Unions to face backlash over approval of NHI Bill

• Employee benefits set to shrink as the bill calls for higher taxes to fund universal coverage

Public sector unions that have voiced support for the National Health Insurance (NHI) Bill are poised for conflict with their members, as they have in effect given the green light for a reduction in employee benefits, delegates to a health-care industry conference heard on Thursday.

The NHI bill, currently before parliament, is the government’s first enabling piece of legislation for its plans for universal health coverage, which aims to provide services that are free at the point of delivery for all citizens.

The bill proposes a central NHI Fund that will buy services on behalf of patients, financed by reallocating medical scheme tax credits, general tax revenue, and a new payroll tax and surcharge on personal income tax.

All of these measures have a direct effect on public servants, the majority of whom belong to medical schemes subsidised by the state.

“Organised labour has been vociferously against increases in VAT, yet they are saying they support increased taxation to fund NHI,” Vishal Brijlal, director of the Clinton Health Access Initiative said at the 21st annual Board of Healthcare Funders (BHF) conference in Cape Town.

The BHF is an industry association for medical schemes and their administrators.

Presenting an analysis of the 117 oral submissions made to parliament’s portfolio committee on health in the past year, Brijlal cited the submission of the National Education, Health and Allied Workers’ Union (Nehawu) as an example. Nehawu has said the government should scrap the tax rebate for medical scheme members, and redirect the money to the NHI fund, according to Brijlal.

Health committee MPs voted 7-4 on Wednesday in support of a motion of desirability of the bill, paving the way for them to begin clause-by-clause deliberations on its content. The motion was supported by the ANC and IFP, but not by the DA, EFF and FF+.

More than two-thirds of the submissions on the bill flagged concerns about its constitutionality, suggesting the committee should carefully scrutinise this aspect of the proposed legislation, said Brijlal.

In considering the bill’s constitutionality, the committee would have to weigh up the potential for legal challenge if it were passed in its current form versus redrafting its content, he said.

The bill designates the NHI Fund as the “single purchaser and single payer” for health-care services, a proposal that the BHF and other critics said in their submissions would make it unlawful for people to buy health-care services that are covered by the NHI.

Brijlal said this limitation is at odds with the Bill of Rights and the constitutionally mandated responsibilities of provinces and other tiers of government.

Cosatu parliamentary coordinator Matthew Parks said Brijlal had misunderstood the submissions of the trade union federation and its affiliates.

“He is welcome to talk to our members. We know there would have to be compromises. Whenever you are dealing with human beings, there are competing interests. The whole point is how to balance them.

“Unions have long been champions of NHI because their members are being bled dry by medical scheme co-payments and running out of day-to-day benefits,” he said.