After more than 10 years in the making, this week eight provinces voted in favour of the National Health Insurance (NHI) Bill at the National Council of Provinces (NCOP). The Western Cape was the only province to vote against the bill.
The ANC, as the majority in Parliament, has been accused of strong-arming Parliament into going ahead with the bill, which has been envisaged as the only way to ensure universal health access to quality health care for everyone, regardless of income as prescribed by the country’s constitution.
The party said the NHI fund would cover “South Africans of all races, rich or poor and legal long-term residents,” with one pool of health-care funding for private and public health-care providers.
That would be done through general taxes, contributions from the mega rich as well as monthly contributions made by the employees to the fund collected and submitted, in a similar manner to UIF contributions.
Over the years, there has been widespread criticism of the bill, with debates on the proposed legislation being largely divisive. Some of the bill’s fiercest critics include the the DA, medical aids schemes and other interest groups. They say it would result in the exclusion of many South Africans as well as asylum seekers who are not protected under the provisions of the NHI Bill.
On Wednesday, after the NCOP adopted the bill, DA health spokesperson Michele Clarke said the ANC government had sacrificed the country’s health care to secure cheap votes in next year’s general elections.
“None of the many submissions raising concerns and questions about the NHI Bill was ever taken into consideration, despite the fact that the Constitutional Court judgment on the Traditional and Khoi-San Leadership Act has it very clear that ‘a reasonable opportunity to participate in legislative affairs must be an opportunity capable of influencing the decision to be taken’.
“The exclusion of asylum seekers from enjoying the right to universal access to quality health-care services, as purported to achieve by this bill, undermines Section 27 of the Constitution which states that everyone has the right to access health care,“ the party said.
Clarke said the documents required to register for the fund would bar many South Africans from accessing it, essentially excluding them from health care.
The EFF, IFP, and Freedom Front Plus (FF Plus) also rejected the bill.
EFF MP Mmabatho Mokause highlighted some of the reservations that had been put forward by the red berets.
“The country is being misled by the ANC government that this bill is an attempt in dealing with the collapse in the health-care system in the country.
“We know very well that this bill will not solve the crisis of infrastructure in public facilities in townships and rural communities,” Mokause said.
Business Unity SA (Busa) and Business4SA (B4SA) have said the country would need in excess of an additional R200 billion in taxes to fund the NHI, which could be problematic for a country struggling economically.
The medical sector, through the medical aids schemes, have said the bill would hinder the work and services provided by the sector once it was implemented as medical schemes would not be able to provide cover for services that were included in the NHI.
“Our strong view is that limiting the role of medical schemes would be counter-productive to the NHI because there are simply insufficient resources to meet the needs of all South Africans,” Discovery Group recently said.
On Wednesday, Independent Media reported that Health Minister Dr Joe Phaahla described the NCOP’s adoption of the NHI Bill as a “historical win” for the transformation of the ailing health-care system.
Phaahla said the bill enjoyed the support of UN Secretary-General Antonio Guterres who had met President Cyril Ramaphosa and other heads of state in the UN General Assembly in September. Guterres had encouraged countries to adopt universal health coverage.
“I am not saying debating other policies is not important but, really, in terms of intervention of transforming the health system, where we come from, this is indeed a very historic day and a very historic achievement because here today we are putting into place, into the statute, a framework to create an opportunity where we can be able to transform the health services, create equity and make sure that the perpetual divisions of South Africans in health can come to an end,” Phaahla said.