President Cyril Ramphosa, in his State of the Nation address last week, failed to provide any details of a supposed compromise agreement on the National Health Insurance Act, but the DA insists that some contentious provisions of the law are likely to be redrafted.
And while senior ANC Ministers said they knew nothing of such an agreement, Presidency spokesman Vincent Magwenya signalled that such talks could indeed be taking place. He told reporters in Cape Town that Ramaphosa was committed to ironing out difference within his administration over the NHI and “one would not be entirely surprised if an agreement is reached in that regard”, according to a Moneyweb report.
Ramaphosa said preparatory work to roll out the NHI would begin this year, amid reported talks of an alleged compromise between the ANC and DA to amend a section of the National Health Insurance Act to protect medical aid schemes.
However, Health Minister Aaron Motsoaledi has denied any knowledge of it, Business Leadership SA remains sceptical of the alleged compromise, and Cosatu is demanding full and immediate implementation of the NHI.
Daily Maverick reports that while delivering the State of the Nation Address last Thursday, Ramaphosa reaffirmed the government’s commitment to improvements to healthcare access and infrastructure, without delving into details of such an agreement.
Informal
In a News24 report last week, Planning, Monitoring and Evaluation Minister Maropene Ramokgopa had said the ANC and DA had come to an informal agreement that the government would not collapse medical aid schemes and that a ministerial advisory council would be established.
Ramokgopa told the publication the agreement was reached during the Cabinet lekgotla after she and Motsoaledi had a meeting with DA leader John Steenhuisen, who also holds the position of agriculture minister.
But on the sidelines of Sona, Motsoaledi said he was not aware of such an agreement.
“The only thing I am aware of is what is in the Act, not what any other person has said.
“The Act clearly says when NHI is in full operation, medical aids will be complementary and to be honest, they are already playing a complementary role, meaning that whatever the NHI is able to pay for, they cannot duplicate it because if you duplicate healthcare services and expenditure, the country will spend much more on health than any other country on earth,” he said.
Steenhuisen, however, confidently confirmed a deal had been struck.
“I expect that the NHI Act will have to have some of its provisions redrafted. This is a compromise that has been reached,” he said, adding that the Act would possibly be reintroduced to Parliament to prevent the collapse of private medical aid schemes.
He told News24 that billions of rands cannot be poured into the NHI as it currently stands.
“We will not be part of the destruction of the private medical aids. If that does happen then we cannot be part of the unity government,” he said.
“Our Medium-Term Development Plan contains certain targets which we felt were problematic, and the need for further discussion on funding models, most notably how to ensure a complementary private and public healthcare system where you actually have the models of public-private partnerships seen with such success in Operation Vulindlela with energy, and with the rail and logistics crisis.”
The move to universal healthcare should be done in phases, he added.
“We have been in a tight fiscal space for decades and don’t have the money to plough into the NHI that’s currently conceived. It’s going to have to be a phased approach… which will have to bring all stakeholders along with it.”
He predicted that over the course of several years, the Act would be subject to amendment as modalities and financial situations change.
“We need to focus on getting the building blocks right …But while doing so, don’t destroy the private healthcare sector; rather have a public healthcare sector where there’s symbiosis.”
‘No compromise’
The ANC’s alliance partner, Cosatu, however, is calling for the full implementation of the Act in its current form, with the union’s president Zingiswa Losi refusing to be drawn on any suggested compromise.
“What I know is what is in the Act. What other people are discussing outside, I am not privy to that, but as Cosatu, we want to see the implementation as is.
“We understand that we are not going to wake up tomorrow with a full NHI being implemented, so we understand that, but what we are happy about in this Sona is that he has been able to make that emphasis that it (NHI) is not going to go away.”
The ANC’s first deputy Secretary-General Nomvula Mokonyane admitted differences over sections of NHI persisted between her party and some GNU partners, but was optimistic they would soon be ironed out.
Forge ahead
Zola Saphetha, secretary-general of the National Education, Health and Allied Workers’ Union, condemned what he said was “recent misinformation” about the NHI, urging the government to immediately forge ahead with its full implementation.
“We no longer want to hear about preparatory steps while more than 56 000 people die of tuberculosis annually. We want to see the President act decisively in promulgating the Act into law and ensuring full implementation of NHI, as guided by Section 57 of the NHI Act.”
Concerns and challenges
Several industry bodies have expressed their intention to challenge the legislation once it is implemented.
Business Leadership SA CEO Busi Mavuso has highlighted the lack of clarity on how the NHI will be funded.
‘Construction’
The government’s most immediate priority is to strengthen the health system and improve its quality, Ramaphosa said, adding that a number of hospitals are “under construction or undergoing revitalisation”.
He mentioned the Limpopo Central Hospital and the Siloam District Hospital in Limpopo, the Dihlabeng Regional Hospital in Free State, the Bambisana District Hospital and Zithulele District Hospital in Eastern Cape, and the Bophelong Psychiatric Hospital in North West.
Moneyweb – Government signals breakthrough in NHI impasse
See more from MedicalBrief archives:
Reprieve for medical aids with NHI ‘breakthrough’?
Will Cabinet lekgotla pave way for NHI compromise?