On June 9, Swiss citizens will be given the opportunity to vote on four national referendums, which include the highly anticipated plan to cap the cost of health insurance. Here’s all you need to know about the latest round of referendums in Switzerland, and how they impact expats.

Expat guide to the Swiss national referendums June 2024

Following the national referendums in March 2024, on June 9, people from across Swiss cities and cantons will be given the chance to vote on four new proposals. Two relate to the cost of basic and supplemental health insurance, one concerns energy while the last one focuses on medical consent rules.

With this in mind, here's all expats and internationals need to know about the Premium Relief Initiative, the Cost Brake Initiative, the new renewable energy law and the “For Freedom and Physical Integrity” popular initiative.

Switzerland to vote on Premium Relief Initiative (Prämien-Entlastungs-Initiative)

The Premium Relief Initiative is a plan to cap the cost of basic health insurance in Switzerland. Under the plans, no person would have to spend more than 10 percent of their annual salary or income on their mandatory health insurance plan. This would be achieved by both the federal government and cantons subsiding health insurers to keep premiums low.

Currently, while all Swiss cantons are required to offer some form of premium subsidy for those on the lowest incomes, the assistance has to be applied for in most cantons and each region has a lot of leeway when it comes to issuing the benefit. Therefore, under the plans, the cheaper premium would be applied automatically upon every premium renewal.

Arguments for and against the Swiss Premium Relief Initiative

The committee in favour of the scheme argued that since 1997, the average cost of health insurance premiums has increased by 158 percent, while salaries have only risen by 12 percent. They added that the Swiss government spends relatively little on the healthcare system compared to other European nations, concluding that by capping insurance costs, they would be helping the poorest people during the ongoing cost of living crisis.

In arguing against the initiative, the Federal Council noted that while it “would relieve some of the population of the burden on premiums”, it would also cost the federal government and cantons several billion francs a year. In order to pay for it, they warned that increases in taxes and austerity measures would be inevitable.

“The initiative does not address the causes of the high premiums,” the council wrote. They added that healthcare is largely the responsibility of the cantons and that by federally subsidising the system, they would be letting both cantons and medical providers off the hook for making healthcare more efficient and affordable.

What is the counter-referendum for the Premium Relief Initiative?

For this vote, the Federal Council and parliament proposed a counter-referendum, where cantons would be set a minimum amount to subsidise premiums. This plan will be implemented if the Premium Relief Initiative is rejected at the ballot box, and no further referendum against it is held.

Cost Brake Initiative in Switzerland (Kostenbremse-Initiative) explained

The second referendum, the Cost Brake Initiative, also concerns health insurance premiums. Currently, the Federal Office for Public Health announces the average increase in the cost of basic health insurance every September. 

If approved, the plan would see health insurance increases linked to salaries and economic growth. If premiums rise more than 20 percent faster than real wages over a two-year period, the law would require both the government and Swiss cantons to make “cost-cutting measures” within a year - what these measures would be is up for parliament to decide.

Voices for and against Cost Brake Initiative 

Much like the Premium Relief Initiative, the committee in favour of the cost brake argued that premiums have risen too fast in recent years and that both health insurers and healthcare providers are incentivised to keep costs high - a recent report by the government estimated that the sector could make savings of 6 billion francs a year without compromising on quality.

Through the cost brake, supporters hope that the legal requirement would force the government to act to curb costs. “The initiative wants all players to finally take responsibility for the cost explosion and to stop the internal distribution battle at the expense of those paying premiums”, the committee concluded.

In contrast, the Federal Council wrote that while higher premiums are putting strain on low to middle incomes, they argued that the cost brake is too rigid a law to be practical. They added that tying premiums to wages would ignore “understandable reasons for cost growth, such as medical progress or the ageing of the population.”

They concluded that forcing the government to cut costs could lead to a deterioration in healthcare services across the country. 

Counter-proposal for the cost brake

Therefore, the Federal Council also recommended a counter-proposal, that would see the government and officials from the healthcare sector meet every four years to determine how much premiums can rise by. If they rise beyond the target, the government would then consider “corrective measures”. This proposal would be adopted if the Cost Brake Initiative is not accepted. 

Explaining the amendments to Swiss energy policy

The third issue on the ballot on June 9 is the approval of an amendment to the Swiss Energy Act and Electricity Supply Act. Following fears of an energy shortage in 2022 and the seemingly infinite issuing of emergency energy-saving plans by the government, the law change is designed to boost energy production in Switzerland through renewable resources.

If approved, the plan would give funding for solar panels on buildings, streamline planning permission for wind and solar farms, make the Swiss grid more efficient and pave the way for the expansion and / or construction of 16 hydroelectric power plants. The plan passed both the National Council (177 yes to 19 no) and Council of States (44 yes, 0 no) last year.

Opinions for and against changes to the energy law

In arguing for the plan, the Federal Council said that the expansion of renewables would help secure Switzerland’s energy supply during global crises. “It makes an important contribution to a reliable electricity supply in our country, protects nature and the landscape and is a concrete step towards reducing the use of fossil fuels,” they added.

In opposition, the committee against the law argued that it denies cantons and local communities a say in major energy projects. They also claimed that the proposal “makes it easier to clear forests and allows the defacement of landscapes and the destruction of protected biotopes…There are alternatives to guarantee the security of the electricity supply.”

The Swiss For Freedom and Physical Integrity referendum explained

Finally, the “For Freedom and Physical Integrity” popular initiative seeks to guarantee the “physical and mental integrity” of people in Switzerland, especially when it comes to medical decisions. Under the plans, a person who refuses to consent to medical or physical interventions by the government will “neither be punished nor should they suffer social or professional disadvantages as a result.”

While the word vaccination is not used in the initiative text, the law places specific focus on not allowing the government to impose restrictions on people based on medical choices. The initiative is seen as a reaction to COVID-related vaccination rules and the 2G, 2G+ and 3G policies enacted during the pandemic.

Who is for and against the For Freedom and Physical Integrity referendum?

In support of the change, the initiative committee argued that current laws are not enough to protect residents of Switzerland’s freedom to make medical decisions. “Man is only free if he can decide what goes into his body. Politics cannot be relied on on this issue,” they claimed.

In response, the Federal Council noted that the “right to physical and mental integrity” is already enshrined in the Swiss constitution, meaning it is unclear what would happen, if anything, if the referendum was accepted. They noted that this lack of clarity could leave the Swiss police, asylum and judicial systems vulnerable to legal grey areas.

When it came to vaccination, they noted that they have “helped eradicate communicable diseases such as smallpox…[and] proved to be an effective way to protect people from serious illnesses.”  What’s more, “no one in Switzerland is allowed to be vaccinated without consent.”

Switzerland to head to the polls on June 9

Following the votes on June 9, the next set of referendums in Switzerland are due on September 22, 2024. For more information about the votes, check out the official election website of Canton Zurich (in German).