Is the National Health Insurance (NHI) compromise between the ANC and the DA a ruse, or has the erstwhile governing party finally made a key concession on the contentious piece of legislation it has doggedly pursued for more than a decade?
DA leader John Steenhuisen appeared confident of a deal to ensure the continuation of private medical aid schemes ahead of the state of the nation address last week.
He said the contentious section 33 of the NHI Act would not be included in the medium-term development plan, the blueprint of deliverables for the GNU for the next five years.
Minister in the presidency Maropene Ramokgopa on Friday said that a ministerial advisory committee will be established to tackle controversial aspects of the NHI Act. In an interview with News24 last week, she said an informal agreement was struck between Steenhuisen and health minister Aaron Motsoaledi on the sidelines of the cabinet lekgotla two weeks ago. Motsoaledi says he is unaware of such an agreement.
Last month Motsoaledi dismissed reports in City Press that the ANC and the DA had reached an agreement, and that a state-owned medical aid would be set up alongside private medical aids to boost competitiveness in the sector.
The latest developments around the contentious legislation add to the uncertainty around its implementation, as the limping health-care system continues to deteriorate.
The NHI Act was signed into law by President Cyril Ramaphosa on the eve of the 2024 general election. Since then, three court challenges have been launched against it. It is also opposed in its present form by business and civil society groups representing medical professionals, and rejected by the DA and other key partners in the GNU.
The FM understands that a further three court challenges on various aspects of the legislation are to be made in the coming months. The act has also not yet been promulgated by Ramaphosa.
Organised business made a submission to Ramaphosa containing alternatives to the plan late last year. A lobby group made up of 22 professional bodies in the medical sector, the Universal Health Care Access Coalition, has also entered the fray. It has developed an alternative to NHI which it believes will genuinely bring about universal access to health care.
The Progressive Health Forum is among its signatories. The forum’s Aslam Dasoo says NHI is doomed to fail, even if it is not struck down by a court — though he does believe it will be.
The coalition’s proposal could be implemented quickly and would reverse the deterioration and inequality in the present system. It relies heavily on the recommendations of the health market inquiry presented in 2020, which the government has largely sidestepped.
On the other hand, NHI is seen as a crucial policy for the ANC and is supported by powerful internal factions. Its implementation is being monitored closely by the party’s leftist allies, the SACP and Cosatu. The SACP last week demanded “immediate clarification” from the government of reports that a compromise on the legislation had been struck between GNU partners.
Significantly, the health minister is the strongest proponent of NHI. Motsoaledi told leaders at the World Economic Forum that his government is fighting a “big war” against opponents of NHI, who he said included “doctors’ groups”. Walking back on the plan would be unthinkable for him, given his push for it since he was first appointed to the health ministry in 2009.
Amid mounting opposition from the outside and agitation for quicker implementation from within the party’s ranks, can Ramaphosa craft a compromise over the contentious, arguably unworkable plan to fix South Africa’s ailing health system?
“The NHI will reduce inequalities in health care by ensuring everyone gets fair treatment.”
— Cyril Ramaphosa
In his state of the nation address last week, he was silent on a potential compromise.
“This year, we will proceed with the preparatory work for the establishment of the NHI. This includes developing the first phase of a single electronic health record, preparatory work to establish ministerial advisory committees on health technologies and health-care benefits, and an accreditation framework for health service providers.
“The NHI will reduce inequalities in health care by ensuring everyone gets fair treatment.”
He added that the government’s “immediate priority” is to strengthen the existing health system and raise the quality of care and patient experiences through reducing waiting times and improving cleanliness and staff attitudes in public health facilities.
Whether he can do so will be worked out in the coming months as the ministerial advisory committee gets to work on key areas contained in the legislation: health technologies, health-care benefits and an accreditation framework for health-care service providers.
While there does appear to be progress on removing contentious aspects of NHI, nothing is set in stone.
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