NHI Bill now in hands of president
• It is a perilous gamble, says DA
The National Council of Provinces (NCOP) has passed the National Health Insurance (NHI) Bill, setting the scene for an intensified pushback from business, healthcare professionals and opposition parties.
“It is a historic day and a historic achievement. We are putting in place a framework ... to transform health services, create equity and make sure the perpetual division of South Africans — at least in health — can come to an end,” health minister Joe Phaahla said during the debate on the bill on Wednesday afternoon, which saw ANC MPs emphasise the party’s 1955 Freedom Charter promise to provide free medical care and its ambitions to eliminate SA’s twotier health system.
Only 14.9% of the population can afford medical scheme membership, which provides cover for generally high-quality private healthcare services, while the rest of the population depends on overburdened public facilities, which vary widely in their capacity to provide care.
The bill lays the groundwork for sweeping reforms that are intended to realise the ANC government’s ambitions for universal health coverage.
It creates a single NHI Fund, which will purchase services from public and private providers that will be free at the point of delivery, and prohibits medical schemes from covering services provided by the NHI.
Details of how it will be financed have yet to be spelt out, but the ANC has consistently indicated it intends to redirect the money employers and individuals pay to medical schemes into the NHI Fund by taxation, a proposition critics say is unviable.
The NCOP was due to debate the NHI bill last week, but the item was pulled from the agenda at the last minute after Business Unity SA (Busa) and Business for SA (B4SA) wrote to its presiding officers and deputy president Paul Mashatile in his capacity as leader of government business in parliament, appealing for it to be sent back to MPs.
The bill was, however, back on the order paper on Wednesday unchanged, and passed by eight of the nine provinces, with only the DA-led Western Cape opposing it.
The DA said the NHI Bill is unaffordable and the ANC has misled the public about what it would achieve.
“As South Africans battle to put food on the table, how can we possibly think of raising taxes to fund NHI? This ANC vanity project is a last-ditch effort for votes that will affect our pockets deeply,” the DA’s Dennis Ryder said.
“It is a perilous gamble, a reckless leap into the unknown that threatens to intensify the very issues it purports to solve,” his colleague Delmaine Christians said.
The EFF’s Mmabatho
Mokause said the NHI Bill would not close the gap between the services available to rich and poor, but would simply enrich the private sector at the expense of SA.
The IFP’s Nhlanhla Hadebe said it jeopardises South Africans’ current access to health services.
The bill will now be sent to President Cyril Ramaphosa for assent. He has several options: he can send the bill back to parliament on technical or legal grounds, refer it to the Constitutional Court to determine whether it is in line with SA’s constitution, or sign it into law.
Busa and B4SA said they are preparing to submit a formal petition to the president not to sign the bill into law, while lobby group Solidarity said it is preparing to litigate if Ramaphosa assents to it.
The DA said it will petition the president to refer the bill to the Constitutional Court to test its constitutionality, failing which it would seek to rally support from enough MPs in the National Assembly to ask the Constitutional Court to make that assessment on behalf of parliament. It has also briefed its lawyers for potential legal action.
Critics of the bill, including organised business, the newly formed SA Health Professionals Collaboration and the DA, argue that section 33, which phases out medical schemes, is unconstitutional because it would erode existing healthcare rights.
Section 27 of the constitution places an obligation on the state to progressively expand access to healthcare. The health department has defended section 33, saying it meets constitutional muster because it is part of a broad thrust to ensure equitable healthcare for all South Africans.
Critics have flagged potential flaws in the public consultation process run by the NCOP’s select committee on health & social services because it made no changes to the version of the bill referred to it by the National Assembly in June.
Trade union federation Cosatu welcomed the NCOP’s approval of the bill, saying it is relieved parliament did not bow to lobbying from the business sector. “Pandering to the vested interests of private industry’s lust for profits at the expense of the health of millions of ordinary South Africans would mark a dark day in our democracy,” it said in a statement.
CRITICS OF THE BILL ARGUE THAT SECTION 33, WHICH PHASES OUT MEDICAL SCHEMES, IS UNCONSTITUTIONAL