Parliament’s portfolio committee on health has adopted its amendments to the National Health Insurance Bill, marking a milestone in the ANC-led government’s plans for achieving universal health coverage.
The committee has made only minor changes to the bill, prompting a warning from SA’s biggest medical scheme administrator, Discovery Health, that the legislation will be open to constitutional challenge, and eliciting an immediate threat of legal action from trade union Solidarity.
The ANC-dominated committee has been considering the bill for the past four years, and has made no substantive amendments to it despite concerns raised by parliament’s legal advisers, issues raised by opposition parties and input received from stakeholders from private healthcare providers to patient advocacy groups.
The B version of the bill was adopted by the committee on Wednesday, with six ANC MPs and the chair voting in favour versus two DA MPs and one MP each from the Freedom Front Plus (FF+) and EFF voting against it. The bill will now go to the National Assembly where it is expected to be passed. It will then be sent to the National Council of Provinces for concurrence, a process that is likely to take at least a year.
The bill is the first piece of enabling legislation for National Health Insurance (NHI) and proposes establishing a central NHI fund that will purchase services from accredited public and private sector providers. These services will be free at the point of delivery for SA citizens, regardless of their income.
While the government has said it intends the fund to be based on social solidarity principles, with the rich and healthy subsidising the poor and the sick, it has yet to indicate how it will be financed.
Discovery Health CEO Ryan Noach said he was disappointed that the amended version of the bill varied little from the original.
Discovery Health does not support the single funder model proposed by the bill, nor its restriction on medical schemes to only offer cover for services not included under NHI.
“The portfolio committee elected not to take the opportunity to make amendments to the bill that would enhance both the feasibility and effectiveness of the NHI Fund, despite detailed and constructive inputs from multiple stakeholders.
“As a result, it is highly likely that this bill will be challenged through various legal avenues, including probably being contested on constitutional grounds,” Noach said.
The financing of NHI remained unclear as there had been no input from the National Treasury, he said.
‘Affordability’
“It is absolutely critical to understand the affordability and economic strategy for supporting the bill’s proposals, as well as the financial systems and controls required to ensure effective oversight of the monies in the fund. [Without] substantial financial support, the necessary health system improvements and the sustainability of this approach will be impossible,” Noach said.
Trade union Solidarity said it would take the government to court if the bill were accepted. “In the run-up to next year’s election, and in order to canvass cheap votes, the ANC government insists on pushing through this law while they are fully aware that their own system cannot support it,” Solidarity’s medical network co-ordinator Peirru Marx said.
The department of health’s deputy director-general for NHI, Nicholas Crisp, said the government was ready to defend the legislation. “Plenty of people say they will challenge some or all of the bill. Millions of people say they will fight to ensure it happens. We’ll allow our court and constitutional processes to unfold,” he said.
FF+ MP Philip van Staden said the health committee’s approval of the bill marked a “very a dark day for healthcare in SA”, and also sounded a warning about prospective legal challenges to the legislation.
Hospital Association of SA spokesperson Mark Peach urged legislators to engage with the matters raised in various forums, including parliamentary hearings. “What we do now will remain with us for generations,” he said.
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