China’s elderly protest health insurance cuts in Wuhan, Dalian


A week of protests by Chinese pensioners over health insurance changes that reduce payouts for medicine and outpatient care has underscored pressure on the Chinese Communist Party to deliver improved social care for a rapidly aging population, even after local government coffers were severely depleted by huge “zero” covid” expenses.

On a drizzly afternoon last week, hundreds of elderly gathered outside the city hall in Wuhan, in central China, to oppose changes to state health insurance, including reducing monthly claims for medicine to one-third of the previous amount.

Huddled beneath umbrellas and watched by police in bright blue raincoats, the peaceful crowd sang the revolutionary anthem “The Internationale” and chanted slogans calling for an explanation, according to videos of the scene shared widely online. If no resolution was reached, the protesters said, then they would stage a second mass demonstration a week later.

As promised, they filled central Zhongshan park and nearby streets Wednesday, with a second group gathering a couple of blocks away by the Wuhan Union Hospital.

This time, the authorities reacted more forcefully. In an apparent attempt to curb attendance, the city’s metro cars did not stop at the nearest station. The video showed shoving matches as police tried to contain the protests. Some tried to climb barriers to escape the melee but were pulled back by uniformed officers.

At the same time as the standoff escalated in Wuhan, another demonstration was beginning in Dalian, a city of 7 million on China’s northeast coast, where hundreds of elderly wrapped up in puffy winter jackets descended on People’s Square to quietly protest the same changes.

The spread of discontent over adjustments to social care comes only three months after Chinese leader Xi Jinping faced mass social unrest over the excesses of his signature zero-covid policy that disrupted daily life and hammered businesses. Shortly afterward, the party abruptly reversed course. Infections soared, leaving hospitals and crematoriums overwhelmed.

Unlike the unusually widespread and politically charged protests in November, single issue protests like those that took place in Wuhan and Dalian this week are common in China, even under the stability-obsessed Xi. Changes to pensions, education, housing and other foundational social policies often draw responses as people petition to protect their rights.

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But these incidents put pressure on the Communist Party promises that things can still get better for everyday people in China as the nation faces a new economic reality. The decades of breakneck growth are over, but Xi has justified his norm-defying third term in part by pledging a to return to the party’s egalitarian origins to progress a central policy agenda of “common prosperity” for the masses.

Such ambitious adjustments are not cheap or easy, and Xi has to deliver them during a time of strengthening economic head winds, including a struggling property market, weak consumption and a shrinking population.

What’s more, mass testing, quarantines and lockdowns have left already cash-strapped local governments seeking ways to reduce costs. While adjustments to medical insurance have been a long time coming, retirees complain that they were not consulted about the changes or given support to adjust to the new system.

Announced in 2020, the adjustments aim to ease pressure on state insurance funds that some experts fear could run out within a decade as the population ages. The idea was to focus on essential care by increasing funds in a centralized account used for major inpatient care while reducing those available in a personal account used for outpatient services and medicines. Although the revisions are a nationwide effort, the specific approach is determined locally.

Debates over how to handle state health insurance funds are likely to increase as the population ages, said Aidan Chau, a researcher at the Hong Kong-based nongovernmental organization China Labor Bulletin. Even after the state justified changes by saying that the money should be left for people who are most in need, workers in places like Wuhan who have quite substantial funds in their individual accounts “think that it’s a cut in their benefits,” he said.

In Wuhan and Dalian, many raised concerns online about being unable to claim as much for basic medicines needed to prevent the onset of more severe symptoms.

“I can tell you with absolute certainty that every single retiree in Wuhan has had complaints,” one resident told a Wuhan government complaint hotline according to a recording that was widely shared online. “Health insurance should get better with adjustments, but to do it this way means we won’t be able to get treatment,” the caller said.

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Confusion over whether the changes disproportionately impact certain groups have fueled anger after reports circulated online that civil servants would be excluded from the reduced payouts. A blog affiliated with state-run Henan Daily went as far as calling Wuhan’s restructuring “radical” in its raising of requirements for claims and cancellation of payouts for gig workers.

State-run China National Health Insurance Magazine denied the charges and said the protesters had been “brainwashed” by rumors, declaring that “when you understand the articles there will be no doubt that older people are the biggest beneficiaries.”

As the city where the coronavirus was first discovered, Wuhan’s lockdown was among the longest and most chaotic in China. During the initial outbreak, authorities pledged to cover the costs of all covid-related treatments, with much of that expense being borne at the local level. And that bill continued to grow as the regime of ad hoc restrictions continued into late 2022, long past when most of the rest of the world had learned to live with the virus.

The city spent $1.3 billion on covid and other related public health expenses in fiscal year 2022, according to a financial bureau budget report submitted to the local legislature in January 2023. Dalian spent $408 million to fight coronavirus in 2022.

Lyric Li in Seoul, Theodora Yu in Hong Kong and Vic Chiang in Taipei contributed to this report.

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