Though early surveys indicated that the initiative spearheaded by the Social Democratic Party, seeking to cap insurance rates at 10 percent of income, would be overwhelmingly accepted, on Sunday 55.5 percent of voters turned it down.

Among the main reasons for the rejection was that implementing this measure (which already exists in Switzerland in the form of subsidies for low-income families) would cost several billion francs a year, further increasing the already very high healthcare costs.

While Social Democrats said the referendum results “are disappointing,” according to business association Economiesuisse,“the Swiss understood that the ‘10-percent initiative’ was misleading.” 

With the ‘no’ vote, “billions of francs in additional costs will be avoided,” the group added.

Another commentator pointed out that “the left is launching initiatives without ever saying how we are going to finance it all.” 

The second health insurance initiative voted on Sunday, that sought to provide a ‘brake’ on health costs, was turned down by 62.7 percent of voters. 

READ ALSO: Support for proposals to curb Swiss health insurance costs wanes 

What will happen to health insurance premiums now?

The Federal Council and the parliament have urged the ‘no’ vote to both, creating counter-proposals to each of the two initiatives — that is, their own bills in response to the concerns raised in the initiatives.

Counter-proposals, which are usually more moderate and more ‘implementable’ than original initiatives — come into force automatically if the initiative is rejected.

Under the counter-proposal to the ’10 percent’ initiative, cantons will have to earmark between 3.5 and 7.5 percent of their budgets for premium reductions of the costs of compulsory health insurance on their territories, while the federal government will continue to contribute 7.5 percent.

While this implies that hundreds of millions of francs of public money will be spent to alleviate the ‘premium burden’ of low-income households, it will still be less than about 6 billion that the original initiative required.

What about the ‘cost brake’ initiative?

In this case, the counter-proposal provides for the government to set a limit every four years on the increase in the costs of compulsory health insurance.

The Federal Council as well as the cantons will consider not only wage growth (as the original initiative sought to do), but also the aging population and other demographic trends, medical progress, as well as  other factors that play a role in health insurance premiums.

Additionally, the Federal Council wants to set up a commission for monitoring costs and quality of health insurance.

And there is more

The left-wing parties have already said they would continue to force  referendums aiming to cut the cost of health insurance.

The Greens are now focusing on basing insurance premiums on income.

As for Social Democrats, the party said it will now “work on launching an initiative for public health insurance.”

Neither of these ideas are new.

The implementation of income-based premiums, while supported by various parties, doesn’t seem likely.

The current system is widely thought to be “fair and balanced”, according to Lukas Engelberger, president of Cantonal Health Directors Association.

That’s because the system in place is based on solidarity  — the idea that all insured people form a group.

It can be thought of in terms of a huge pot to which each resident of Switzerland makes a contribution (that is, premium payments), so that in an emergency there are enough resources available to give someone the help they need when they need it.

If the present approach were to change, however, and become income-based, it would be difficult to maintain the solidarity component which, according to officials, has proven its worth.

READ ALSO:  How the Swiss health insurance system is based on solidarity 

In terms of one state-run health insurance scheme, as is the case elsewhere in Europe, Social Democrats have been calling for scrapping of multiple private carriers in favour of the government running the scheme for a while.

The reason for this radical change is that “with a single player, it will be easier to maintain decent prices,” according to MP Baptiste Hurni, who is behind this proposal.

In a 2014 referendum on this subject, 62 percent of voters said ‘no’ to the plan,  with those opposing arguing that a private insurance system offers more choices  and provides a higher quality of services —including better access to specialists and shorter wait times for medical procedures —  than a public option.

They also pointed out that higher premiums are inevitable given an ageing population and higher life expectancy, and shifting to a public system would generate few savings.

However, attitudes may have changed in the last 10 years.

A survey conducted by the Basel Center for Health Economics (BCHE) in January 2024, showed that 68 percent of Switzerland’s population would like the current system to be replaced by a single health insurer.

READ ALSO: Could Switzerland ever change to state-run health insurance scheme?