Big business threatens NHI legal action

Organised business has urged President Cyril Ramaphosa not to sign the National Health Insurance (NHI) Bill, threatening legal action if it becomes law. Business Unity SA CEO Cas Coovadia said the country “needs an NHI underpinned by the constitution and which is affordable and implementable. This bill does not meet these criteria and is not ready to be signed into law.”

Organised business has urged President Cyril Ramaphosa not to sign the National Health Insurance (NHI) Bill, threatening legal action should it become law.

The bill is on Ramaphosa’s desk after the National Council of Provinces passed it in December, paving the way for the government’s intention to reform SA’s healthcare and achieve universal coverage. The president could sign the bill into law or send it back to parliament for amendments should there be any concerns.

The NHI is aimed at ending the two-tier health system in SA, laying the groundwork for sweeping reforms intended to realise the ANC government’s ambition for universal health coverage. However, the legislation, which is likely to see the phasing out of private health insurance, has had pushback from opposition parties, business lobby groups and professional health bodies. Analysts and critics of the NHI fear it will be used by the ruling party as an election gimmick.

South Africans will go to the polls this year in the most fiercely contested elections yet.

On the sidelines of the government’s annual strategy meeting last week, minister in the presidency Khumbudzo Ntshavheni told reporters Ramaphosa is likely to sign the bill into law before the elections to ensure that the seventh administration would begin its implementation.

Business Unity SA (Busa) CEO Cas Coovadia said that while legal action would be the organisation’s last resort to prevent the bill becoming law, the option has not been ruled out.

“What the country needs is an NHI underpinned by the constitution and which is affordable and implementable. This bill does not meet these criteria and is not ready to be signed into law,” Coovadia said.

“Legal action is certainly an option we will consider because any attempt to implement the legislation in its current form will have significantly negative consequences for healthcare in our country, across society, as well as further reducing investor confidence.”

The legislation will create a single NHI Fund that will buy services from public and private providers that are intended to be free at the point of delivery. It will prohibit medical schemes from covering services provided by NHI.

Details of how it will be financed have yet to be spelt out, but the ANC has indicated it intends to redirect the money that employers and individuals pay to medical schemes into the NHI Fund by taxation, a proposition critics say is unviable.

“The country is in pre-election mode and adoption of the NHI Bill is a cornerstone of the government’s policy platform and its election campaign,” chair of the Business for SA (B4SA) steering committee Martin Kingston said.

“However, the weaknesses and the material negative implications of the NHI Bill in its current form will have devastating consequences for the country and her people for generations to come. There is a significant obligation on the president to ensure the bill passes constitutional muster,” he said.

Busa and B4SA said they are concerned about the constitutionality of certain sections of the bill, particularly section 33, which gives the health minister the power to determine a restricted role for medical schemes.

“Busa noted that the single fund model (where the government will buy and pay for all healthcare services for everyone) introduces significant concentration risk and adversely impacts people’s ability to seek care in the private sector,” it said in a statement.

“The bill provides for the adding of new taxes and altering tax policies, tasks that should be handled by the National Treasury in a money bill as per the constitution. Additionally, the bill breaches the separation of powers by giving the minister of health judicial discretion.”