As the new cabinet gets to work, the ANC is likely to push for the implementation of the National Health Insurance (NHI) Act in its present form, a political lobbying company representing Momentum said at a thought leadership seminar this week.
Momentum, one of the country's largest insurance and medical scheme providers, held the annual seminar in Cape Town, with a virtual link to participants in Johannesburg, where Ethicore — which represents Momentum in engagements on the contentious act — outlined its expectations for the NHI under the government of national unity (GNU).
Ethicore's MD, Wisahl Jappie, said while the new cabinet is made up of a variety of political parties, the ANC holds key positions that make it possible to continue with the implementation of the NHI. She said finance minister Enoch Godongwana could allocate the required budget to start the process.
“The ANC will default to its policy resolution. We can assume that the ANC and political heads at the helm of the health ministry will continue to push for the implementation of the NHI,” she said.
When President Cyril Ramaphosa signed the NHI Bill into law at a highly publicised event at the Union Buildings shortly before the elections, some political parties — notably the DA, which is now part of the GNU — slammed the move as an election ploy, and threatened to challenge the legislation in its current format in court.
Political parties have not abandoned the manifestos that got them here, so they will continue to challenge some policies. Even if the ANC continues with the GNU, it will be faced with challenges from cabinet.
Representatives of medical schemes, doctors and other affected organisations also vowed to institute legal challenges. These include trade union Solidarity, the Health Funders Association, the South African Medical Association, the Board of Healthcare Funders and the South African Health Professionals Collaboration.
Ramaphosa has now returned Aaron Motsoaledi to the health portfolio, which he held for a decade between 2009 and 2019, while Joe Phaahla was demoted to deputy minister.
In a statement welcoming the new appointments, the national department of health said it “believes the return of both political principals will ensure continuity and stability in the implementation of key health priorities which include the National Health Insurance to enable the country to attain universal health coverage”.
Jappie said this statement started a narrative showing that, from the ANC's perspective, the NHI will be implemented. However, despite an agreement by the parties in the GNU to work together in governing South Africa, she expected pushback from those parties in the government that oppose the act, as they still maintain their political autonomy.
Apart from the DA, the IFP, Patriotic Alliance, Freedom Font Plus, UDM and Rise Mzansi have also expressed opposition to the NHI Act.
“Political parties have not abandoned the manifestos that got them here, so they will continue to challenge some policies. Even if the ANC continues with the GNU, it will be faced with challenges from cabinet,” Jappie said.
She said political parties in the GNU will continue to challenge some policies to show the public that they have not lost their identities.
Business Times previously reported that the Health Funders Association believes the new arrangement in government could lead to a negotiated settlement on the NHI.
Ethicore said the ANC has determined health policy for 30 years and is likely to try to continue this, but many parties will not allow it. The company said that while the bill has been signed into law, policy implementation will be influenced by multiple voices in the government, which will inevitably lead to debates and discussions about the act.
Jappie said uncertainty about what will happen to the NHI had medical schemes wondering whether a multiparty government can deliver on the promise of universal health care.
“The question is whether the NHI will be able to withstand the inability of a single party to win; if modalities limit vetoes and if the consensus is not reached, can they speak as one voice when it comes to policy implementation?”
The law is likely to be implemented in a phased approach, with the president and health minister promulgating sections of the act, and not in its entirety, Jappie said. Some contributing factors to this are expectations that parts of the act will be challenged in court, she added.
Some medical schemes have set their sights on section 33 of the NHI Act. It states that once the act is fully integrated, medical schemes can only provide services not covered by the NHI fund.
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