Parliament’s health committee has run out of time to process the controversial National Health Insurance Bill in the National Assembly before the ANC’s elective conference after a key meeting with the health department was delayed.
The NHI Bill is the government’s first piece of legislation in realising its plan for universal health coverage, which promises to provide citizens with healthcare services that are free at the point of delivery.
Two weeks ago, the committee’s chair, Kenneth Jacobs, said MPs aimed to have the bill adopted by the National Assembly before parliament rises on December 6, a little over a week before the ANC conference begins on December 16.
At that stage, a meeting had been scheduled for input from the health department on the issues raised during public submissions and MPs’ detailed deliberations on the bill. That was to have been followed two days later by a meeting with the state law adviser and parliament’s legal team.
However, the meeting with the health department was postponed for a week, leaving the committee without enough time to complete its work on the bill. Its last meeting for the year is on Friday, when it plans to adopt a report on its oversight visit to the Eastern Cape.
Only after the committee has considered the health department’s suggested changes to the bill, along with legal input, can it compile its “A-list” of proposed changes. Parliament will then draft a revised version of the NHI Bill, known as the “B version”, incorporating the amendments approved by the committee. It will then be submitted to the National Assembly for a second reading debate and a vote.
“There is still a lot of work to do,” said Jacobs. “We have to follow due process — my job is to ensure we are not found to be procedurally incorrect.”
Parliament will reconvene after the State of the Nation address in February, the committee should complete its work on the bill in “a month or less”, he said.
After the bill is approved by the National Assembly it will be sent to the National Council of Provinces for concurrence.
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Nicholas Crisp, the health department’s deputy director-general for NHI, said last week’s meeting with the committee had to be postponed because both he and health minister Joe Phaahla had been among the delegation accompanying President Cyril Ramaphosa on a state visit to the UK.
Crisp presented MPs with a series of changes proposed by the department, which largely sought to clarify definitions, remove inconsistencies and close loopholes that were at odds with the government’s intent.
For example, the department has suggested clause 5c — which states that the Competition Act is not applicable to any transactions included in terms of the NHI Act — be changed so that only the NHI Fund is exempted.
The department has maintained its stance on the role of medical schemes, saying they should be limited to providing cover for “complementary” services not provided by NHI.
It has conceded, however, that the governance structure for the NHI Fund, which will purchase services on behalf of the population, vests too much power in the health minister.
It has suggested that instead of the minister having sole authority to appoint the NHI Fund board, the full procedure of selecting and appointing board members be approved by the cabinet. The minister would be able to dissolve the board only after an inquiry and approval by the cabinet.
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