The National Council of Provinces has adopted the National Health Insurance Bill and will send it on to president Cyril Ramaphosa for consideration and to be signed into law.
The controversial bill was pushed through by ANC majority-led provinces following a week’s delay after business groups appealed to the house for further consultations. The DA-led Western Cape was the only province to oppose the bill.
Various critics and opponents of the bill said prior to the vote that they were ready to take the matter further.
They will first appeal to the president to consider sending the bill back to the National Assembly for review. If this does not work, legal challenges to the bill are expected to follow. The health department has previously indicated that it is ready for these challenges.
The NHI Bill aims to lay the foundation for universal healthcare in South Africa by establishing the NHI Fund, which will become the country’s single and only purchaser of healthcare services. The bill would also set in law the extreme limitations on the medical aid industry and private healthcare sector, sounding their death knell.
This would all be established despite deep concerns and a host of unanswered questions about how the system would operate, including which services it would offer and how the whole scheme would be funded. According to the health department, these critical questions can only be answered once the NHI Bill has been made law – ostensibly when nothing can be done about it.
Estimations on the cost of the NHI vary, but researchers have put the total cost anywhere between R300 billion and R660 billion a year. The government has confirmed that tax hikes will be used to fund the scheme, along with the removal of rebates like medical aid tax credits and other vague funding mechanisms.
Aside from funding concerns, many red flags have been raised around the administration of the scheme, including the potential for corruption; the extent of the health minister’s powers; and the impact on skills loss, with many doctors and other health professionals voicing their intent to emigrate should the scheme proceed.
Proponents of the bill have argued that it is unconscionable that South Africa operates on a two-tier health system where a small percentage of the population enjoys a higher level of health services by spending more than what is spent on the public healthcare system.
There appears to be a belief that by removing access to the private sector, all the money that has been spent on the sector will somehow make its way to the public sector – including the skills, equipment and facilities.
However, opponents have argued that the bill goes too far in cutting the private sector out – particularly with private health insurance and medical aid being almost completely sidelined by the bill. Critics have argued that the NHI Bill, in its current form, actually limits and removes access to healthcare, which would be unconstitutional.
Despite warnings from private groups, analysts and even parliament’s own legal experts, proponents have pushed the bill through on the basis that “the greater good” is more important than individual rights.
Opponents of the bill have labelled the “rushing” of the bill through parliament as a “populist” vote-farming exercise by the ANC ahead of the 2024 elections.
The bill will now move on to the office of president Cyril Ramaphosa to be considered and signed into law.