Motsoaledi doubles down on NHI

Newly appointed health minister Aaron Motsoaledi says he is determined to push ahead with the ANC’s controversial plans for National Health Insurance (NHI), despite legal challenges and opposition from political parties in the new government of national unity.

In an interview with Business Day on Thursday, Motsoaledi extended no olive branch to the private sector and castigated medical schemes and private healthcare providers for profiting at patients’ expense.

Medical schemes covered only some conditions in full, while private providers charged what they liked, leaving patients to fund the balance, he said.

“The current system is wrong. The patient is pitted against their own doctor,” said the minister, who returned to the health portfolio two weeks ago after a five-year stint as minister of home affairs.

“When I was taught medicine, the first thing in an emergency (was) to check the ABCs — airways, breathing, circulation. Now the first thing an ambulance will check is your pocket, ” he said.

Motsoaledi was an energetic supporter of NHI in his previous role as health minister from 2009 to 2019.

NHI is the ANC’s plan for universal health coverage and intended to ensure all eligible patients receive care that is free at the point of delivery from public and private sector providers. The National Health Insurance Act was signed into law by President Cyril Ramaphosa two weeks before the general election in May.

The act paves the way for the establishment of a governmentcontrolled NHI fund that will purchase services for patients.

The legislation is already facing two legal challenges, one from trade union Solidarity and the other from the Board of Healthcare Funders, an industry association for medical schemes. Several more are in the offing.

In his budget speech to parliament earlier in the day, the minister said that NHI was a health financing system that would level the playing field between rich and poor. “If you want to see what inequality means, come to the health sector in SA,” he said.

“We can no longer, with our eyes open, sustain such inequality. If there is something we can do, about it, we must do it here and now, and not in some distant ill-defined future,” he said.

Motsoaledi said that he was open to talking to stakeholders about their differences on NHI.

But when he was asked whether he saw scope to soften section 33 of the National Health Insurance Act, which says medical schemes will be allowed only to cover services not provided under NHI, he dismissed the possibility saying: “Medical schemes [as] they are now won’t solve the problems that we’re having [of inequitable access to health in SA]”.

The minister panned the notion of low-cost benefit options for medical schemes, saying it would be wrong to provide poor people with less cover than rich people who could afford more generous options.

“It’s like sticking a plaster on a crack,” he said. “I don’t favour them. It’s wrong. It’s not dealing with health, it’s money.”

Proponents of low-cost benefit options (LCBOs), which would provide a pared down version of current medical scheme packages, say that these options could extend private healthcare to millions more people and help reduce the load on the overburdened state sector.

The Council for Medical Schemes spent several years working on a regulatory framework for LCBOs and submitted its report and recommendations to the then-minister of health Joe

Phaahla in November 2023. During the debate, ActionSA’s Kgosi Letlape proposed that legislators abandon their medical aid membership, which enables them to access private healthcare facilities, and use public hospitals and clinics instead.

“I can assure you, if all of us get our services from the public sector, what we find there will stop: the absent doctors, the absence of drugs and services, it will stop,” he said.

The DA, which is part of the government of national unity, voted against the National Health Insurance Bill when it was before parliament.

DA MP Michele Clark said that her party had warned against the potential devastation the NHI could cause, and urged the health portfolio committee to scrutinise the preparatory work that was to be done with the NHI indirect grant.