Despite the formation of a new government, court challenges to the National Health Insurance (NHI) Act are likely to proceed, says an industry body representing medical aid funds. The Health Funders Association (HFA) convened a scenario planning symposium this week, during which stakeholders evaluated possible outcomes for the NHI following the establishment of a government of national unity.
The NHI bill, signed into law by President Cyril Ramaphosa at a highly publicised event at the Union Buildings on May 15, sparked a backlash from the medical sector, trade unions, and political parties, including the Democratic Alliance (DA), which labelled it an election ploy. With the African National Congress (ANC) unable to secure a majority and having to form a coalition government, concerns have arisen regarding the future of the NHI legislation.
The ANC and the GOOD party have endorsed the Act, but DA leader John Steenhuisen has vowed to contest it in the Constitutional Court. The Inkatha Freedom Party (IFP) also opposes the bill, calling it “a recipe for disaster.”
A negotiated settlement?
Elsabe Klinck, managing director at Klinck and Associates, noted that while the new government arrangement could lead to a negotiated settlement, pursuing legal action would provide a binding court ruling. Several organisations, including trade union Solidarity, the HFA, the South African Medical Association, the Board of Healthcare Funders (BHF), the South African Health Professionals Collaboration, and the DA, are preparing to challenge the bill in court.
Klinck emphasised that the court challenges could delay the Act’s implementation for at least three years, with all cases likely to be consolidated into one ruling. Christoff Raath, Joint CEO of Insight Actuaries and Consultants, remarked that the nature of the government of national unity complicates predictions about the bill’s future. He suggested the government could make some modifications to the NHI framework.
The private sector must not be divided
Despite their competitive nature, Raath urged medical schemes to collaborate on the NHI, stating that the private sector must not be divided now. Charlotte Mbewu, Chair of the HFA NHI Steering Committee, addressed the confusion among medical aid members regarding the bill’s implications and timeline. She reassured that there were no immediate impacts on medical schemes or their members, advising against panic.
Mbewu stressed that medical schemes support universal healthcare but are concerned about the feasibility of the government’s proposed single-payer system, which could strain the country’s health system.
The HFA plans to challenge only Section 33 of the NHI bill, which limits medical schemes to providing “complementary or top-up cover” that does not overlap with NHI personal healthcare service benefits. The association argued that the bill, in its current form, could have catastrophic effects on medical schemes, leading to a “death spiral” and eroding the health sector.