The government is determined to press ahead with implementing National Health Insurance (NHI) despite the fiscal constraints facing SA, health minister Joe Phaahla told parliament on Wednesday evening.
MPs are now considering the NHI Bill, the government’s first piece of enabling legislation for its plans for universal health coverage, which seeks to provide services that are free at the point of delivery for all citizens.
The bill proposes a central NHI Fund that will purchase services on behalf of patients, financed by reallocating medical scheme tax credits, general tax revenue and a new payroll tax and surcharge on personal income tax.
It was tabled in parliament in 2019 and is being considered by the National Assembly’s portfolio committee on health. It conducted public hearings on the bill in each of SA’s nine provinces, received more than 33,000 inputs in response to its call for written submissions, and heard 107 presentations, before deliberating on the bill clause by clause.
Some stakeholders said the economy is too weak to support NHI, but the UK had built its National Health Service after World War 2 when buildings were in ruins and its economy was in a dire state, Phaahla said.
He offered no concession on the long-term future of medical schemes, saying there will ultimately be no need for them as the NHI Fund will provide comprehensive benefits.
The department of health has noted stakeholder inputs on the bill and believes most of its provisions should remain unchanged, he said.
“Some stakeholders were concerned about too much power being vested in the minister, and called for parliament to have direct oversight. I don’t believe the worry about accountability is warranted,” he said. It will be possible to amend some clauses to reduce direct involvement of the health minister in operational matters, he said.
MPs on the portfolio committee have taken a consistently party-political line on the bill, with ANC MPs expressing largely unreserved support for the bill’s provisions, and opposition MPs criticising it at every step of the way.
Opposition
Earlier in the evening, the department’s director-general for NHI, Nicholas Crisp, finalised his two-day briefing on the bills’ proposed amendments or repeals of other laws.
The ACDP, DA, FF+ and EFF reiterated their objection to the bill, and opposed the proposed changes outlined by Crisp.
DA MP Lindy Wilson called for other portfolio committees to be consulted on proposed amendments or repeals of legislation they oversee, such as the Road Accident Fund Act, which falls under transport.
DA MP Michele Clarke said the Treasury should be called to brief the health committee on the financing of NHI. “My colleagues on finance say the bill’s costing has not been discussed at the finance or appropriations committee. I believe the Treasury needs to come and address us [on the] finance model so we can understand what it is going to cost and it’s affordability,” she said.
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