Will government consider amendments to the National Health Insurance (NHI) Act? As government lawyers seek more time to respond to two lawsuits against the Act, President Cyril Ramaphosa reopening talks with key stakeholders and the Health Minister continuing with public discussions, there is speculation that the door may be open for some amendments, notes MedicalBrief.
Government has missed the deadline to respond to papers filed by Solidarity four months ago, with the union now saying it will continue to argue its case against the NHI Act before the court on an unopposed basis.
In a statement in Politicsweb, the trade union said it had served its court papers on the government on 24 May and agreed to the state’s request for postponement. But according to Peirru Marx, Solidarity’s network co-ordinator of the medical professions, the government’s last opportunity to file its opposing papers expired last Wednesday (2 October).
The respondents include President Cyril Ramaphosa, Health Minister Aaron Motsoaledi, and Finance Minister Enoch Godongwana, reports News24.
However, Department of Health spokesperson Foster Mohale said its lawyers were engaging with the office of the Deputy Judge President for an extension to 27 November.
“It is correct that 2 October was previously agreed as the deadline for answering affidavits … Our lawyers are busy with preparations of answering papers, which have taken a long time, given the magnitude of the application. Solidarity is aware of these engagements, and it would be surprising if it proceeded unopposed. The Department will object to such an approach,” he said.
The main thrust of Solidarity’s argument is Section 32 of the Act, stating that medical aids may not reimburse members for services once these become available on the NHI. This limits individual choice and infringes on the rights of medical schemes to do business, said the union.
The government has also requested a further extension to file opposing papers in the application brought by the Board of Healthcare Funders (BHF), which represents the medical scheme industry. The latest deadline was 16 October, but the government has said it is unable to meet it.
The court has not yet set a new date.
The BHF’s founding affidavit focuses on Ramaphosa’s decision-making process when he signed the Act into law, despite numerous appeals from stakeholders who argued that it was unconstitutional.
On receiving legislation from Parliament, the President is supposed to diligently, and in a way that passes the test of rationality, satisfy himself that it is constitutional.
The objective of the BHF's founding affidavit is to extract the Record of Decision from Ramaphosa under the uniform rules of court.
Once this is received, the BHF will supplement the grounds for review.
One of the key documents featured in the BHF papers is a letter written in 2018 from the National Treasury to the Presidency alerting it to several constitutional concerns with the Bill. Among other things, the Treasury warns that as health is a provincial competency in the Constitution, the NHI usurps the powers of the provinces, which is unconstitutional.
It is an open secret that the Treasury has opposed the NHI in its current form. Because of the 2018 letter, the Treasury cannot credibly file an opposing affidavit and will, therefore, abide by the court’s decision.
Meanwhile, Bestmed, SA’s fourth-largest open medical scheme, has warned that unchecked increases in medical aid contributions will only deter young people from investing in medical schemes, and help bolster support for NHI.
On Friday, reports BusinessLIVE, Bestmed became the latest scheme to announce massive rises for its more than 100 000 main members, averaging 12.75% for all options in 2025, subject to Council for Medical Schemes (CMS) approval.
Discovery Health, with a 57.8% market share, told clients last month to expect increases of 7.4%-10.9% next year, depending on plan. MediHelp has proposed rises of 10.8%, Bonitas 10.2% and Momentum 9.4%.
Bestmed CEO and principal officer Leo Dlamini said big rises, unavoidable because of rising medical inflation, harmed the sector’s reputation and reinforced the idea that NHI, which the scheme opposes in its present form, was a cure-all for SA’s healthcare issues.
“We run the risk of an industry that’s unaffordable, which alienates customers with our pricing. It is a real long-term concern,” he said.
The sector covered only 9m people, he added, a “small percentage” of the population. When the government looked at tariff rises and inflation within the Reserve Bank’s target range “they would think we are just profiteering and cater for just the elites in society”.
“It doesn’t help the narrative against the NHI. If the costs continue to escalate, the 9m we cover will dwindle to 7m or even lower. The only thing that will save the industry is if we are able to increase the base, and bring in a bigger pool of young people.
“We are unable to do that because as part of the Medical Schemes Act, we must cover prescribed minimum benefits (PMBs), which on average, before we add anything else, add about R1 000 a month to cover. This is why we have been pushing for exemptions from providing PMBs.”
It is uncertain whether the CMS will approve proposed increases.
Medical scheme membership has been flat for years, mainly due to high unemployment, and medical inflation and scheme contributions increases have long exceeded the consumer price index (CPI).
In August, the CMS published its recommendations and pricing guidelines for 2025, urging moderation in tariff hikes, and recommending a 4.4% increase, plus “reasonable utilisation estimates”.
Business Tech reports that in previous years, the council said its historical data pointed to reasonable utilisation estimates adding around 3.5 percentage points to the hikes, while private medical inflation generally exceeds CPI by 2% to 3%.
This would put the “reasonable” range anywhere between 6.4% and 7.9%. However, medical schemes say medical inflation is higher than projected.
Vary by plan
While it carries a weighted average of 10.2%, the price increases for Bonitas will vary by plan, it said, with the highest price jump seen for comprehensive cover, which will shoot up almost 15%.
Lee Callakoppen, Principal Officer of Bonitas, said that for several years, the group had kept its contribution increases well below the industry average – maintaining a healthy financial position while ensuring benefits were not eroded.
On top of the price adjustments, Bonitas also has other changes in the pipeline for 2025, including a mental health component, hearing loss management, a weight loss programme, a female health programme as well as an enhanced maternity programme, among others.
News24 article – Govt wants more time to file affidavits defending NHI (Restricted access)
PoliticsWeb article – Court battle against NHI to continue unopposed: Solidarity (Open access)
See more from MedicalBrief archives:
Solidarity says NHI legal battle lines drawn
Government’s NHI claims are ‘fallacies’, says BHF
Medical schemes and union kickstart NHI legal challenges