In nine months, up to two million low paid and economically vulnerable citizens will find themselves without medical insurance and will be forced to pay for medical expenses from their own pocket or rely on state resources. Many workers will have their rights under group personal accident policies unfairly curtailed. Their rights to healthcare guranteed under section 27 and their property rights under section 25 of the Bill of Rights will be taken away overnight. Michael Settas of KaeloXelus and Patrick Bracher of Norton Rose Fulbright presented a stark analysis of a grim healthcare future as the first step towards National Health Insurance (NHI) at a Free Market Foundation media briefing on 15 March. Gazetted in December 2016, the final demarcation regulations show a blatant disregard for ordinary people’s right to access healthcare and are based on the unsubstantiated claim that health insurance products are harmful to the medical schemes industry.
Drawing a line in the sand between medical insurance products and medical schemes the regulations come into force on 01 April 2017 and eliminate existing policies from 01 January 2018. Limited “gap cover” and “hospital cash plans” will still be allowed but primary healthcare insurance policies will be banned. The consequence is that up to two million policyholders who have exercised their freedom of choice and rights to obtain primary healthcare through affordable insurance products, will suddenly be uninsured.
Free Market Foundation director, Jasson Urbach said, “Drip by toxic drip the government is destroying the private healthcare sector to prepare the ground for the full introduction of NHI. With the demarcation regulations, the government is making a concerted effort to attack the medical insurance sector by marginalising the funding vehicles as a means of removing lower income earners’ access to insurance. These products were created specifically to provide a means for poorer people to access private medical cover after the introduction of the Medical Schemes Act in 1998”.
Bracher added, “Accident and Health products amount to “property” for the purposes of section 25 and the regulations are potentially in breach of the Constitution. No-one should be deprived of property except in terms of the law of general application, not a law targeted at some medical insurance policyholders. And no-one should be deprived of property arbitrarily without compensation – there is no recourse for anyone who has paid a short-term premium for the last 15 years who is now deprived of their existing cover”.
The demarcation regulations are government interference in mutually agreed private contracts between freely consenting adults and insurers to minimise their risks of huge medical bills when catastrophe strikes.
Despite clear evidence that SA cannot afford NHI and that government infrastructure, medical practioners and the ability to effectively manage NHI are badly lacking, Health Minister Aaron Motsoaledi is pressing ahead in the face of industry opposition. Treasury is struggled to raise an additional R 28 billion in this year’s budget so the estimated price tag for the NHI of R 200 billion is pure fantasy. Yet the private sector continues to be marginalised.
The Department of Health has requested that the Council for Medical Schemes (CMS) grant a limited two-year exemption period for primary healthcare providers who submit themselves to regulation under the Medical Schemes Act before existing primary healthcare insurance policies are banned so that the department can conduct further research into the development of low-cost medical scheme benefit options (LCBOs). However this is a 10-year old discussion and further delays are expected.
Settas posed fundamental questions for the architects of NHI including why is the right to primary healthcare being abolished and why is NHI being driven through without waiting for the outcomes of the Competition Commission’s Healthcare enquiry?
“Not only does NHI face formidable challenges in funding, there is a severe shortage of healthcare providers, a massive disease burden and a blundering bureaucracy”, said Settas and that by extrapolating existing conditions, under NHI, you will have to wait to see a dentist once every 16 years.
Government should not attempt to provide free cover for all citizens but should focus on those who cannot afford medical insurance and leave those who can to the private sector.
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