ActionSA MP Kgosi Letlape wants “public representatives to experience the same realities as the people they serve” when it comes to healthcare.
He’s argued compulsory membership entrenches “a double standard” by insulating MPs and other office bearers from the conditions faced by millions of South Africans reliant on the public health system.
As a result he has formally given notice of its intention to introduce the Parliamentary and Provincial Medical Aid Scheme Amendment Bill, which would end compulsory membership of the Parliamentary Medical Aid Scheme (Parmed) for MPs, Members of Provincial Legislatures and certain constitutional office bearers.
Announcing the proposal this week, Letlape said the bill would make Parmed membership voluntary, allowing qualifying office bearers to remain on the scheme, join another registered medical scheme or use public healthcare facilities.
“This intervention represents the first step in ActionSA’s broader mission to ensure that public representatives experience the same realities as the people they serve — starting with public healthcare,” Dr Letlape said in a statement.
If enacted, the amendment would align Parmed with the voluntary membership principle in the Medical Schemes Act, 1998. However, fiscal and governance implications remain. The Treasury has previously cautioned that voluntary membership could expose Parmed to adverse selection, with younger and healthier members opting out, potentially increasing premiums for those remaining.
If the state continues to subsidise a fixed percentage of contributions, per‑member costs to the fiscus could rise even as overall membership falls.
The Council for Medical Schemes has noted that while all registered schemes are regulated, employer‑specific oversight mechanisms would need to be strengthened to ensure accountability for public funds in a multi‑scheme environment.
Constitutional provisions on protected remuneration, particularly section 219, would also need to be observed to avoid reducing benefits for certain office bearers, such as judges, during their term of office.
The bill’s progress will depend on the outcome of the initial procedural stages and whether it secures sufficient support to be placed on the Assembly’s order paper. Its long‑term significance will rest on the design of the subsidy model, the management of the transition to voluntary membership, and Parliament’s capacity to oversee a more fragmented benefits environment without eroding fiscal discipline or accountability.
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