Draft amending law · Health, Social Protection and the Family

Health Insurance and Universal Health Coverage — Amendment and Development

A proposed amendment to Health Insurance Law No. (22) of 2020 moving beyond enrolment expansion to affordable universal health coverage, clear benefits, stronger financial protection, strategic service purchasing, constitutional and judicial safeguards and quality oversight.

Prepared by: Ali Zuweid

Document number: POL-73
Version: 1.0
Publication / update date: 5 October 2026
Scope: Republic of Iraq

Executive summary

Iraq is not starting from zero. Health Insurance Law No. (22) of 2020 is in force; it established the Health Insurance Authority and Health Insurance Fund, and implementation and geographic expansion have begun. However, Federal Supreme Court Decision (60/Federal/2022), issued on 14 May 2023, ruled several parts unconstitutional, including provisions on contribution-setting, certain registration and eligibility rules, finality of objection decisions, discrimination in certain premiums and retroactivity of some obligations. Subsequent implementation has also shown a practical need to regulate provider contracting, strategic purchasing, quality, data and protection against unexpected charges.

This document therefore adopts comprehensive amendment rather than repeal and replacement. It preserves the Authority, Fund, contracts, acquired rights and existing digital infrastructure while rewriting core provisions determining eligibility, financing, guarantees, purchasing, provider oversight and insured persons' rights in disputes. It makes the benefits package a published, evidence-based decision, reduces reliance on out-of-pocket payment at the point of service, prohibits extra billing outside the system and links contracting to quality, accreditation and data.

The amendment separates three functions that must not be conflated: resource collection and risk pooling within the Fund; determining entitlements and the benefits package under transparent rules; and purchasing services from public and non-governmental providers through contracts and payment instruments delivering quality and efficiency. The Law thus becomes a universal health coverage framework rather than merely a card or payroll-deduction system.

Constitutional and legal context

The Iraqi Constitution grounds health insurance and healthcare rights in two complementary provisions. Article (30) obliges the state to guarantee social and health security for individuals and families, especially children and women, and guarantees it for Iraqis in old age, sickness, disability and other circumstances. Article (31) recognizes every Iraqi's healthcare right and requires the state to safeguard public health and provide prevention and treatment, permitting private treatment institutions under state supervision. Health insurance financing and financial obligations must also be read with Article (28), under which taxes and fees may be imposed, amended, collected or exempted only by law, and Article (100), prohibiting immunity of administrative acts or decisions from appeal.

Health Insurance Law No. (22) of 2020 was published in Iraqi Gazette issue (4614) on 1 February 2021 and took effect six months after publication. It established the Health Insurance Authority and an affiliated fund and regulated enrolment, provider contracting, contributions and beneficiary co-payments. In 2023, the Federal Supreme Court ruled specified provisions unconstitutional; the Ministry of Justice later published a translated version expressly identifying the Law with amendments resulting from that ruling.

Workers' Pension and Social Security Law No. (18) of 2023 also established a health insurance, social services and working women's benefits branch among social security branches, allocated part of employers' contributions to it and required the Workers' Pension and Social Security Department to provide care and treatment for insured workers. The two systems must therefore coordinate purchasing of health benefits rather than impose duplicate financing on workers and employers for the same basic service.

Legislative implication: The problem is no longer absence of health insurance law, but the need to amend an existing law already being implemented, address the constitutional ruling's effects and complete its financing, benefits, purchasing and oversight design for national expansion.

Current position and legislative gap

By February 2026, executive bodies announced approximately 2.4 million covered citizens in Baghdad and a plan to expand to nine additional governorates. During September 2026, distribution of health insurance cards to persons with disabilities began in several governorates while migration to a broader digital system for records, claims and cards continued. The Law has thus moved from theoretical establishment to operations requiring more precise accountability, quality and sustainability rules.

In June 2026, the Health Minister directed a temporary halt to renewing expired contracts and concluding new ones pending revision of contracting rules, showing that purchasing quality and contractual conditions are central to insurance success, not peripheral administrative matters. WHO is also working with Iraq during 2026–2028 to update and cost the essential health services and benefits packages for national health insurance design and align national health policy with primary care and universal coverage.

Financial protection remains central. The latest available international data show household out-of-pocket expenditure at approximately 53.98% of Iraq's current health expenditure in 2023. This indicator alone does not measure insurance success, but shows enrolment expansion is insufficient if a large share of treatment, medicine and test costs is still paid directly when needed.

Gaps addressed by the amendment
Area	Gap	Legislative response
Constitutionality	Provisions ruled unconstitutional or no longer practically applicable.	Replace them with express rules on contributions, appeal, non-retroactivity and equality.
Entitlement	Confusion between registration, waiting and entitlement to services.	Coverage begins for compulsory and subsidized categories without arbitrary waiting periods.
Benefits package	Service scope may change through decisions lacking a clear public process.	A published package, technical assessment, public consultation and periodic review.
Financial protection	High payment shares for some medicines and tests under the existing Law.	A simpler co-payment rule, exemptions for priority services and vulnerable groups, and an annual protection ceiling.
Purchasing and contracting	Need to connect price to contract, quality, outcome and operating capacity.	Strategic purchasing, accreditation, model contracts, blended payments, claims audit and performance indicators.
Beneficiary rights	Weak regulation of complaints, claim denials and additional billing.	Grievance rights, written reasons, prohibition of additional billing and continued judicial appeal.
Sustainability	Financing needs actuarial analysis, reserves and periodic disclosure.	Independent actuarial assessment, a medium-term financial plan and deficit and reserve rules.

Proposed legislative policy

Preserve institutional continuity: no parallel fund or cancellation of valid contracts, cards or records; modernize the existing Authority and Fund.
Unify workers' contribution rate: avoid different percentage rates by employment grade; contribution amounts remain automatically income-proportionate because the same rate applies to different earnings.
Do not delegate imposition of material financial obligations to the Authority: compulsory rates are set by law, or budget law where required; the Authority may reduce co-payments or expand benefits where sustainable.
Make the benefits package an understandable, reviewable entitlement: a published list of covered services, referral or prior-approval requirements and exclusions, with publishable scientific and financial reasons.
Purchase services for value: contracts should not merely purchase invoices; they define quality, accreditation, referral pathways, data, price, performance indicators and sanctions.
Protect citizens at the point of care: no unauthorized extra payment, denial of emergency care or interruption of basic services because of an administrative dispute between the Fund and provider.
Progressive expansion towards universal coverage: national coverage becomes a legal objective with a timetable and funded expansion plan, prioritizing vulnerable groups and underserved areas.
Connect with primary healthcare: primary care, family physicians and referral form part of purchasing design, without obstructing emergency access or services unsuited to prior referral.

Draft First Amendment to Health Insurance Law No. (22) of 2020 and Development of Universal Health Coverage

In the name of the people

Presidency of the Republic

On the basis of the enactment by the Council of Representatives pursuant to Article (61), paragraph (First), and Article (73), paragraph (Third), of the Constitution, the following Law is enacted:

Chapter One — Title, Definitions and Scope

Article (1) — Title

This Law shall be called the ‘First Amendment to Health Insurance Law No. (22) of 2020 and Development of Universal Health Coverage Law’ and shall be read together with the amended Law as a single law.

Article (2) — Replacement of Definitions

The text of Article (1) of the Law shall be replaced by the following definitions:

Authority: the Health Insurance Authority established under the Law.
Fund: the Health Insurance Fund, in which insurance resources are pooled and from which expenditure on purchasing health services is paid.
Insured person: any person whose entitlement to coverage under the Law has been established and who is registered in the system, whether the contribution is borne wholly or partly by that person, their employer or the public budget.
Benefits package: the set of health services and goods that the Fund guarantees to finance or help finance under published access conditions.
Universal health coverage: access by the population to the quality health services they need, from prevention through treatment, rehabilitation and palliative care, without financial hardship.
Co-payment: the portion specified by law or under this Law that an insured person pays when receiving a covered service; it is not an insurance contribution.
Provider: a public, private or charitable health institution or professional meeting licensing and accreditation requirements and contracted with the Authority.
Strategic purchasing: deliberate decisions about the services the Fund purchases, who provides them, how providers are contracted and how they are paid, to achieve quality, efficiency and equity.
Referral: the organised movement of an insured person between levels of care according to medical need, excluding emergencies and cases specified in the benefits package.
Accreditation: institutional verification that a provider meets approved quality, safety and operating-capacity standards.
Claim: a provider’s request for payment for a health service delivered to an insured person under an insurance contract.
Health data: data relating to health status, diagnosis, treatment, service use or an associated financial claim.

Article (3) — Scope of Application

This Law applies to citizens covered by health insurance and to federal bodies and governorates not incorporated into a region, within the limits of constitutional powers.
Regions may join the federal Fund’s arrangements or conclude arrangements for portability of benefits and settlement of costs through legislative and contractual instruments that do not diminish their constitutional powers.
Health insurance for visitors and foreign residents shall be regulated by law and entry and residence instructions, ensuring valid coverage from a licensed entity or an approved financial arrangement before imposing costs on the Fund without corresponding financing.

Chapter Two — Entitlement and Coverage

Article (4) — Right to Registration and Freedom from Arbitrary Waiting Periods

Entitlement for persons under mandatory coverage and categories whose contributions are borne by the budget begins when eligibility is established and registration completed. A six-month or similar waiting period before receiving essential services may not be imposed.
A limited waiting period may be imposed on voluntary members for costly elective services to counter adverse selection, provided it is published and proportionate and excludes emergencies, primary care, existing chronic diseases, maternal and child care and life-saving services.
An insured person’s right to urgent services may not be suspended because an employer delays remitting a contribution already deducted from that person. The debt shall be recovered from the defaulting entity under the law.

Article (5) — Categories Covered

Coverage is mandatory for state and public-sector employees under this Law.
A worker covered by the health insurance, social services and working women’s benefits branch of Workers’ Pension and Social Security Law No. (18) of 2023 shall be covered by the essential health benefits package through the coordination, purchasing and financial settlement arrangements in Article (13) of this Law. This shall not entail duplicate health contributions for the same essential benefit.
Pensioners and family members shall be covered under family entitlement rules issued by the Council of Ministers on the Authority’s proposal, without discrimination on grounds of sex.
The public budget shall wholly or partly bear contributions for categories specified by law or the budget law, including low-income persons, social protection beneficiaries, persons with disabilities, children without care and those whom the state decides to support for social or health reasons.
Membership shall be open to the self-employed, independent professionals and those outside a formal wage system. The government shall establish a timetable for moving from voluntary to universal coverage after preparing a practicable income and insurance contribution collection mechanism and presenting it to the Council of Representatives.

Article (6) — Family Members and Non-discrimination

The Law’s provisions on family members shall be replaced by a gender-neutral rule based on actual dependency, educational status, disability or loss of income. Instructions shall specify ages and required documentation without distinguishing between husband and wife or son and daughter where dependency circumstances are equivalent.

Article (7) — Plan for Achieving Universal Coverage

Within ninety days of this Law’s entry into force, the Authority’s Board shall prepare a financed national expansion plan achieving coverage of the target population in governorates not incorporated into a region within no more than thirty-six months, specifying financial needs and provider capacity in each governorate.
Expansion shall prioritise vulnerable groups and underserved areas. A governorate may not be deferred merely for lack of private providers where services can be purchased from public or charitable institutions or referrals organised between governorates.
A half-yearly report on registrations, beneficiaries, service use, costs and coverage gaps shall be submitted to the Council of Representatives and published for the public.

Chapter Three — Benefits Package and Financial Protection

Article (8) — Essential Benefits Package

The benefits package shall guarantee, at minimum, primary healthcare, emergencies, maternal and child services, prevention and early detection, treatment of priority communicable diseases, protocol-based treatment of chronic diseases, basic mental healthcare, medically necessary diagnostic, therapeutic and surgical services, rehabilitation and palliative care to the extent determined by the package.
A life-saving service may not be excluded merely because its technical code is absent from the list if it substantively falls within a guaranteed benefit. The list shall subsequently be corrected.
Supplementary or low-priority services not covered by the Fund shall be specified in a published, reasoned list.

Article (9) — Mechanism for Determining Benefits

The Authority shall establish a permanent benefits-package and health technology assessment committee with expertise in medicine, public health, health economics, pharmacy, nursing and finance, and beneficiary representatives, under published conflict-of-interest rules.
Decisions on inclusion, exclusion and prioritisation shall be based on disease burden, effectiveness and safety, economic value, protection against financial risk, equity, impact on those most in need and implementation capacity.
A draft substantive amendment to the benefits package and its reasons shall be published before adoption, allowing an appropriate period for public comment, except in urgent health situations where an interim decision subject to subsequent review may be taken.
The package shall be reviewed at least annually. An essential benefit may not be reduced during the financial year except for a substantiated safety reason or serious financial deficit, accompanied by a published impact assessment and remedial plan.

Article (10) — Co-payment

Co-payment exemptions shall apply to emergency services, primary healthcare designated as the system’s gateway, vaccination and prevention, priority maternal and child services, covered services for groups fully subsidised by the budget, and cases that the Board exempts for health or financial reasons.
Co-payment for any other covered service shall not exceed ten per cent of the approved tariff. The Authority may reduce or abolish it, but it may be increased only through a legislative amendment.
Higher rates imposed on medicines, tests, imaging and dental services in earlier provisions shall be repealed insofar as they conflict with this rule. The cost-sharing mechanism shall be unified to make it understandable and predictable.
The Board shall annually set a cumulative household co-payment ceiling based on actuarial assessment and income indicators. Once it is reached, the household shall be exempt from remaining co-payments until the end of the year.

Article (11) — Prohibition of Balance Billing

A contracted provider is prohibited from charging an insured person any amount for a covered service beyond the prescribed co-payment, including physician, facility or supply charges included in the contract price.
If an insured person chooses an uncovered service, accommodation upgrade or additional option, they must receive prior written notice of the price and the covered alternative. Provision of necessary medical care may not be conditional on purchasing the extra.
Unlawful balance billing constitutes a contractual and financial breach requiring reimbursement to the insured person, in addition to the penalties prescribed in this Law and the contract.

Article (12) — Emergencies and Prior Authorisation

Emergency services shall not require prior authorisation or referral. Prior authorisation may be required for certain costly elective procedures if medical criteria are published and decisions issued within a period that causes no harm, with an expedited route for cases that cannot tolerate delay.

Chapter Four — Contributions, Financing and Risk Pooling

Article (13) — Contributions and Coordination with Workers’ Social Security

A state or public-sector employee mandatorily covered by this Law shall contribute one per cent of monthly contributory salary, without varying the rate by employment grade or title.
No additional health contribution under this Law shall be collected from a worker or employer covered by Workers’ Pension and Social Security Law No. (18) of 2023 for the same essential benefits package. Coverage shall be financed from resources legally allocated to that Law’s health insurance, social services and working women’s benefits branch, through purchasing and financial settlement arrangements between the Health Insurance Fund and the Workers’ Pension and Social Security Fund.
Within six months of this Law’s entry into force, the Authority and the Workers’ Pension and Social Security Directorate shall conclude a regulatory and financial agreement specifying the benefits package purchased for workers; calculation, transfer or offsetting of resources allocated to the health branch; claims settlement; data exchange; audit; and continuity of service. The agreement shall neither mix pension reserves with health expenditure nor diminish rights established under either law.
The employer contribution prescribed in the Health Insurance Law shall not be collected for a worker for whom the employer pays a statutory contribution to another mandatory health insurance branch for the same essential benefit. Two mandatory contributions for the same health purpose may not be combined except under an express statutory provision defining the additional purpose.
The government contribution necessary to cover subsidised groups and the state’s obligations as a public funder shall be included in the federal budget law.
Mandatory rates in this Law may not be amended by administrative decision or instructions; their amendment shall be by law.

Article (14) — Persons Outside Payroll Systems

The federal budget law or a special law shall determine the mandatory contribution for groups outside regular payrolls when they move to mandatory coverage, based on a published actuarial study considering ability to pay and benefit costs.
During voluntary membership, the Authority may establish actuarial premiums within limits approved by the Council of Ministers, provided pricing assumptions are disclosed and no discrimination is made on grounds of health status or pre-existing disease.
Registration may not be refused, nor an individual contribution increased, because of pre-existing disease, disability or advanced age where the person belongs to a legally covered category.

Article (15) — Sources of Financing

The Fund’s resources shall consist of statutory contributions, public budget allocations, employer contributions, revenues earmarked for health by budget or tax laws, returns from prudent investment of reserves, gifts and grants accepted under the law, sums recovered for invalid or fraudulent claims, and any other resources established by law.

Article (16) — Pooling Resources and Avoiding Risk Fragmentation

Resources allocated to insurance shall be pooled in a single fund or interconnected subaccounts that do not segregate people with high health risks into less adequately financed pools.
Different essential packages may not be created for groups of citizens according to their employer. Separate supplementary coverage may be offered at the beneficiary’s or employer’s expense, provided it does not affect essential entitlements.
Transfers between accounts and branches shall be used to equalise risks associated with age, illness and geographical distribution under a methodology approved by the Board, whose general components shall be published.

Article (17) — Reserves and Actuarial Sustainability

The Authority shall conduct an independent actuarial assessment at least every two years, covering revenues, liabilities, growth in utilisation, benefit costs, reserves and demographic and epidemiological scenarios.
The Board shall establish a financial reserves policy specifying the target level, low-risk investment instruments and rules governing use.
If the assessment reveals a structural deficit, the government shall submit to the Council of Representatives a financial correction plan setting out alternatives before reducing essential benefits, including improved collection, price control, waste reduction, increased public transfers or a legislative amendment to contributions.
The Authority may not contract an external loan in the state’s name or create a sovereign obligation. Any exceptional domestic borrowing shall be subject to public debt and budget laws and approval by the competent bodies.

Chapter Five — Governance and Oversight

Article (18) — Board of Directors

The Authority’s Board shall be reorganised to ensure representation of the Ministries of Health, Finance, Labour and Planning and the Fund; one representative each of workers, employers, care providers and beneficiaries; and two independent experts in health financing or actuarial science and quality.
A member may not participate in a contracting or pricing decision in which the member or an entity they represent has a direct financial interest. Members shall submit an annual declaration of interests.
The Board’s regulatory decisions, summary minutes and reasons for decisions on benefits, tariffs and contracting criteria shall be published, except for personal information or legally protected trade secrets.

Article (19) — Financial Oversight and Audit

The Authority’s and Fund’s accounts shall be subject to oversight by the Federal Board of Supreme Audit within its remit.
A professional internal audit function shall be established, reporting organisationally to the Board and audit committee, rather than to the executive management whose work it audits.
An independent, licensed Iraqi auditor or consultancy may be engaged for specified purposes, without replacing the remit of constitutional and statutory oversight bodies.
Annual financial statements, the performance report, outstanding liabilities and claims indicators shall be published after approval.

Article (20) — Integrity and Conflicts of Interest

Insurance contracts shall be subject to applicable public procurement, integrity and conflict-of-interest rules, with a central register of providers, contracts, prices and beneficial ownership where required by law.
An Authority employee responsible for contracting, pricing or audit is prohibited from holding an undisclosed financial interest in a contracted provider.
The Authority shall establish a secure channel for reporting fraud, fictitious billing and conflicts of interest, referring facts constituting an offence to the competent bodies.

Chapter Six — Purchasing Services, Contracting and Quality

Article (21) — Contracting Principles

The Authority shall contract with providers on the basis of geographical need, operational capacity, accreditation and quality, fair pricing, data integrity and the absence of a disqualifying conflict of interest.
A contract shall specify, at minimum: service scope; tariff or payment method; quality indicators; target waiting times; referral rules; data submission; audit; complaints; billing; fraud prevention; penalties; and termination and safe patient-transfer procedures.
The lowest price alone shall not determine contract award or contracting. An establishment without actual capacity to provide the service for which it will bill may not be contracted.
The Authority shall publish standard contracts, general criteria, lists of contracted providers and their contracting status.

Article (22) — Accreditation and Quality

Contracting requires a valid licence and compliance with accreditation standards appropriate to the service. A transitional period may be granted to a public institution needing specified improvements if its closure would threaten access to services.
In cooperation with the Ministry of Health, the Authority shall monitor indicators of clinical safety, infection, readmission, avoidable complications, beneficiary satisfaction, compliance with guidelines and accuracy of coding and billing.
Quality indicators shall not be used to penalise providers serving more complex cases without risk adjustment. Comparisons shall be fair and auditable.

Article (23) — Provider Payment Methods

The Authority may use a mix of payment methods according to service type, including risk-adjusted capitation for primary care, diagnosis-related group or bundled payments for inpatient cases, contractual budgets and fee-for-service where needed.
The Authority shall avoid payment systems that create a clear incentive to overprovide or withhold services and shall periodically review the effects of incentives.
A limited portion of remuneration may be linked to measurable quality and outcome indicators, provided this does not lead to rejection of high-risk patients.
Pricing and payment methodologies and their update schedules shall be published, protecting individual commercial data where required by law.

Article (24) — Continuity of Service upon Suspension or Termination of a Contract

If a provider’s contract is suspended or terminated, the Authority shall notify beneficiaries, provide a reasonable alternative and continue ongoing treatment that cannot medically be interrupted until safe transfer.
An insured person shall incur no additional cost because of a financial or contractual dispute between the Authority and the provider.
Immediate action may be taken to suspend new referrals to a provider posing a serious risk to patient safety, while ensuring emergency alternatives and continuity.

Chapter Seven — Rights, Grievances and Accountability

Article (25) — Rights of Insured Persons

An insured person has the right to know their entitlements, benefits package, contracted providers and required payment before non-urgent care; receive written reasons when a benefit or claim is refused; choose a provider within the network under published rules; have their data protected; submit complaints and grievances; and be free from discrimination on grounds of illness, disability, sex, age or social status within their statutory entitlement.

Article (26) — Complaints and Grievances

The Authority shall establish a unified complaints and grievances system accessible electronically, in person and by telephone. Each application shall receive a number, date and tracking route.
Urgent medical grievances shall be determined within a period proportionate to the risk of delay. Other grievances shall be determined within periods specified by instructions, not exceeding thirty days except for a justified reason notified to the applicant.
No decision of a committee within the Authority shall be final or immune from challenge. Administrative decisions remain subject to statutory grievance and judicial appeal procedures.
A grievance shall not suspend emergency services or ongoing treatment where interruption would expose the patient to serious harm.

Article (27) — Breaches and Contractual Penalties

For a non-criminal error or breach, one or more of the following measures may be imposed according to severity and repetition: warning, corrective plan, recovery of unduly paid sums, suspension of new cases, a contractual fine within the limits prescribed by contract and law, or contract termination.
The decision shall state reasons, and the party in breach shall have an opportunity to be heard and seek review, except for an interim measure necessary to protect patients or public funds.
Where conduct involves forgery, fraud, bribery or misappropriation of public funds, the file shall be referred to the competent investigative bodies, without precluding recovery of funds or contractual measures.
No obligations or fines shall be imposed retrospectively for periods preceding the creation of the obligation or the effective date of the rule establishing it.

Chapter Eight — Data and Digitalisation

Article (28) — Digital System and Interoperability

The Authority shall adopt a unified digital system for registration, entitlement, claims, contracting and settlements, interoperable with health, financial and social protection systems under applicable legal frameworks.
A beneficiary may not be denied an essential service because of a technical failure or lost card if identity and entitlement can be verified by an alternative method.
A digital identity, insurance card or approved verification method shall be used. Biometrics must not become an exclusive requirement without an alternative when they cannot be used for health, technical or legal reasons.
Data collection shall be limited to what is necessary for care, payment, oversight and planning. Retention periods, permissions, access logs and incident notification procedures shall be determined under applicable data protection and cybersecurity laws.

Article (29) — Data and Performance Transparency

The Authority shall periodically publish aggregated, non-identifying data on registration, utilisation, waiting times, payments, rejected claims, complaint rates, quality, geographical distribution and expenditure by service type, enabling parliamentary and public oversight and assessment of equity and efficiency.

Chapter Nine — Transitional and Final Provisions

Article (30) — Repeal, Transition and Commencement

Provisions of Health Insurance Law No. (22) of 2020 shall be repealed or replaced insofar as they conflict with this amendment, particularly provisions already ruled unconstitutional or imposing payment rates above the ceiling in Article (10) of this Law.
Articles (37) and (38) of the original Law, as single-purpose structural transitional provisions, shall be deemed to have exhausted their effect and may not be invoked again to create a new institutional change. Relations between the Ministry of Health, local health bodies and regions shall be governed by applicable constitutional and organisational legislation.
Article (43) of the original Law shall be replaced with an institutional review five years after this amendment enters into force, submitted to the Council of Ministers and Council of Representatives. The review shall not detach the Authority from its parent body or change its legal personality except by law.
Valid contracts, cards, records and existing rights and obligations shall continue until aligned with this Law. The amendment shall not interrupt ongoing treatment or extinguish a valid acquired right.
The Council of Ministers, the Authority and the Ministry of Health, each within its remit, shall issue the necessary regulations and instructions within one hundred and eighty days of publication.
This Law enters into force ninety days after publication in the Official Gazette. Provisions concerning the issuance of regulations, preparation for expansion and the non-immunity of decisions from challenge shall apply immediately upon publication.

Statement of Reasons

To implement Articles (30) and (31) of the Constitution on health insurance and the right to healthcare; address the legislative consequences of Federal Supreme Court Decision No. (60/Federal/2022); develop Health Insurance Law No. (22) of 2020 after its actual implementation and expansion to new governorates and groups; move beyond registration alone towards universal health coverage with published benefits, financial protection, strategic purchasing and measurable quality; prevent balance billing; and strengthen grievances, oversight, actuarial sustainability and governance of contracts and data, this Law is enacted.

Explanatory Memorandum

1. Why an amendment rather than a new law?

The Authority, Fund, digital platform, provider network, contracts and cards now exist in practice. Repealing the Law and building a new institution would create transitional risks with no inherent added value. The proposal therefore preserves the institutional structure while changing its core rules where constitutional or operational problems have emerged.

2. Addressing the Federal Supreme Court’s ruling

The proposal directly addresses the main issues raised by the judgment: it does not give the Board open-ended power to impose or alter mandatory contribution rates; vary employee contribution rates by grade; impose a general waiting period for mandatory members; make an internal committee’s decisions final and unchallengeable; or create retrospective fines or obligations. It also limits external audit so that the Federal Board of Supreme Audit’s remit is not diminished and prohibits external borrowing that could create a sovereign obligation outside constitutional frameworks.

3. From a ‘service list’ to a benefits package

Health insurance succeeds when citizens know what the system has actually purchased for them. The package is neither an open-ended promise of every possible treatment nor a fixed, unchanging list. It is a clear prioritisation mechanism based on illness, effectiveness, equity, cost and financial protection. This is consistent with international approaches to benefits-package design and work under way in Iraq during 2026–2028 to update and cost the essential package.

4. Reducing payment at the point of service

The original Law imposes different rates reaching 25% for some employees and 50% for higher grades for medicines, laboratory tests, imaging and dentistry, in addition to surgical rates. This design is complex and may weaken financial protection. The proposal establishes a uniform ceiling of no more than 10% for non-exempt services, exempts primary care, emergencies, prevention and subsidised groups, and introduces an annual household ceiling determined by the Authority through financial assessment. The aim is to shift financing from the moment of illness to prepayment and risk pooling.

5. Unifying the contribution rate for state employees

Instead of 2.5% for certain grades and 1% for other employees, the proposal sets a single rate of 1% of contributory salary for state and public-sector employees. The amount paid thus remains proportional to salary without varying the deduction rate by grade. Any subsequent change to the mandatory rate must pass through legislation, rather than administrative decision.

6. Preventing duplicate health insurance for workers

Workers’ Pension and Social Security Law No. (18) of 2023 contains an existing branch for health insurance, social services and working women’s benefits, funded by specified shares of employer contributions. The proposal therefore does not treat workers covered by that Law as uninsured and impose a second health contribution on them or their employers. Instead, it requires financial and purchasing coordination between the Health Insurance Fund and the Workers’ Pension and Social Security Fund to purchase the essential benefits package and settle costs, while keeping pension reserves separate and protecting rights under both systems.

7. Why does the budget remain a principal funder?

Universal coverage cannot rely exclusively on contributions from formal-sector employees. Children, poor people, persons with disabilities, non-workers and informal groups need solidarity-based financing from the public budget. The proposal therefore distinguishes a ‘contribution’ from the ‘right to coverage’: a person may be insured without paying an individual contribution because the state bears it on their behalf.

8. Strategic purchasing rather than purchasing invoices

The insurance system effectively becomes a major purchaser of services. Paying for every test and procedure without controls may encourage unnecessary service volume; a rigid budget without measurement may encourage underprovision. The proposal therefore permits a mix of capitation for primary care, diagnosis-related groups, bundles, budgets and fee-for-service, and requires review of the incentives created by each method.

9. Contracting and quality

The June 2026 directive suspending renewal and conclusion of certain contracts pending amendment of the contracting system provides practical evidence that contracting is a genuine bottleneck. The proposed law makes contracts instruments of quality assurance: no price without indicators, no contract without licensing and accreditation, no termination leaving patients without alternatives, and no balance billing beyond what the system authorises.

10. Primary care and referral

Health insurance should finance care pathways rather than bypass the health system. Primary care closest to communities should be the gateway for most non-emergency cases, with co-payment exemption and appropriate incentives for family physicians. Referral must not become a barrier, however: emergencies and services unsuited to prior referral remain directly accessible.

11. Digitalisation without technology-based exclusion

Expanding insurance cards, digital records and electronic claims is necessary to control fraud and accelerate service, but system failure or a lost card should not become grounds for refusing treatment. The proposal therefore requires alternative verification and interoperability between systems and limits data collection to legitimate health and financial purposes.

12. Relations with the private sector

The Law neither privatises the health system nor guarantees the private sector a right to contracts. The Fund purchases services from public, private and charitable providers according to need, quality and cost. A public institution may provide services financed under a clear contract, helping measure output and quality, while the private sector complements provision where it adds capacity, specialisation or better access.

13. National expansion and federalism

The proposal provides a coverage plan for governorates not incorporated into a region within federal competence, leaving regions mechanisms for joining or for benefit portability and financial settlement under the Constitution. The aim is to prevent coverage from becoming isolated pools without turning health financing legislation into an instrument for overriding the distribution of powers.

Alignment with Existing Legislation

Legislation and Files Requiring Alignment
Legislation / area	Relationship	Treatment
Iraqi Constitution of 2005	Articles 28, 30, 31 and 100, and rules distributing powers.	Establish financial obligations by law, protect the right to health, prevent immunity of decisions from challenge and respect federalism.
Health Insurance Law No. 22 of 2020	The principal Law.	Remains in force as amended; no replacement institution is created.
Federal Supreme Court Decision 60/Federal/2022	Invalidated provisions of the Law.	Redraft affected articles without reviving provisions held unconstitutional.
Proposed new Public Health Law POL-72	Regulates public health functions, the network, referral and planning.	POL-73 finances and purchases benefits; it does not reorganise all Ministry of Health functions.
Patient Rights and Medical Liability POL-74	Clinical rights, compensation and liability.	This Law guarantees insurance and administrative rights only, leaving the comprehensive patient-rights framework to specialised legislation.
Medicines, Food and Medical Devices POL-75	Pricing, quality, registration and oversight.	The benefits package addresses what is financed; it does not replace the medicines and devices regulator.
Workers’ Pension and Social Security Law No. 18 of 2023	Contains a branch for health insurance, social services and working women’s benefits, with earmarked resources, and requires care for insured workers.	Integrate the benefits package, purchasing and financial settlements between the two funds; transfer or offset legally earmarked health resources; prevent duplicate contributions; and keep pension reserves independent.
Data protection and digital government	Medical records, claims and digital identity.	Apply data minimisation, access-permission and interoperability rules, with precedence for specialised horizontal legislation when it enters into force.

Financial Impact and Sustainability

This document does not give an aggregate cost for universal coverage: such a figure would imply false precision without complete claims data, an updated and costed benefits package, beneficiary numbers by age, illness and governorate, and actual contract prices. The current 2026 effort to update and cost the essential services and benefits packages is the proper starting point for estimating the obligation.

The amendment’s direct financial impact comes through four channels: reducing co-payments for some services; expanding subsidised groups; increasing digital oversight, accreditation and audit costs; and, conversely, reducing expected waste through strategic purchasing, claims audit and prevention of improper billing. The Law therefore requires actuarial assessment and a deficit-correction plan before a political decision to expand the package or increase contributions.

Method for Calculating Financial Impact Before Each Expansion
Component	Data required	Financing decision
Number covered	Age, sex, governorate, employment category and subsidy status.	Estimate contributions and public transfers.
Benefits package	Utilisation rates, unit costs and referral pathways.	Determine the expected annual obligation.
Financial protection	Co-payments, exemptions and household ceiling.	Measure the costs transferred from households’ pockets to the Fund.
Provider contracts	Prices, operational capacity, quality and claims rates.	Choose payment method and purchasing budget.
Reserves	Claims volatility and high-cost events.	Determine the required solvency margin.

Transitional Provisions and Implementation Requirements

Mandatory Regulatory Programme Following Adoption of the Amendment
Period	Output	Purpose
0–90 days	National expansion plan, establishment of benefits-package committee and conflict-of-interest rules.	Link expansion to published financing and governance arrangements.
0–180 days	Standard contract, accreditation criteria, complaints and grievances system, and balance-billing rules.	Correct contracting problems and protect beneficiaries.
Within 12 months	Updated and costed benefits package, payment methodologies, first actuarial report and reserves policy.	Move to measurable strategic purchasing.
Within 24 months	Roll out electronic claims, connect core databases and introduce quality indicators.	Reduce fraud, accelerate settlement and improve decisions.
Within 36 months	Complete targeted expansion in governorates not incorporated into a region according to readiness and financing.	Turn universal coverage into a time-bound obligation rather than an open-ended slogan.

Transition from existing to new contracts must not interrupt cancer treatment, dialysis, scheduled surgery, continuing medication or any service whose interruption could cause serious harm. Any migration of data to a new platform must also permit rollback and recovery and be supported by audit logs.

Relevant International Principles

The World Health Organization defines universal health coverage as all people obtaining the quality health services they need without financial hardship. Its benefits-design guidance emphasises that this cannot mean unlimited financing of every service: prioritisation must be systematic and transparent, balancing effectiveness, equity and financial protection. Strategic purchasing literature also recommends that purchasers clearly determine whom they cover, what they purchase, from which providers and how they pay, and review the incentives of different payment methods rather than relying on one method for every service.

The proposal applies these principles to Iraqi circumstances. It neither copies another country’s model verbatim nor assumes social insurance alone is sufficient. It combines contributions with public funding, gives primary care a central role, preserves a diversity of providers and makes financial protection, equity and quality statutory measures of the Fund’s success.

Sources and References

Iraqi Council of Representatives — Constitution of the Republic of Iraq, 2005Constitutional reference for provisions on health insurance, healthcare, taxation and challenges to administrative decisions.
Ministry of Justice / Iraqi Gazette — Issue 4614, Health Insurance Law No. (22) of 2020Official text of the Law published on 1 February 2021.
Ministry of Justice / Iraqi Gazette — Workers’ Pension and Social Security Law No. (18) of 2023Official reference for the Law establishing the health insurance, social services and working women’s benefits branch within workers’ social security.
International Labour Organization — Implementation of Workers’ Pension and Social Security Law No. (18) of 2023Documents the expansion of social protection and introduction of health insurance entitlements in the new workers’ system.
Federal Supreme Court — Judgment on the Challenge to the Health Insurance Law, Case 60/Federal/2022Official statement on the judgment issued on 14 May 2023 and the provisions held unconstitutional.
Ministry of Justice — Health Insurance Law with Amendments Resulting from the Federal Supreme Court’s DecisionOfficial record of publication of the Law in its form affected by the Court’s decision.
Iraqi News Agency — Coverage of 2.4 Million Citizens in Baghdad and Plan to Expand to 9 Governorates, 2 February 2026Implementation data on registration, expansion and the digital platform.
Iraqi News Agency — Directive Suspending New and Expired Contracts Pending Amendment of the Contracting System, 24 June 2026Reference for the operational need to reform insurance contracting rules and provider quality.
General Secretariat of the Council of Ministers — Government Activities Report, 21 September 2026Documents expanded distribution of insurance cards to persons with disabilities in additional governorates.
General Secretariat of the Council of Ministers — Government Activities Report, 20 September 2026Reference to the operational transition towards biometric cards.
World Health Organization — UHC Partnership, Iraq, 2026–2028Projects to update and cost the essential services and benefits packages and support health financing and universal coverage.
World Health Organization — Universal Health CoverageDefinition and fundamental principles of comprehensive care and protection from financial hardship.
World Health Organization — Benefits Design and Health FinancingPrinciples of prioritisation, equity and financial protection in package design.
World Health Organization — Analytical Guide to Assess a Mixed Provider Payment SystemReference on mixed payment methods, provider incentives and strategic purchasing.
World Bank / WHO Global Health Expenditure Database — Out-of-Pocket Expenditure in IraqLatest displayed value for 2023: 53.98% of current health expenditure.
Iraq National Development Plan 2024–2028Includes facilitating implementation of the Health Insurance Law, developing the electronic system, issuing electronic cards and contracting with health bodies.