Health minister Aaron Motsoaledi. Picture: THE SOWETAN
Health minister Aaron Motsoaledi. Picture: THE SOWETAN

The cabinet has rejected the fiercely contested National Health Insurance (NHI) bill, sending it back to the health department for further work, it emerged on Thursday.

The bill paves the way for far-reaching health reforms aimed at achieving the ANC-led government’s ambition of providing universal health coverage. Its main aim is to establish an NHI fund that will purchase health services on behalf of patients from public- and private-sector providers, which will be free at the point of care. A key aspect of the bill is the future role it envisages for medical schemes, which currently provide cover to about 8.9-million people.

The bill has been mired in controversy in recent weeks, after a leaked Treasury letter laid bare conflict between its officials and presidential adviser Olive Shisana after she reversed aspects of the bill previously agreed to by the ministers of health and finance. The Treasury raised a host of concerns, ranging from the sharply diminished role of medical schemes laid out in the revised version of the bill to a lack of consultation about far-reaching proposed changes to the role of provincial health departments.

Shisana heads the NHI "war room" in the presidency, which took control of the NHI process in August.

Shortly after the Treasury letter was leaked in mid-November, health director-general Precious Matsoso went public with her concerns, saying she had been completely sidelined in the process of revising the bill after the public comment period close, despite being the department’s accounting officer. The bill was redrafted by Shisana and two people selected by health minister Aaron Motsoaledi — his adviser, Aquina Thulare, and deputy director-general Anban Pillay.

Without directly alluding to it, a statement issued on behalf of the cabinet on Thursday made it clear that it had not approved the bill for submission to parliament at its latest meeting on Wednesday. It was not on the list of bills and policies approved for public comment, nor was it on the list of draft legislation that had been given the green light to enter the parliamentary process.

Presidential spokesperson Khusela Diko confirmed the bill came before cabinet on December 5 and had not been approved. "It will be finalised in the New Year," she said. 

She declined to elaborate on the cabinet’s concerns about the bill, saying she was unable to comment on the processes.

Attempts to obtain comment from acting cabinet spokesperson Phumla Williams were unsuccessful on Thursday.

Motsoaledi’s spokesperson, Popo Maja, declined to comment on the cabinet’s deliberations or the status of the NHI Bill, as did finance minister Tito Mboweni’s spokesman, Jabulani Sikhakhane.

Motsoaledi had previously defended the government’s approach to crafting the bill, saying that there had been nothing irregular in the manner in which it was being being processed.

kahnt@businesslive.co.za