Concerns raised as NHI Bill approved by National Council of Provinces
 

6 December 2023, 18:30
Contributor: Linda Ravenhill

The National Council of Provinces (NCOP) has passed the National Health Insurance Bill (NHI), following support from eight of the eleven provinces. The Bill will now be forwarded to President Cyril Ramaphosa for potential enactment into law. 

While proponents of the Bill have argued it is unconscionable that the country continues to operate a two-tier healthcare system which favours the few, critics of the Bill have raised numerous concerns, including how the scheme will be administered, the extent of the health minister's powers, and the potential loss of skills from the healthcare sector should the NHI be implemented.

Exactly how the government plans to fund the scheme is unclear, raising further red flags. Researchers have estimated it will cost between R300 billion and R600 billion annually. It is unlikely that monies garnered from tax hikes and the removal of rebates for medical aid tax credits, which the government has confirmed as funding sources, will contribute significantly to these running costs.

The ball is now in the President's court. Should he decide not to sign the Bill into law at this time, there are several courses of action available: considering the almost certain constitutional challenges, he may choose to return the Bill to Parliament for review and amendment; alternatively, he could refer the legislation directly to the Constitutional Court for a decision on its compatibility with South Africa's law.

Regardless of the President's decision, Minister of Health Joe Phala has indicated that passing the Bill is not the end of the consultative process but the beginning. He was quick to reassure stakeholders that they had an important role to play, particularly (unsurprisingly) when it comes to implementing the scheme. Given that none of the recommendations made during the previous consultation processes was adopted, whether any meaningful consultation will be undertaken moving forward is questionable.

Regardless of which side of this debate you fall on and whether it is indeed pre-election populist politicking on the part of the ANC, as many say it is, what is not in doubt is the far-reaching consequence the actions of the NCOP will have, should the Bill go ahead in its current format.