The Ad Hoc Joint Committee on Parliament and Provincial Medical Aid Scheme met recently to discuss and adopt the Draft Strategic Plan and Draft Committee Programme documents for the implementation of the terms of reference regarding the review process of the Parmed Act of 1975.
Members agreed they need to take a closer look at the terms of reference in terms of tariffs, needs and options for members, impact on members, and the necessity to amend legislation. It was pointed out there is a lack of cohesion between the Parmed Act and Medical Schemes Act of 1998 and it was up to the Committee to decide if changes should be made or not.
The sticky point stems from Section 2 of the Parmed Act of 1975 which states that every person who is the member of the executive, member of the NA, judge of the Constitutional and Supreme Courts, member of the legislature, and any office bearer who is listed through the proclamation would be covered by the medical scheme. The Parmed Act stipulates that membership is compulsory.
On the other hand, Section 28 of the Medical Schemes Act limits membership to one medical fund, and it does not impose upon a person or prescribe to a person which medical aid to be long to. Concerns have been raised that members of parliament are not afforded an opportunity to choose for themselves the medical scheme they want to belong to. The Medical Schemes Act consolidates the laws that regulate medical aid schemes, and it sets the parameters of membership to a medical scheme in terms of Section 28.
The Committee was then taken through the life cycle of the legislation review or policy process, identification and management of stakeholders, and programme proposals. It was stated there is interest from other stakeholders and consultations would have to be made with the primary stakeholders. It was pointed out the Committee might not meet the deadline because the review process is structured and complex.
The Committee discussed if its lifespan should be extended, agreed to hold a workshop to engage affected stakeholders and those not directly affected to take scrutinise the policy reasons behind the compulsory membership to the medical scheme and see if reasons for the establishment of the Act could still stand.
Briefing by Legal Advisor
Dr Barbara Loots, Parliamentary Legal Advisor, informed the Committee the main issue or bone of contention is the compulsory membership to Parmed for public representatives and the high costs that go with the membership. This stems from Section 2 of the Parmed Act of 1975 which states that every person who is the member of the executive, member of the NA, judge of the Constitutional and Supreme Courts, members of the provincial legislature (who have an option), and any office bearer who is listed through the proclamation would be covered by the scheme.
She reminded the Committee that the Parmed Act is very old and was enacted in 1975. She highlighted that Parmed is a specific scheme that talks to a specific group of people, unlike the Medical Scheme Act of1998 that regulates other medical schemes that most people have got access to. She said the background she was presenting to the Committee would indicate to it who to bring in as a member of the public and where to make amendments.
The Medical Schemes Act is the general overarching piece of legislation and Section 28 of the Act states no person can belong to more than one medical aid scheme. There is a gap between Parmed and the Medical Schemes Act. The Parmed Act allows for full rules for exemptions. It makes provisions for exemptions. The rules of Parmed come back to be regulated by the Medical Schemes Act.
Dr Loots explained that the Committee had a very old piece of legislation which is informed by policies and reasons which they could no trace back accurately to a modern piece of legislation that tries to link up all the pieces and the puzzle doesn’t completely fit.
The question is for the Members to consider, in consultation with relevant people affected by Section 1 of Parmed Act, the policy reasons behind the compulsory membership to the medical scheme and see if reasons for the establishment of the Act could still stand. Members need to find out if the reasons for its enactment could be justified in terms of the needs of people being covered, and decide if it is relevant and could be aligned with the Medical Scheme Act.
She further suggested that Members have to take a closer look at the terms of reference in terms of tariffs, needs and options for members, impact on members, and the necessity to amend legislation. There is a lack of cohesion between the two pieces of legislation and it was up to the Committee to decide if changes should be made or not.
Briefing by Committee Staff
Mr Ludumo Sishuba, Committee Content Advisor, took the Members through the Draft Strategic Plan and Committee Programme, focusing mainly on the life cycle of the legislation review or policy process, management of stakeholders, and programme proposals.
Since the Parmed Act dates back to 1975 and has been amended four times, he reported that the process the Committee was engaging in was that of the legislation review. The Committee decided to adopt a three-pronged approach where research has to be undertaken, hold consultation with stakeholders and analyse input, and then do an evaluation of the process. The terms of reference deal with the MPs. He stated the legislation indicated there is interest from other stakeholders and consultations have to be made with the primary stakeholders. He pointed out the Committee might not meet the deadline because the review process is structured and complex.
He informed the Committee that consultations would have to start from August to October 2018. Already, during the month of May they have engaged with stakeholders and would continue to do so until July 2018. This process was dealing with governance of the structure review and highlights the stakeholder reference group. The process is being managed by Members who are affected. The reference group would comprise 2 members from the judiciary and 2 members from the legislatures to insulate the issue of interest and minimise conflict of interest.
In terms of managing the stakeholders, the draft document outlined the stakeholders that would be engaged with. It identified three types of stakeholders:
- Primary stakeholders (judges, provincial legislatures, retired law-makers and judges, executive, and Parmed)
- Secondary stakeholders (these are individuals or groups indirectly impacted by the legislation: Competition Commission, SALGA, Magistrates Commission, Medical Schemes companies, SARS, Fund Managers, Independent Commission for the Remuneration of Public Office Bearers, etc)
- Tertiary stakeholders (these are individual or groups not directly impacted by the legislation, but may have an interest because of their relationships with primary and secondary stakeholders: media, advocacy groups, research institutes, and interested citizens)
Lastly, he noted that the document was proposing that the currently underway programme of May to July 2018 should take into consideration of what is happening in the NA and NCOP. 14 June 2018 is penciled for the first briefing with stakeholders. Then 21 June 2018 is scheduled for briefing by judges, while t28 June 2018 is planned for the workshop with Council for Medical Schemes on strategic issues. These engagements, he said, are there to test assumptions.
DiscussionMr S Marais (DA) remarked that he does not understand the logic behind bringing in the public if the Parmed Act states that the medical scheme is a closed one. He did not have a problem if it’s an open scheme and accepts the public. He also found it difficult to understand how the reference group is going to be objective when it is benefiting from the scheme even though it has been brought in for impartiality. He further stated that when stakeholders are invited to make representations, the Committee needs to ensure it achieves its purpose and not allow people to re-invent what it has done.
Ms S Kaylan (DA) wondered if the tertiary stakeholders would have an impact on the legislation because they are not directly affected by the legislation. She also suggested the Committee must decide about the category for placing family members of the deceased. The Committee must decide if they would be placed in the tertiary category as interested citizens.
Ms B Dambuza (ANC) proposed that the planned workshop should be held before the Committee interacts with the Parmed Board so that Members are well versed about what is happening in the industry. It was good to learn that the terms of reference were recognising the MPs because many retired MPs were complaining about the medical scheme. The Committee needs to report to the Speaker’s Office that the reference group be included in the amendments. She added that the retired groups are organised and have their own voice that needs to be listened to.
Mr S Tleane (ANC) agreed with Ms Dambuza on the workshop idea, stating that information that would be gotten there would wisen them up and they would be able to contribute to discussions with the Parmed Board. There is a lot of wisdom to be gotten during the engagement to ensure the Committee makes sound decisions. He suggested the Chief Whip should be asked for an extension of time seeing that the content advisor pointed out the Committee might not meet the deadline due to the complexity of the review process.
Mr M Khawula (IFP) suggested research should be done on the proclamation for NCOP members because Section 1 of Parmed Act, from A – E, makes no reference to NCOP delegates.
Ms Z Ncitha (ANC) proposed that the invitation should be extended to the provinces because the majority of the beneficiaries are more than the MPs. She also stated it is not clear why SALGA is listed as a stakeholder and wondered if the plan is to recruit municipalities or just to get information to enrich the process because SALGA is not directly affected.
Mr H Chauke (ANC) suggested the proposed workshop be a stakeholder engagement workshop to engage key and organised stakeholders like former MPs to be fully represented in the medical scheme. He further stated the medical scheme should be opened up to the public because any law that was passed in Parliament has to take into account of the public interest. He also made it clear that they must be careful when they request for an extension because that means they would need to cut down on some of the planned engagements. One week should be identified for engaging with all the stakeholders.
Ms M Chueu (ANC) pointed out that consultations with other groups would be for making input, not to get information on Parmed. Consultations with such groups could be done during the identified week for engaging with stakeholders. The input from judges should be taken into consideration because they decide on how MPs should be remunerated yet the judges had Rolls Royce benefits. So, the Committee should be careful of the judges’ input.
Mr N Singh (IFP) stated it is important to see if the Act could withstand the test of time before the courts because it was established a long time ago under apartheid. It is imperative to look if they are obliged to become members of Parmed. He said he was relatively satisfied with Parmed, but they need to look at the law to see if it is binding.
Mr Tleane proposed their lawyers should be given a chance to look at the legal implications. Members should be allowed options to opt out and at the same time look at how Parmed could be transformed, and this would give the Committee an opportunity to make proposals to Parmed. This would make Parmed a friendlier animal than what it is currently.
Mr Chauke said the Committee needed to identify issues that were going to be packaged for the workshop. The workshop would be an eye-opener even for the way forward. He suggested Members should submit proposals for the workshop to the secretariat for preparations.
The Chairperson stated that Parmed is a closed scheme. It used to be highly subsidised by Parliament until it was changed by Judge Moseneke. She said Parmed is not a bad scheme, but the problem lies with the tariffs. The scheme only needs to give members an option.
Mr Marais cautioned that people who are going to make representations should not be allowed to add too much information or dilute the process to a point that the Committee loses track of its focus.
The Co-Chairperson urged the Committee to have a dynamic interaction with the stakeholders. The workshop would be conducted on 14 June 2018. Members are encouraged to forward paragraph submissions; this would make it possible to allow clustering of relevant stakeholders in one workshop to save time. Affected and potential members would be invited to the workshop. The constitutionality of Parmed would be checked by legal people because the tariffs are ridiculous, and the decision by Judge Moseneke would be reviewed because MPs are people with families. He noted that SA had the worst paid MPs in the world, but in the eyes of the public the MPs are getting a lot of money. Most people don’t know or see the work details of parliamentarians. They only see them falling asleep in Parliament and forget that parliamentarians work while other people are sleeping. Lastly, he said it is not clear whether to have tertiary stakeholders or not, but that would be decided by the outcome of the workshops.
The meeting was adjourned.
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