state if they failed to make the required payments. The liability could become apparent when a person sought medical treatment. If an individual had no income and could not pay immediately, the state could recover the debt after they began earning, using a mechanism similar to the collection of unpaid child maintenance.

Võrk also suggested calculating individual health insurance contributions on the basis of Estonia’s minimum wage rather than the average wage. At present, this would result in a monthly payment of approximately €115.

Finance Minister Jürgen Ligi of the Reform Party, who also sits on the supervisory board of the Estonian Health Insurance Fund, said the proposal was moving in the right direction but raised serious practical questions.

According to Ligi, the government would have to ensure that people were genuinely able to afford the payments. The system would also need safeguards against “insurance of convenience,” under which people who could afford to contribute more would pay only the minimum amount while receiving full healthcare coverage.

For this reason, Ligi opposed linking the contribution to the minimum wage. He argued that such a solution could allow higher-income individuals to receive insurance on terms that were disproportionately favourable compared with those of regular employees paying social tax on their full salaries.

Riina Solman, Tallinn’s deputy mayor and a former Isamaa government minister, rejected the proposal more decisively. She warned that an additional monthly payment would place an excessive burden on households already affected by the economic downturn and rising living costs.

For many families, she argued, even a relatively small additional expense at the end of the month can be significant. A compulsory contribution of €115 could therefore function as a new tax that many uninsured people would simply be unable to pay.

Jevgeni Ossinovski, a Social Democratic MP and former minister of social affairs, also questioned the idea of making individuals responsible for securing their own coverage. He previously proposed guaranteeing health insurance to every permanent resident of Estonia.

Ossinovski stressed that uninsured people do not form a single, uniform group. Some are company owners or other individuals who have sufficient income but minimise their social tax payments by receiving dividends or using other tax arrangements. In such cases, he said, stronger enforcement by the state would be justified.

However, the uninsured population also includes socially vulnerable people with little or no capacity to pay. Introducing compulsory contributions and initiating debt recovery proceedings would not necessarily bring additional revenue from this group and could deepen their financial and social exclusion.

The debate therefore concerns more than simply extending formal insurance coverage. Policymakers must decide whether universal access should be financed primarily through individual obligations, stronger enforcement of existing tax rules or broader state guarantees.

Supporters of compulsory contributions argue that the current system allows too many people to remain uninsured and leaves Estonia performing poorly by European standards. Critics counter that a uniform monthly payment would fail to reflect major differences in income, employment status and vulnerability.

While there is broad recognition that Estonia’s high number of uninsured residents requires action, political agreement on who should pay—and how much—remains distant.