Flat tax for nurses in accredited centres: why the budget law is confusing and 'without a parachute'

The Budget Bill 2026 contains, among many others, a provision that prompts some reflection, both in terms of its content and, even more so, its formal aspect. It is necessary to recall that the budget bill submitted by the government to the Senate on 22 October 2025 originally consisted of 154 articles. Following the Senate's approval of the Government's maxi amendment, the provisions contained in the Bill were replaced by a single article divided into 973 paragraphs.

The paragraph referred to is paragraph 944, which, in truth, is very poorly written. However, it should be assumed that the provision was intended to establish a flat tax on overtime remuneration for nurses employed by accredited private healthcare and social healthcare facilities. Therefore, with reference to the remuneration paid from the year 2026, the 5% substitute tax regime of Irpef and the related regional and municipal surtaxes, already provided for by paragraph 354 of the Budget Law 2025 for overtime remuneration paid to nurses employed by companies and entities of the National Health Service, is extended to nurses of such facilities. Despite the convoluted drafting, this should be the official reading, as can also be seen from Volume IV of the Dossier prepared by the Study Service of the Parliament, where it is briefly stated that "Paragraphs 944 and 945 - inserted by the Senate - extend to nurses employed by accredited private healthcare and social-health facilities the Irpef substitute tax regime already provided for remuneration for overtime work paid to nurses employed by companies and entities of the National Health Service. This regime contemplates - as a substitute tax for Irpef and the relative regional and municipal surcharges - a rate equal to 5 per cent'.

In terms of political choices, we are in the presence of yet another tribute to private, albeit accredited, healthcare. But political choices are unquestionable and everyone is free to comment on the merits of them. The efforts - alleged or real - that have been made over the past few years to increase the attractiveness of the nursing profession should always and in any case privilege public healthcare; but the verb in the conditional tense is a must, and this sort of indiscriminate wage dumping certainly does not benefit the ability of healthcare companies to recruit or retain nurses. For private healthcare, the benefits introduced by paragraphs 7 and 10, from which public employees are excluded, could perhaps suffice: in essence, a nurse from a private facility is given more tax advantages than a colleague from a public healthcare company.

In terms of form and legislative technique, on the other hand, some perplexity arises because the entire second period is vague and misleading, so much so that it would seem, at first reading, that the flat tax is extended to all personnel, also because of the incongruity of that 'as well as ' after which private accredited healthcare and social-health facilities are mentioned for the first time. Paragraph 944 was not present in the October text and was inserted with the maxi amendment at the last moment, as evidenced by the numbering acquired. Naturally, there is nothing in the technical-illustrative note prepared by the MEF because the provision was not present in the original text. But the most puzzling thing is that no financial coverage is provided for the provision in Law 199/2025. In the twin provision of 2024, paragraph 355 correctly identified the burden as EUR 53 million for the year 2025. At this point the cases are two: either it is an oversight due to the haste to vote on the maxi-amendment - in any case inexcusable - or it was not possible to quantify the burden because it seems very difficult, if not impossible, to estimate the loss of tax revenue for workers who are not included in the annual account. In both hypotheses, it is legitimate to raise some doubts on the constitutionality of paragraph 944, and the fact remains that the two mirror paragraphs have the same purpose but substantially divergent wordings.