NCOP delay of NHI Bill vote comes as a surprise

• Parliament mum on reason for National Council of Provinces’s decision to reschedule vote

In a surprise move, the National Council of Provinces (NCOP) made a last-minute decision on Wednesday afternoon to delay by a week its planned vote on the contentious National Health Insurance (NHI) Bill.

This comes hard on the heels of intense lobbying by organised business, which on Monday appealed to the NCOP’s presiding officers and deputy president Paul Mashatile to stop the house passing the bill.

Parliament did not provide a reason for the NCOP’s decision to reschedule its vote on the bill, which had been published on the days’ order paper with a detailed list of speakers to take part in the debate.

Parliamentary spokesperson Moloto Mothapo said only that changes in the parliamentary schedule are often made for technical and logistical reasons.

Deputy health minister Sibongiseni Dhlomo said as there was a delay in the Western Cape submitting its final position on the bill so the NCOP’s select committee on health and social services submitted its report on the bill to the house only on Tuesday. The NCOP may have needed more time to consider the report before it voted on the bill, he said.

DA chief whip Siviwe Gwarube said opposition parties are left in the dark, with no reason offered by the NCOP for its eleventh-hour postponement of the vote. She condemned the

development, suggesting the ANC-led executive has “reached its tentacles” into the legislature.

Under NHI, the government aims to provide all eligible patients with health services free at the point of delivery, with the rich and healthy subsidising the poor and sick. The bill paves the way for the establishment of a central NHI fund that will purchase services from accredited public and private providers, and prohibits medical schemes from providing cover for services offered under NHI.

The legislation was submitted to parliament in 2019, passed by the National Assembly with minor changes in June and submitted to the NCOP for concurrence. To the dismay of organised business, healthcare professionals, and medical schemes, the NCOP made no amendments to the bill, despite conducting public hearings in all nine provinces and calling for stakeholders to submit written comment to parliament. Only the Western Cape voted against the bill.

Business Unity SA (Busa) and Business for SA (B4SA) welcomed postponement of the NCOP vote on the bill. “Busa and B4SA will continue to engage government on the substantive and procedural constitutional shortcomings of the bill, to ensure that these concerns are addressed,” they said in a statement.

COSATU

Trade union federation Cosatu expressed disappointment at the delay, saying parliament has already spent more than four years on the bill. “Busa is putting a lot of pressure on government, but there is no reason to delay it,” said Cosatu parliamentary coordinator Matthew Parks.

The NCOP has enough time to pass the bill before parliament rises on December 8, but if it fails to do so, it could do so when it reconvenes after the state of the nation address in February, he said.

Cosatu said it remains convinced that SA’s myriad healthcare crises requires creation of a NHI. “Government and the NCOP should not place the profit margins of private industry above the needs of society,” it said.

During its passage through parliament, the bill met a barrage of criticism, ranging from concern that the governance structure of the NHI fund leaves it vulnerable to corruption to warnings that scaling back medical scheme cover for private healthcare is unconstitutional.

Critics have also warned that raising taxes to fund NHI is unfeasible, and that even if the government were to raise the extra R200bn the health department estimates is required, this would only stretch to the provision of very basic services.

The Health Funders Association, one of SA’s two key industry bodies for medical schemes, said the bill is being rushed through before next year’s general election, and offers “an unrealistic election promise rather than a pragmatic solution” for the complex health challenges facing SA.

It appealed to the president not to sign the bill into law, saying it disregards the input of funders, business and other stakeholders, and has no workable funding mechanism.