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Monday, 11 November, 2024
HomeFocusANC and DA Ministers in GNU Cabinet dust-up over NHI

ANC and DA Ministers in GNU Cabinet dust-up over NHI

Disagreement over the National Health Insurance (NHI) – coming hard on the heels of a third legal case launched against the Act this month – led to the first showdown in the Government of National Unity (GNU) Cabinet between ANC and DA Ministers.

Insiders said tempers flared at an extended meeting on Friday, with the main disagreement linked to a target set in the medium-term development plan (MTDP) that medical aids would be scrapped by 2029.

The MTDP translates GNU priorities into a detailed five-year plan and spells out interventions that government will make over its term of office.

However, reports the Sunday Times, Health Minister Aaron Motsoaledi lost his temper with DA Ministers and had to be called to order by his colleagues, according to a source at the meeting.

“There’s a section on NHI saying that a target is full implementation, effectively squashing medical aids. The DA looks at this and says, ‘Sorry, this is not a possibility, we can’t protect something like this’,” said the highly placed insider.

This resulted in a heated exchange between the parties and after Motsoaledi started shouting, he had to be called to order by colleagues.

“Motsoaledi tried to class it as a war between rich and poor but some people said this was not true because many public servants are on medical aid and you wouldn’t call them rich,” said the source.

When pressed for comment, Motsoaledi referred the Sunday Times to Cabinet spokesperson and Minister in the Presidency Khumbudzo Ntshavheni.

Ntshavheni said Cabinet meetings were confidential. However, she added: “The MTDP will be finalised at the January 2025 Cabinet lekgotla to allow clusters to finalise their priority proposals.

“Relating to NHI, it … will be implemented as reiterated by President Cyril Ramaphosa in his reply to the National Assembly on 17 October.

“As it relates to complaints against the NHI, the President and Minister of health are waiting for Busa (Business Unity SA) to return with specific issues they have with NHI. A generalisation is not acceptable, as there cannot be a problem with universal access to quality healthcare for South Africans.”

This was the first time the ANC has come face to face with the reality of its 29 May electoral defeat and the fact that the DA and other opposition parties are determined to have their say in the GNU.

After a fiery debate, it is understood Ramaphosa and Deputy President Paul Mashatile intervened, proposing the MTDP be sent back to Cabinet clusters and that other issues of contention be referred to the clearing house – a GNU dispute-resolution mechanism.

While the DA is believed to have claimed victory, ANC insiders said it was Ramaphosa who decided the MTDP should be turned back and presented again at the Cabinet lekgotla in January.

The Sunday Times understands DA Ministers strongly objected to the document endorsing the NHI in its present format and making provisions for how it should be funded.

Finance Minister Enoch Godongwana said that referral of the MTDP back to clusters would not affect his midterm budget due to be delivered at the end of the month.

Delivering the State of the Nation address in July, Ramaphosa had said the Cabinet would convene strategic sessions to consider the MTDP, which would translate GNU priorities into a detailed plan and interventions the government would make in the next five years.

Maropene Ramokgopa, the Minister responsible for Planning, Monitoring & Evaluation, presented the plan to the extended Cabinet meeting which was also attended by Deputy Ministers, provincial Premiers, directors-general and other top government officials.

Western Cape Premier Alan Winde apparently led the objection from the DA side, taking issue with the inclusion of NHI as a spending priority.

DA Ministers represented in the GNU – John Steenhuisen, Dion George, Siviwe Gwarube, Leon Schreiber and Solly Malatsi – are all said to have spoken on NHI and raised other issues with the plan.

Senior government insiders said it had been clear earlier in the week that the different Cabinet clusters would not be ready for the special meeting and that “they needed time to prepare”, but “the Cabinet Secretary insisted” on continuing with the meeting.

Several Ministers are understood to have requested a postponement, saying they would not be ready but this fell on deaf ears.

Insiders confirmed DA Ministers had raised concerns about the NHI but had not raised “specifics” about their objections. This, the Cabinet insider said, was also the case with Busa, which had been given a deadline to report back to the President on NHI.

The insider said DA Ministers were never going to agree to adoption of the plan when it hadn’t been thoroughly discussed in Cabinet clusters and other platforms; was unclear on the funding model for NHI; and still contained plans to scrap medical aids.

Cosatu, however, has said public and private healthcare is in a crisis and that the only solution is the NHI.

Spokesperson Matthew Parks said private medical aid was becoming increasingly unaffordable and “only about 16% of society can currently afford it”.

“The rest of society depends upon public healthcare and leaving aside the 2029 target, even those who do have medical aid are struggling with expensive premiums,” he told The Mercury.

“Right now, the system is broken. Public healthcare is broken and private healthcare is broken.”

Parks said it was crucial that medical tariffs be managed, describing hospitalisation costs at private hospitals as astronomical, further affecting members’ medical aid premiums.

“There is a need to add some conditions to the NHI law, but this route is no different to what Sweden, Denmark, Norway and many other countries have done to support universal healthcare.

“We support NHI wholeheartedly… public health care is under-unded and over-stretched while private healthcare is under-utilised but too expensive for most people.”

The SACP’s general secretary Solly Mapaila said the government must proceed decisively with the implementation of the NHI.

He said critics “are driven by profits and …capture of healthcare and its conversion into a commodity, which they make available only to those who can afford to buy it, thus excluding the vast majority of the workers and poor”.

Legal action forges ahead

Earlier this month (1 October), the SA Private Practitioners Forum (SAPPF) – the country’s largest association of medical specialists – launched legal action in the High Court in Pretoria against the NHI Act, asking it to review and set aside Ramaphosa’s decision to sign the Act into law and to declare it invalid.

This is the third legal attack on the Act, which has already been challenged by Solidarity and the Board of Healthcare Funders, reports BusinessLIVE.

“It is important that people know healthcare professionals are concerned,” said SAPPF CEO Simon Strachan. The SAPPF represents about 3 000 specialists and 1 500 other healthcare professionals, including GPs.

The SAPPF has asked the court to review and set aside the President’s decision to sign and assent to the Act on the basis that he failed to discharge his constitutional duties.

It has cited the President, the Health Minister, the Finance Minister and National Treasury as respondents.

The Constitution gives the President only two options after Parliament passes a Bill: he can assent to it because he is satisfied it meets constitutional requirements, or he can send it back to Parliament for reconsideration if he has reservations about its constitutionality.

Since numerous stakeholders and Parliament’s own legal adviser had raised concerns about the constitutionality of the NHI Bill when it was before Parliament, Ramaphosa was aware of these shortcomings, and signing it was “irrational, for an ulterior purpose, or tainted by the consideration of irrelevant factors,” said Strachan in his founding affidavit.

Election

The SAPPF has also taken aim at the Act itself, and asked the court to declare it unconstitutional and invalid, calling it vague and irrational and saying it unjustifiably limits the constitutional rights of patients and healthcare professionals.

It would also infringe on healthcare professionals’ rights to freedom of trade, occupation and profession, it said.

Vincent Magwenya, Ramaphosa’s spokesperson, declined to comment on the matter, saying the President’s legal team had yet to receive the SAPPF’s papers. “However, as soon as we receive their papers we will respond accordingly,” he said.

Delays and delays

Meanwhile, briefing Parliament’s Health Committee on its annual report for the 2023/24 financial year, the National Department of Health (NDoH) said it had developed a model for the contracting of primary healthcare services under the NHI programme but that the testing of the model in nine pilot sites had been delayed, reports LegalBrief.

It had, however, achieved an unqualified audit opinion in the 2023/24 financial year, and paid 90% of invoices within 30 days.

It had spent 99.59% of its R58.5bn budget, with the lowest spending in the NHI programme.

According to the briefing, provinces spent 98.5% of the R52.6bn in conditional grants, with preliminary approval for R604m in rollover funds.

The committee raised several concerns, including the delay in the release of the Digital Vibes report, and the lack of consequence management for irregular expenditure.

On the Digital Vibes issue, Motsoaledi said it was an SIU report which was referred to the previous administration, and that consequence management had been implemented. The Department also committed to strengthening internal controls and supporting provinces to improve audit outcomes.

 

Sunday Times PressReader article – ANC, DA gloves off in GNU dust-up (Open access)

 

BusinessLIVE article – Medical specialists launch legal action against NHI (Restricted access)

 

The Mercury PressReader article – Cosatu advocates for NHI (Open access)

 

LegalBrief article (Restricted access)

 

See more from MedicalBrief archives:

 

NHI tug-o’-war for GNU and new Minister

 

Government plays for time on NHI court cases

 

Motsoaledi stands firms on medical aids under the NHI

 

Medical schemes and union kickstart NHI legal challenges

 

 

 

 

 

 

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