Approval by the National Council of Provinces (NCOP) of the controversial National Health Insurance (NHI) Bill continued to draw fire on Thursday with a growing number of organisations saying they would petition the president to send the legislation back to parliament.
The bill creates the legislative framework for the ANC government’s policy of universal health coverage, which aims to scrap SA’s two-tier health system and ensure all eligible patients are provided with free services at the point of delivery. If enacted, it will pave the way for the establishment of an NHI Fund that will be the sole purchaser of healthcare services, with medical schemes restricted to covering only services that are not provided by the NHI.
The National Assembly spent three-and-a-half years considering the bill, but the NCOP dedicated only six months to it and made no amendments to the draft legislation. The bill was approved by eight of the nine provinces on Wednesday evening, with only the Western Cape voting against it.
Parliament is now expected to send the bill to President Cyril Ramaphosa, who can either sign it into law, refer it back to parliament on legal or technical grounds, or refer it to the Constitutional Court to gauge its constitutionality.
News of the bill’s passage through parliament has drawn fire from organised business, healthcare professionals and medical schemes, with Business Unity SA (Busa), Business for SA (B4SA), the newly formed SA Health Professionals Collaboration (SAHPC) and the Health Funders Association (HFA) saying they will petition Ramaphosa to send the bill back to parliament for further consideration.
Busa and B4SA said they would petition the president on constitutional grounds because the bill limits citizens’ freedom of choice and ability to access healthcare. Section 33 of the bill, which says medical schemes will be limited to provide cover for benefits not covered under NHI, is at odds with the constitution’s provisions for the progressive realisation of the right to healthcare. In addition, the NCOP’s public consultation on the bill was rushed and inadequate.
“Busa and B4SA have, throughout the entire NHI Bill legislative process, highlighted the deficiencies in the bill, including those unconstitutional provisions that required clarification and amendment. Our concerns, recommendations, research, data and inputs, as well as those made by a wide range of experts and affected stakeholders, have been summarily ignored by the parliamentary portfolio committee on health and the NCOP,” said B4SA steering committee chair Martin Kingston.
“No amendments were made at all, including those suggested by the department of health itself, which is deeply concerning for our country and democracy,” he said.
Should it be brought into law, the bill would delay access to universal health coverage, lead to disinvestment in the health sector and damage the economy, he said.
The SAHPC, representing nine associations for healthcare professionals, said the bill is unconstitutional and unworkable and could lead to a deterioration in standards. The bill does not adequately address the threat of corruption, and places the training and retention of health professionals at risk, it said.
“The president has both an opportunity and obligation to ensure that the NHI improves, rather than limits overall healthcare for everyone,” said SAHPC spokesperson KC Makhubele.
The HFA, an association for medical schemes and administrators, said parliament failed to take proper cognisance of the bill’s implications for citizens’ constitutional rights, healthcare as a whole and the economy.
“This is too important to let pass without every effort being made to ensure the president, as guardian of the constitution, is fully aware of the unintended, yet completely foreseeable, consequences signing the NHI Bill into law in its current form would have for SA,” said HFA chair Craig Comrie.
The Hospital Association of SA, representing private hospitals, and the Board of Healthcare Funders (BHF), which represents medical schemes, also expressed disappointment at the NCOP’s approval of the bill. The BHF said the bill’s restrictions on medical schemes would render them unsustainable and this section should be removed entirely.
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