NHI: What comes next

 ·5 Jul 2023

After four years of lengthy deliberations and parliamentary processes, the National Health Insurance Bill (NHI) was passed by the National Assembly on 13 June 2023.

However, the passing of the bill by the NA is just the next step in a lengthy process to get the regulations signed into law.

The proposed laws still need to be processed by the provinces in South Africa, will undoubtedly face several legal challenges – on top of those already underway – and will be hamstrung by a lack of capacity within government to roll the changes out timeously.

This is what lies ahead.


What comes next in government

According to the Parliamentary Monitoring Group (PMG), following the passing by National Assembly, the Bill is now being processed by the National Council of Provinces.

The NCOP processes will include:

  • Briefing of permanent delegates in the NCOP;
  • Briefings of delegates to legislatures in all provinces;
  • Advertisements for input from the public to comment on the Bill;
  • Public hearings to be conducted by the NCOP;
  • Provincial legislatures to follow their own public participation processes in preparation for submission of negotiating mandates to NCOP;
  • The Select Committee’s position will be consolidated and final mandates received from provinces.

According to the PMG, as this is a Section 76 bill, “it will be subjected to extensive scrutiny by the provincial legislatures because the content of the bill affects the interest, concerns, and capacities of the provinces,” it said.

If the NCOP also passes the bill (concurring with the National Assembly), then the bill will be passed on to the office of the president for assent.

If the NCOP does not concur, the bill will be sent back for further amendments and processing.


Long road ahead

Even if it’s smooth sailing for these processes over the next few months if not years, this does not mean the NHI is a done deal.

The bill (even if it becomes an Act) still faces an uphill battle from critics, opponents and stakeholders in the private sector who have already launched legal challenges against the laws.

Several stakeholders – from the private sector, legal firms and from Parliament’s own legal advisors – have flagged several key issues in the bill as it currently stands, including serious constitutional problems. It is unlikely that these glaring holes will go unchallenged.

And even without the potential delays caused by court orders and other hurdles, the Department of Health itself has conceded that the NHI will not be fully implemented any time soon.

The scheme is expected to roll out in phases, starting in 2026.

Deputy Director General of National Health Insurance, Dr Nicholas Crisp, said the intended outcomes of the NHI will only be realised in 15 to 30 years, and the laws currently being processed lay the groundwork and framework for this reality.

One of the biggest hangups over the NHI remains funding. A notice circulating this week among stakeholders confirmed previous positions from the government that taxpayers would be funding the NHI – through a payroll tax and a surcharge on income tax.

Given that the government will look to a narrowing base of taxpayers to foot the bill, and will need as much as R280 billion to make the scheme succeed, analysts say it’s something the country won’t see successfully implemented in a thousand years.

Intellidex director Peter Attard Montalto said that, given the blatantly obvious constraints on the government and South Africans as a whole, the system is impossible to implement.

“It is simply impossible: logistically, in terms of pathway management, systems that are in place, and in terms of funding as well,” he said.


Read: NHI could be the next SARS – not the next Eskom: Crisp

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