The South African Parliament has approved the National Health Insurance (NHI) Bill, which paves the way for universal healthcare in South Africa. Several parties, including the Democratic Alliance (DA), Economic Freedom Fighters (EFF) and Inkatha Freedom Party (IFP), opposed the bill; however, the African National Congress (ANC) used its majority in the National Assembly to vote in favour of it.
The NHI Bill proposes the elimination of comprehensive medical schemes, despite the membership of nearly nine million South Africans in such schemes. It also suggests that most healthcare services, including doctor’s visits and medications, would be free for all citizens, and medical schemes would no longer cover services covered by the NHI.
The bill now awaits review by the National Council of Provinces (NCOP), followed by public hearings and subsequent approval by the president.
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The conditions of the NHI Bill, a contentious piece of legislation in South Africa, would see comprehensive medical schemes, which currently serve approximately nine million South Africans, phased out, and medical plans barred from covering services already covered by the NHI.
To fund the NHI, the government plans to impose an additional tax on citizens’ personal income and allocate the savings gained from eliminating tax credits for medical scheme membership.
According to The Citizen, Members of Parliament (MPs) engaged in discussions over the proposed legislation prior to the vote. Health Minister Joe Phaahla expressed concern about the disparity between the public and private healthcare sectors. He argued that the bill aimed to prevent the collision of two separate tracks, where the public health system is burdened while private healthcare overserves its clients, resulting in rising costs for medical scheme members.
Phaahla contended that the current situation is unsustainable, as access to top healthcare professionals is limited to those with financial means, and he described it as unjust.
Opposing the bill, DA MP Michele Clarke criticised it as ‘disastrous’ and predicted that it would harm South Africa’s healthcare system. She questioned the assumption that South Africans would continue paying for medical aid without receiving any benefits. Clarke argued that without private patient funding, private health facilities would become reliant on government funding, effectively transforming them into public health facilities lacking dedicated budgets.
She further expressed concerns about corruption, drawing parallels with the handling of the COVID-19 pandemic, The Citizen reports.
EFF President Naledi Chirwa characterised the proposed legislation as one of the ANC’s biggest ‘scams.’ She argued that the true eradication of a two-tier healthcare system would require nationalisation rather than tendering for healthcare. Chirwa criticised Health Minister Phaahla for failing to disclose the actual cost of the NHI and Finance Minister Enoch Godongwana for not clarifying the bill’s funding mechanism. She pointed out that the referral system outlined in the NHI would still subject people in townships, rural areas and informal settlements to public health facilities, thereby not making healthcare more accessible to the poor.
Chirwa alleged that the NHI is emblematic of the Ramaphosa administration’s objective of privatising everything and rendering the state impotent.
IFP MP Magdalena Hlengwa cautioned against the NHI Bill, asserting that it would restrict access to healthcare due to the substantial funding it would require. Hlengwa expressed concerns about the bill granting the minister of health excessive powers, potentially leading to undue influence and negatively affecting oversight.
While expressing support for the bill, the GOOD Party’s MP Brett Herron acknowledged that it is not perfect. While the party recognised the bill’s positive objectives, it also emphasised the importance of addressing potential barriers to the NHI’s success, including corruption.
Following the parliamentary debate, the NHI Bill received 205 votes in favour and 125 against.
The bill will now proceed to the National Council of Provinces (NCOP) for review, where it will undergo further public hearings. Once these processes are completed, the draught legislation will be submitted to the president for approval.
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Picture: Greg Rosenke / Unsplash
