Mmusi Maimane. Picture: SOWETAN
Mmusi Maimane. Picture: SOWETAN

Opposition to health insurance reform intensified on Tuesday with the DA arguing that the proposed legislation may be unconstitutional.

The DA said it wants parliament to seek urgent legal opinion on the constitutionality of the “crippling” National Health Insurance (NHI) Bill.

Various groups, including the Free Market Foundation and SA Institute of Race Relations, have previously registered their concerns that NHI will effectively lead to the nationalisation of health services, and reduce efficiency. ​

Shares in the country’s biggest medical aid administrators continued to fall on Tuesday as details of the NHI Bill drove uncertainty in the market around the future of private healthcare. AfroCentric was down 4.03%; Momentum marginally better, down 2.19%; with Discovery having taken the biggest hit since Thursday last week, down 11.31% in late afternoon trade on Tuesday.

One of the more contentious aspects of the proposed legislation is the future role for medical schemes, which currently provide coverage to about 8.9-million people

Since the details of NHI were released last week, Discovery’s shares lost a total 16.22%, chopping about R13.5bn from its market capitalisation, which was sitting at R69.54bn on Monday. Discovery Health is SA’s biggest medical scheme administrator. ​

The bill will also throw into doubt the future of private medical aid schemes.

The bill, which was tabled in parliament late last week, will have far-reaching health reforms aimed at achieving the government’s ambition of providing universal health coverage. Its main aim is to launch an NHI Fund that will purchase health services on behalf of patients from public- and private-sector providers. This will be free at the point of care.

One of the more contentious aspects of the proposed legislation is the future role for medical schemes, which currently provide coverage to about 8.9-million people.

According to the bill, “once NHI has been fully implemented as determined by the minister through regulations in the [Government] Gazette, medical schemes may only offer complementary cover to services not reimbursable by the fund”.

The bill says NHI is to be phased in, and is to be fully implemented by 2026. 

DA leader Mmusi Maimane said during a news conference in parliament on Tuesday that after careful consideration of the bill the party is not satisfied that it will pass constitutional muster and will therefore be requesting parliament to seek a comprehensive legal opinion on its constitutionality.

“It appears that the NHI Bill proposes a system that provinces will not be able to opt out of. ‘Health services’, as defined, will be bought and determined at national level, with the minister of health effectively becoming the single authority over the health sector in the country,” said Maimane.

“On face value, it appears that the bill actively seeks to curtail this constitutionally granted shared power between national and provincial spheres of government, and we believe that the bill and the system that it proposes is overly intrusive on the constitutionally enshrined rights of provincial legislatures to also legislate on matters relating to healthcare.”

He said the DA’s view is that the government should radically improve public healthcare — which is free at the point of entry — while strengthening private healthcare by increasing competition within the sector. “Ultimately, the public health system needs to be at the same level of standard as the private healthcare system is. South Africans cannot afford a situation where it is simply a race to the bottom and their lives do not materially improve.”

‘Nationalisation of all healthcare’

The NHI Bill seeks to fundamentally alter healthcare policy in SA by creating a state-owned entity to consolidate all funds within the public and private health system, Maimane said.  

“This is the nationalisation of all healthcare in SA. Health minister Zweli Mkhize himself admitted that medical aids will most likely cease to exist under NHI.

“It is our view that, in its current form, the NHI Bill will not bring about universal healthcare but will consolidate power, cripple the private health sector and collapse our economy. At a conservative estimated cost of more than R250bn, the NHI is to the health sector what Zuma’s nuclear deal would have been to the energy sector,” said Maimane.

Citing the plunging share price of financial services group, Discovery, Freedom Front Plus MP Philip van Staden said the proposed legislation is already having a negative impact on SA’s economy. “With the unemployment rate currently at 29%, the concern is that the NHI will seriously restrict the functioning and survival of the 80 registered medical aid companies in the country and this will cause the unemployment rate to rise even higher, seeing as these medical aid companies will have to retrench personnel.”