Minister damns ‘elitist’ challenge to NHI

Health minister Aaron Motsoaledi has come out guns blazing against Solidarity’s legal challenge to the National Health Insurance Act, arguing that the trade union’s case is devoid of merit and reflects its “discriminatory and elitist ethos”.

“What appears to be the nub of Solidarity’s complaint is its discomfort with the fact that the majority of the population who now use the public healthcare system will be afforded access to private healthcare providers and facilities under the NHI Act, which are now the exclusive domain of those who are betteroff,” he said in court papers.

The act lays the legislative groundwork for the ANC’s vision for universal health coverage, and provides for a government-controlled NHI fund that will purchase services for all eligible patients. This is aimed at tackling the deep inequity in SA’s health system, which sees the majority of the population dependent on patchy public health services, while wealthier medical scheme members get better quality private healthcare.

NHI is based on social solidarity principles, in which the healthy and better off subsidise the sick and the poor. The legislation is opposed fiercely by organised business, healthcare professionals, medical schemes and civil society organisations, many of whom have launched legal action or indicated they intend to. Solidarity was the first organisation to attempt to overturn the act, signed into law by President Cyril Ramaphosa two weeks before the general election in May.

The Board of Healthcare Funders, representing medical schemes and administrators, and the SA Private Practitioners Forum, representing healthcare

professionals, followed suit soon after. Solidarity asked the high court in Pretoria to declare the act unconstitutional and invalid, setting in motion what is set to be a long legal battle. It argued that the act is vague, impractical, unaffordable, and unconstitutional on multiple grounds. One key objection centres on the act’s limitations on the future role of medical schemes, which it maintains will erode members’ existing access to healthcare and is thus regressive and at odds with the constitution.

Section 33 of the act says medical schemes will be restricted to providing “complementary cover” only for benefits not covered by NHI once the scheme has been declared fully implemented by the minister.

In his responding affidavit, filed on Wednesday, the minister said the act was designed to tackle inequity between private and public healthcare, which was “much worse than ... under apartheid. Our constitution demands a healthcare system that is equitable and transformed, and which puts human life and dignity at its centre. This is what the act is designed to achieve and what it will achieve.”

As NHI is to be implemented stages, medical schemes would operate much as they do today for at least another decade, said the minister. “I estimate this to be a period of between 10 and 15 years,” he said.

“There will be a period when both the (NHI) fund and medical schemes are permitted to cover similar services before the minister declares the act to be fully implemented. This will be a necessary part of the process to protect healthcare users from being without cover during the process of moving from medical schemes to the fund,” he said.

The act did not limit healthcare access. “If there is a benefit which a user would like to access which is not covered by the NHI fund, the user is at liberty to pay for it out of pocket or access complementary medical scheme coverage,” he said. “This is similar to the scenario which plays out now with medical aids and has been implemented for many years without challenge.

“A simple example is that when a medical aid beneficiary has depleted their allocated funds (in a medical savings account for example), the beneficiary must pay out of pocket.”

Solidarity’s deputy CEO for legal affairs, Anton van der Bijl, said it was clear from the minister’s papers that the health department did not conduct a proper costing and feasibility analysis of NHI before flighting the legislation. “The minister bizarrely argues that it cannot be done beforehand and that the costs of the act will only be revealed as it is implemented.

“This is in essence a plea from him to blindly trust his department to properly appropriate our hard-earned tax money and competently implement the act.. We remain resolute that through years of mismanagement and corruption this trust has not been earned, and will therefore continue our fight against the act,” Van der Bijl said.

The minister said “extensive costing processes” were undertaken and were ongoing, but did not provide details.