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TAIPEI, Taiwan — Retirees have taken to the streets in two cities in China in recent days in rare protests against the most significant health care reforms in over two decades.

Largely older Chinese retirees turned out at least in the hundreds in the cities of Wuhan and Dalian, singing socialist anthems and even some shoving up against police, according to social media footage from the protests.

They were demonstrating against changes to medical insurance, ushered in as local governments struggle to repay mounting debts in the fallout from the coronavirus pandemic.

Most Chinese citizens draw medical insurance coverage from two sources: a public insurance fund and a mandatory, employer-sponsored personal health savings plan that employees and employers contribute to each month.

The reforms are intended to cover public health shortfalls. They could also free up subsidies for doctor's visits for people with less money in their health savings accounts. But reimbursement will go down for some outpatient costs, like certain medicines.

The changes are being rolled out nationwide as China tries to recover from three years of COVID-19 controls, mass testing and other measures that strained and indebted local governments. Chinese leader Xi Jinping only recently lifted the stringent "zero COVID" policies in December.

In the last year alone, Chinese provinces were reported to have spent at least $50 billion on COVID-19 containment, like testing and quarantine facilities. Many local hospitals are warning their staff of tight budgets.

To retirees, it looks like local governments are dipping into citizens' personal health savings accounts to cover budget shortfalls.

Longer term, these peaceful demonstrations hint at a fundamental issue: China's society is aging faster than expected. That has strained social programs like public health insurance, yet local governments have other debts to pay — and they're turning to their citizens to help.

The medical insurance changes affect retired citizens the hardest, as they tend to rely on the personal health savings account to cover outpatient fees.

At large demonstrations this week, protesters argued that transferring funds from their accounts would be tantamount to theft of private property.

"This is our money, earned through blood and sweat," one retiree from the central city of Wuhan said in a recorded phone call with the provincial medical insurance authorities, that has been widely shared online. "I complain because I believe in our government and our Communist Party to find a path forward to solve this."

On Wednesday, at least hundreds of protesters marched in the port city of Dalian, in northeastern China, against the health policy changes.

"Return us our money," they shouted while standing in front of the city government office, demanding the mayor come out, according to videos posted to Chinese social media and Twitter.

In Wuhan, retirees stood in Zhongshan Park, on the west bank of the Yangtze River, and, per social media videos, they sang TheInternationale, a French revolutionary anthem taught and sung in Chinese since the Communist Party took power in 1949.

It was the second time in a weekthat retirees demonstrated in Wuhan, where the novel coronavirus was first detected in humans in late 2019. On Feb. 8, hundreds of people protested against the new policy in the city.

The Wuhan provincial government said in a statement last Saturday that while it was true that the reforms would result in lower payments to everyone's personal insurance accounts, the goal was to ultimately allocate health care resources more fluidly for all.

"Prior to this," the statement said, "the overall public planning fund covered hospitalization and outpatient serious illnesses, while personal accounts covered outpatient minor illnesses, giving rise to situations where the insured did not have enough to spend when they did get sick, but did not have enough to spend if they weren't seriously ill."

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