South Africa

National Health Insurance Bill slated 

The Portfolio Committee on Health in South Africa has considered and adopted its 75-page report on the National Health Insurance (NHI) Bill, despite strong opposition from various stakeholders, who have vowed to take their grievances with the Bill to court.

The Bill was introduced in Parliament in August 2019 and was subsequently referred to the Portfolio Committee for consideration. 

The NHI Bill aims to ensure universal access to healthcare by creating a single public health fund funded through general taxes and contributions from higher-income individuals.

According to Parliament, “This means that every South African will have a right to access comprehensive healthcare services free of charge at the point of care at accredited health facilities, such as clinics, hospitals and private health practitioners.” 

Health Minister Joe Phaahla predicted that the Bill would be controversial and even give rise to legal action.

“There are already challenges, just in terms of the implementation of our structure of preparing for the NHI in the department. We are already in court with some of the right-wing organisations,” he said in December 2022.

“Once the Bill is passed in Parliament, there will be a slew of litigations.”

President Cyril Ramaphosa has voiced his support for the NHI Bill and emphasised the need for universal healthcare to address disparities in quality healthcare based on location. 

Ramphosa said the Bill is expected to be debated and passed into consideration in the National Council of Provinces after June.

Parliament reported that the Portfolio Committee’s report on the Bill will be debated in the National Assembly.

However, the approval of the Bill has sparked threats of legal action from various stakeholders, including trade union Solidarity and private insurer Discovery Health. 

Solidarity

Solidarity has vowed to continue to take the government and the Department of Health to court if the NHI Bill is accepted as final. 

The trade union has been staunchly opposed to the Bill since its inception.

Solidarity approached the court in June 2022 over the Bill, which resulted in sections 36 to 40 of the legislation being declared unconstitutional. 

The Bill also underwent a public participation process before the court action, wherein Solidarity “actively participated” by submitting comments and making presentations in parliament.

Network Coordinator of the medical industry at Solidarity, Peirru Marx, said Solidarity “strongly condemns” the Portfolio Committee’s acceptance of the Bill.

Marx said the Bill is a ploy by the ANC to “canvass cheap votes” while the party is “fully aware that their own system cannot support it”.

“They [The ANC] are misleading South Africans by saying that the NHI will promote healthcare in South Africa while concealing the fact that healthcare is readily available, but that the officials managing these essential services do not have the political will to do what is necessary to improve the quality of health services that must be delivered.”

Solidarity claims the Bill would “result in a disaster in the medical industry”, and the ANC should focus on repairing the current system rather than attempting to build a new one.

Private insurance

Ryan Noach, CEO of Discovery Health

Private healthcare providers and medical aid schemes are concerned about their viability under the proposed legislation. 

Once implemented, the Bill will only allow private insurance and medical aids to offer complementary coverage for services not covered by the fund. 

Discovery Health, one of the country’s largest medical scheme providers, has stated the Bill is open to constitutional challenge. 

Chief executive at Discovery Health Dr Ryan Noach told 702’s The Money Show that the key issue with the Bill lies in its funding – or, rather, the lack thereof.

Industry stakeholders estimated in 2016 that the NHI would cost the country R350 billion, he said.

However, there has been no clarity around the financing of the NHI, said Noach.

According to the Bill, “the Fund is entitled to money appropriated annually by Parliament to achieve the purpose of the Act.” 

This money will come from various sources, including general tax revenue, funds shifted from government departments and agencies, and payroll taxes. It may also involve reallocating funds from medical scheme tax credits. 

The Minister of Finance will introduce a money Bill to authorize these funds, which will be earmarked specifically for the Fund’s use. 

However, Noach said there had been no money Bill and that the National Treasury has barely started to work on it.

He said the Portfolio Committee has also ignored comments from Parliament’s own legal advisor, who raised constitutional concerns with the Bill in its current form.

“So we think there is a very high likelihood that this faces constitutional challenge and probably other legal challenges from a broad range of stakeholders,” he said.

“The Parliamentary Portfolio Committee did hold a series of hearings, which were well attended by a range of people across the healthcare system and many legal concerns were raised.”

However, “none of those have been answered yet”.

*Headline image: Health Minister Joe Phaahla. Source: GCIS

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