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NHI Bill vote delayed amid backroom political twists and last-minute business lobbying

NHI Bill vote delayed amid backroom political twists and last-minute business lobbying
From left: Health Minister Joe Phaahla. (Photo: Leila Dougan) | (Photo: Leila Dougan)

When at the last moment Wednesday’s National Council of Provinces vote on the controversial National Health Insurance Bill was delayed for a week, the door for further engagements opened. It’s understood some background discussions are already under way.

That something was up became clear when the National Council of Provinces (NCOP) was running 10 minutes late on Wednesday. It takes a little bit of time to prep the deferment motion that was announced in the chamber.

The vote on the National Health Insurance (NHI) Bill that seeks to introduce universal public healthcare in SA is now scheduled to be held on 6 December. And that vote must happen, regardless of the political twists and turns that were on display on Wednesday afternoon. 

At this stage of the legislative process, few options exist. 

One would be to withdraw the NHI Bill entirely — a political impossibility ahead of the 2024 elections when the governing ANC alliance partners are actively demanding the NHI. 

Or the Bill may be rejected in the NCOP — again a political pickle, and difficult unless the ANC changes its stance, given that eight provinces declared their support for the Bill on 21 November. If that happens the Bill will be sent to the mediation committee to potentially linger for years, like the 2018 National Gambling Amendment Bill — again, politically unpalatable in the run-up to next year’s elections.

If the Bill is approved in the NCOP next week, it will be sent to President Cyril Ramaphosa to be signed into law — or to be returned to Parliament according to section 79 of the Constitution because of concerns over the legislation’s constitutionality, or defects in the process, such as inadequate public participation and consultations.

Read more in Daily Maverick: ANC gets its ‘revolutionary’ NHI legislation adopted despite opposition criticism and likely litigation

The NHI Bill would not be the first to be returned to the national legislature. The Expropriation Bill was returned twice, in 2016 and 2018, and will now come before the NCOP on 7 December. According to the Parliamentary Monitoring Group, since 1994 a total of 18 Bills were returned to Parliament by various presidents.

The possibility of the NHI Bill being returned to Parliament was signalled  on Wednesday when, at a media briefing, Presidency spokesperson Vincent Magwenya was asked about the Bill and organised business’s eleventh-hour lobbying. 

Magwenya confirmed business had reached out to Ramaphosa.

“Concerns have been expressed directly to the President,” he said, pointing out the President had a constitutional duty to properly consider and apply his mind before signing this Bill, or any legislation, into law. Petitions may be sent, and previously have been sent, to a President as part of this process.

The presidential spokesperson noted, “The passing of the Bill does not necessarily mark the end of the process.”

A day earlier, on Tuesday, organised business in the form of Business Unity South Africa (Busa) and Business for South Africa (B4SA) said they had appealed for a delay in the vote in letters to Parliament’s presiding officers and Deputy President Paul Mashatile, in his capacity as leader of government business, or the liaison between Cabinet and Parliament.

‘Utterly unimplementable’

“For the National Assembly and the NCOP to disregard proposed amendments that will have a beneficial and tangible impact on citizens, or indeed would prevent harm to citizens, in the interest of rushing the Bill through Parliament, is unconstitutional. It makes a mockery of due process and portrays the NCOP as nothing more than a rubber stamp,” said Busa CEO Cas Coovadia in a joint Busa-B4SA statement.

Describing the current Bill as “utterly unimplementable”, organised business pointed out no money existed to implement the new public health proposals.

Read more in Daily Maverick: National Health Insurance roll-out one step closer, but private healthcare has burning questions

Controversially, the NHI Bill not only sets down a compulsory referral system for patients, who would no longer choose their GP; it also limits private medical aids to services not available in universal public healthcare. The law would end private medical schemes once the NHI system was fully implemented, according to section 33.

Wednesday afternoon’s twists and turns highlight the complex political dynamics when the realities of governance in South Africa’s brutal economic scenario clash with blunt political instructions to push through a law — also against parliamentary legal advice and health department proposals — to clinch upcoming voting support.

Daily Maverick learnt the letters from Busa and B4SA were acknowledged. The role of those letters emerged when the DA leader in the NCOP, Cathy Labuschagne, gave a rundown of the political machinations on Wednesday afternoon.

Even though the NCOP chief whip, ANC delegate Seiso Mohai, on Tuesday evening called for a debate on the NHI Bill — a great PR moment to play to ANC alliance partners Cosatu and the SA Communist Party — with 30 minutes to go on Wednesday it was a different matter.

“By 1.30 pm we were urgently called to a whips’ meeting… The chairperson of the NCOP had requested for the Bill not to be debated,” Labuschagne said.

DA Chief Whip Siviwe Gwarube sharply criticised this turn of events. “It’s unthinkable the national legislature is dictated to by some mysterious forces. It can not be that at the 11th hour an order is removed … on the basis of a letter that the NCOP chairperson refuses to share,” Gwarube said. 

If the NHI Bill is passed, the DA will petition the President to refer it to the Constitutional Court to test its constitutionality. And if that did not happen, the DA would try to rally a third of MPs in the National Assembly to themselves go to the Constitutional Court for such an assessment under section 80 of the Constitution, according to Gwarube.

As a last resort, lawyers have been briefed and DA court action was set to unfold. 

The rescheduling of the NHI Bill vote to next Wednesday was described as “programming-related issues” by Parliamentary spokesperson Moloto Mothapo in a text message. “Such rearrangements are not uncommon as part of parliamentary programming,” he added.

Read more in Daily Maverick: There are paths to quality universal healthcare besides NHI

Effectively, a week has now opened up for further consultations and engagements even if just to tell organised business to calm down and stand down.

Busa and B4SA on Wednesday afternoon welcomed the deferment. “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 ‘deeply dismayed’

Cosatu, however, was “…deeply dismayed government wilted like a cheap suit under pressure from a little bit of lobbying by business”, according to its statement.

“We need government to speak with one voice as this level of policy uncertainty is not helpful. The ANC needs to exert itself and remind government and the NCOP that the NHI is an ANC policy mandate, not some seasonal slogan,” the labour federation said in its statement, with a reminder the overwhelming majority of workers are in support of an NHI.

The NHI Bill has been in the making for four years in Parliament but dates back to the ANC’s 2010 Durban National General Council when the decision in principle was taken to change South Africa’s health system to universal health access.

A key motivation then, and still today, is that only about 15% of South Africans are members of private medical aid schemes, which forms the basis of a highly unequal healthcare system. While in recent years cheaper medical aids have hit the market, the sign-up rates have remained level.

To date, the NHI Bill has not been costed, although it’s estimated to require R450-billion a year. Some have argued it would require a 3 percentage point hike of value-added tax (VAT).

To date, Budgets have set aside only a few hundred million rands to prepare for implementing NHI. This comes as the government’s own assessments show the overwhelming number of health facilities fall short of cleanliness, patient care, friendliness, management and other standards.

On December 6, the NHI Bill’s next steps will emerge. Regardless, the complex political dynamics in the run-up to next year’s elections against tough economic realities make for difficult decisions. DM

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Comments - Please in order to comment.

  • JOHANN SCHOLTZ says:

    NHI will be the end of SA as we know it. I have nothing against the concept of universal healthcare, but it needs to be properly implemented and managed. The ANC have failed at everything. Why will this be any different? Universal healthcare costs multiples of the numbers they are talking about. In European countries spending on healthcare takes up a third of budgets. Those countries have a wide taxbase. What will happen in SA is that it will become like so many other areas, education, security, electricity for which you are taxed without receiving a service. This will likely be the final straw for many. Expect the steady trickle of people leaving the country to become a stream. Healthcare professionals especially will be leaving in their droves.

    • Janet Sully says:

      I agree. The steady trickle of tax paying citizens will become a faster flowing departure of people. So the tax base will get even smaller than it is now. Please fix the existing hospitals & clinics, get them back up to acceptable standards of cleanliness & hygiene, fix all broken medical machines, stock up the pharmacies, buy new ambulances & get them kitted out properly, open up the nursing colleges that this govt short-sightedly closed, use the estimated billions of rands to fix up what exists. Then let us talk about national health care.

      It is really about the potential cash cow that is the goal with this NHI bill. And it is not going to be used for health care. We all know that. And the govt also knows that. Where will the ministers & families go for health care??? Certainly not in a govt hospital. (Like the children of ministers are not going to govt schools – private schools are the norm).

      Let us see the ministers begin using govt hospitals & clinics right now, in the state they are in, then perhaps we might believe their sincerity when they say this NHI bill is for the benefit of ALL of the people of this country. Let the union bosses (who are so disappointed right now), stop paying their medical aids and go to govt hospitals for treatment. As the saying goes, put your money where your mouth is

  • Jon Quirk says:

    How can any responsible government, of any country, even countenance the passing of an uncounted bill, that even at a casual glance is clearly totally unaffordable?

    The honest government would come clean and say wish lists are not policy, and can never be. We will reconsider it at a time when we have unemployment down from the present 50%, a far more accurate assessment than the govt, stats of 38%, the economy is healthy and debt is under control at less than 60% of GDP.

  • Louise Louise says:

    “utterly unimplementable”

    The only conclusion one can come to about why this NHI illusion still exists, is that it is designed to destroy society even further. There is no other conclusion because this is precisely what it will do. This government is committing treason by the very act of trying to implement this insane bill/act because it is acting AGAINST the interests of millions of South Africans and IGNORING the catastrophe that exists in the “health” service today.

  • Thug Nificent says:

    The ANC government is USELESS!

  • Willem Boshoff says:

    I have no doubt that if this ill-conceived bill becomes reality the COSATU and ANC bigwigs who are pushing it through will not be standing in queues with the rest of the people. It’s been said in the comments and I will reiterate: if private medical care gets the bullet professional people will leave SA in droves. This will be worse for the South African economy than Eskom and Transnet combined. We’re voting for our lives in 2024 and we better vote!

  • Beyond Fedup says:

    What a sick joke! These incompetent and useless morons, AKA anc, couldn’t run a bath without screwing it up! Fix the current healthcare and hospitals as a start and then lead by example i.e. no more private healthcare for all government employees, mayors, DGs, ministers, Cyril the spineless as well etc. No more overseas trips for healthcare like the obnoxious Zuma, Mabuza & co. They follow in the rotten footsteps of Mugabe, who having destroyed their own healthcare in their country, travel to SA, Moscow and Singapore. Like everything these anc criminals lay their voracious, inept and predatory hands on, it will be another huge revenue stream for the elite and cadres to plunder and exploit – like just every SOE and then leave a wasteland and much misery/poverty behind. You can never trust this bunch of thieves and hyenas!!

  • Lynda Tyrer says:

    I wonder if all those in favour of NHI understand they too will no longer have the right to say who or where they will receive their medical treatment. Do they think hospitals will have special wings for them with special doctors and that they can jump the queues. I doubt the defence force medical section would be able to handle all the thousands of govt employees and officials for special treatment or are they all going to fly to Russia at the taxpayers cost each time ?

  • Geoff Coles says:

    Budgets for a few hundred million prepared…. but is there cash even for that

    • D Rod says:

      There will print it – mark my words…. When populists get into government (and they will) that is what they will do. It happened over and over even in countries whihc have much higher voter IQs (not being funny – check where we stand globally in terms of IQ)

  • Beyond Fedup says:

    I for one will cancel my medical aid as I want no part of it where my contribution goes to the government, like our taxes, which are treated as personal ATMs by this thieving, monstruous and parasitic government. SA will lose it doctors, specialists etc. and many citizens who will simply move overseas. As right thinking citizens, NGO’s, business etc., we have to fight for our rights and take it all the way to the Constitutional courts to prevent this wholesale destruction and theft by a parasitic, corrupt, and rapacious criminal mafia posing as government. NB – I am not anti universal healthcare per se – we simply can’t afford it and it can NEVER be left in government or their stooges’ hands.

  • Rae Earl says:

    Typical of this clown fraternity (ie ANC cabinet) who think they know better that the experts while actually having no clue about the damage they’ll do with this legislation. The NHS in the UK was run by a very much better informed population than we have; despite this the NHS is next to useless with people waiting weeks or even months for critical surgery or medical care. At the estimated R425 billion a year to run the NHI the greedy and crooked political elite are slavering at the thought of using this new cash cow to continue and increase their living the high life on the proceeds of open theft from extracted from the citizens of SA. What a disgusting attitude.

    • Alan Paterson says:

      There are indeed problems in NHS and this relates in part to remuneration and staff numbers. Next to useless for the NHS is a bit excessive. I have worked for the NHS and, for example, in my field there are seven adult liver transplant centres and three paediatric units doing over 800 transplants annually. South Africa has two, one mixed adult/paediatric the other paediatric performing about 60 to 70 annually. For similar population numbers there are over 140,000 NHS doctors from GP to specialist compared to maybe 35,000 in South Africa. They qualify over 8,000 new graduates annually, for us just over 2,000. Medicine is increasingly labour intensive. Patients wait weeks or months in UK for medical procedures. Our wait lists run to months, years or never in the public sector. Finally with respect to staff numbers, the NHS is looking to fill a shortage of over 6,000 and this is just general practitioners.

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