A crucial vote on the National Health Insurance (NHI) Bill was postponed yesterday, bringing relief to business groups and health professionals who had urged the National Council of Provinces (NCOP) not to pass the Bill in its present form, writes MedicalBrief.
The NCOP was to have voted on the Bill yesterday, following the NCOP’s Select Committee on Health and Social Services last week approving it without any amendments. But The Citizen reports that the matter has since been deferred to 6 December, according to a hybrid plenary session yesterday.
And in another glimmer of hope that the Bill could be amended, Cyril Ramaphosa's spokesman yesterday said the President won't simply sign the Bill into law.
"I don't think there should be any panic," Presidency spokesperson Vincent Magwenya said at a briefing yesterday, according to a News24 report.
"Concerns have been expressed directly to the President (about) certain parts of the Bill. Once the Bill has been passed, the President still has a constitutional imperative in processing that Bill before he signs it. He will look at the process. One of the things he will look at is, has there been sufficient consultation and if so, have those consultations sufficiently addressed the issues of concern," Magwenya explained.
He said it was within Ramaphosa's remit to send back a Bill if he has any concerns.
"The passing of the Bill doesn't necessarily mark the conclusion of the process. The President does not, each time he receives a Bill, just sign it as a given. If he so desires, he can open another round of consultation to satisfy himself that what he will sign will not be subjected to endless litigation," the spokesperson added.
The hasty adoption of the Bill – without important amendments – spells disaster not just for patients but for the economy as well, a newly formed group of health professionals warned this week, adding to the chorus of opposition from business organisations and experts, who say there is “too much at stake to get NHI wrong” while “disregarding submissions by clinician bodies”.
The consequences of rushing through the Bill will undermine the country’s ability to deliver quality healthcare to the very patients the draft legislation seeks to protect, they say.
The recently-established SA Health Professionals Collaboration (SAHPC), a group of about 25 000 doctors and health professionals, has labelled the rushed adoption of the Bill by the NCOP Select Committee on Health & Social Services last week as “deeply concerning”, reports TimesLIVE.
It has urged the NCOP to send it back to the committee on procedural grounds.
In a joint statement, the body – which includes the South African Medical Association (SAMA), Federation of South African Surgeons (FoSAS), South African Dental Association (SADA) and South African Society of Obstetricians and Gynaecologists (SASOG) – accused the committee of disregarding submissions by “numerous clinician bodies, whose primary objective is to safeguard the future of healthcare in the country”.
“While reforms to the public and private healthcare sectors are urgently needed, there is too much at stake for the country’s healthcare system to get the NHI wrong. We are concerned that the Bill’s hasty progression through the legislative process … is a lost opportunity to put the country on a pathway to quality healthcare for all,” said SAHPC spokesperson Simon Strachan, who is also CEO of the SA Private Practitioners Forum.
In another appeal this week, business bodies, Business Unity South Africa (Busa) and Business for South Africa (B4SA), also called for the NCOP to disregard the Bill, accusing the committee of not following proper processes and failing to consider amendments made by stakeholders, reports BusinessLIVE.
The committee adopted the Bill without any amendments to the version passed by the National Assembly, despite intense lobbying from various quarters, and despite inviting written and oral submissions from the public.
Not even technical changes and corrections suggested by the Department of Health were incorporated.
On Monday, Busa and B4SA said they had submitted letters to the presiding officers of the NCOP and Deputy President Paul Mashatile, in his capacity as leader of government business in Parliament, to have the Bill sent back to the committee for proper engagement.
They pleaded for a delay on its vote, asking that the Bill be sent back to Parliament’s Select Committee so MPs could take another stab at it.
They said no consideration was given “to the many constitutional issues, procedural and substantive, which were raised by four provinces and a wide range of stakeholders”.
Busa CEO Cas Coovadia told TimesLIVE it would be unconstitutional for both houses of Parliament, the National Assembly and the NCOP to disregard proposed amendments “that will have a beneficial and tangible impact on citizens”.
“It makes a mockery of due process and portrays the NCOP as nothing more than a rubber stamp … in its current form it is utterly un-implementable and will have severe consequences for South Africa, the economy and every citizen, for generations to come.
“The truth is there is no money to fund this NHI Bill, there is no clarity over its benefits, contracting terms, capacity, systems, management, governance or even a plan that begins to outline a viable approach to these fundamental considerations. We have also repeatedly cautioned against a single fund for the NHI that will require taxes to be raised to unsustainable levels,” said Coovadia.
He added that the Bill’s proposal to sharply curtail the role of medical schemes and allow them to offer cover only for services not provided by the NHI fund was unconstitutional.
“No other country in the world has a legislated limitation on the role of private health insurance, not even wealthy countries with a substantial tax base and extensive publicly funded healthcare,” he said.
Busa and B4SA have consistently called the Bill unaffordable, saying that the government’s estimate that it will need to raise an extra R200bn in tax revenue to finance NHI with R480bn a year would require increasing personal income tax by almost one-third, VAT from 15% to 21%, or applying a payroll tax that is 10 times higher than the current Unemployment Insurance Fund contribution.
Even if the government did manage to raise R480bn for the NHI fund, this would cover only very basic healthcare, they said.
In the Western Cape, on Monday, the provincial legislature's Standing Committee on Health & Wellness, dominated by the DA, voted against the Bill in a meeting which lasted just under 10 minutes.
Committee chairperson Gerrit Pretorius said NHI “has the very real potential of being the final nail in our country's coffin, and there is little choice but to reject it”.
“We urge the NCOP to take the Western Cape’s mandate seriously and to give it the full consideration that is due by law and precedent.
"The message is clear: to pass this Bill would lead to the total collapse of both the healthcare sector and the greater economy of South Africa. It must be rejected.”
He told News24 that while the goal of universal health coverage was “a noble one”, the Bill would have dire economic consequences for South Africa.
“With a mounting debt crisis, a stagnant economy, and an energy crisis that makes real the threat of total economic collapse, South Africa already cannot meet its financial obligations.”
However, ANC MPL Rachel Windvoegel said during the committee meeting that the party’s stance remained the same and that they supported the Bill.
Section 33 of the Bill, which deals with the phasing-in of the NHI and the phasing out of private medical aid insurance, is certain to be challenged on constitutional grounds, due to the limitation it would impose on the right to health. Trade union Solidarity has already indicated that it will challenge this.
The Citizen – NCOP postpones NHI Bill decision to next week
News24 – ‘I don’t think there should be any panic’: Ramaphosa won’t just sign NHI Bill into law
BusinessLIVE article – Big business slams NHI process as a mockery (Restricted access)
See more from MedicalBrief archives:
One step closer for NHI as NCOP committee adopts Bill, unchanged
Medical aid tax rebates to go to NHI
Key healthcare players flag NHI risk
Lessons for NHI in world's largest health study?