National Health Insurance (NHI) Bill: Motion of desirability
Documents
Media Statement: Health Committee Votes In Favour Of Motion Of Desirability Of NHI Bill
Meeting Summary
NHI: Tracking the bill through Parliament
In this virtual meeting, the Portfolio Committee on Health considered the motion of desirability on the National Health Insurance (NHI) Bill [B19 - 2019]. The Bill was tabled in Parliament and referred to the Committee on 8 August 2019. The National Health Insurance Bill sought to provide for universal access to health care services in the Republic in accordance with the Constitution of South Africa, 1996. The NHI Bill envisages the establishment of a National Health Insurance Fund and sets out its powers, functions and governance structures.
The Committee voted in favour of the motion of desirability of the NHI Bill, with seven members voting in favour of the motion and four members rejecting the motion.
As a result, the Committee will proceed with the Bill and schedule meetings to process the Bill clause by clause.
After the vote, the Alternate Members of the Committee were given an opportunity to comment on the motion as they did not have voting rights. A Member of the ACDP stated that her party rejected the NHI Bill. She argued that the state lacked the institutional capacity to procure in a transparent and effective fashion, as was highlighted throughout the Covid crisis. A Member of the DA indicated that her party rejected the Bill as it would not reach its intended objectives. It was not compliant with key Constitutional principles or rights. A Member of the EFF noted that in its current format the EFF rejected the Bill. The EFF was of the position that the NHI Bill primarily sought to enrich the privately-owned healthcare sector. The country was being misled. The Bill was a disingenuous attempt at dealing with the collapsed healthcare system. The NHI would not resolve the crisis of infrastructure of public facilities in rural and township areas. It would merely open the gates of private hospitals at a higher cost. Government intended to outsource its duty, to provide healthcare, to the private sector.
Meeting report
The Chairperson welcomed the Members of the Committee to the meeting.
The Chairperson welcomed Mr Xaba (ANC) as a new Member of the Committee.
The purpose of the meeting was to consider and adopt the motion of desirability of the NHI Bill. The Committee was also to consider and adopt the minutes of 20 April 2022 and 4 May 2022. Announcements would be made at the end of the meeting.
The Chairperson reminded the Members that this virtual meeting was deemed to be a precinct of Parliament and therefore constituted a meeting of the Committee of the National Assembly, for official purposes only. He noted that the rules for virtual sittings and the rules of the National Assembly applied.
The Chairperson asked for the motion to be displayed.
Consideration and adoption of the motion of desirability of the National Health Insurance (NHI) Bill
The Chairperson noted that a motion had been developed. The Chairperson would read through the motion. At the end, he would ask the Committee Secretary to read through the list of Members who were eligible to vote in the Committee. Members would be asked to state whether they supported or did not support the motion.
The Chairperson read through the motion.
The National Health Insurance (NHI) Bill [B19 - 2019] was tabled in Parliament and referred to the Committee on 8 August 2019. The National Health Insurance Bill seeks to provide universal access to health care services in the Republic in accordance with the Constitution of South Africa, 1996. The NHI Bill envisages the establishment of a National Health Insurance Fund and sets out its powers, functions and governance structures. In facilitating effective public participation on the NHI Bill, the Committee conducted nationwide, in-person public hearings in all nine provinces, from 26 October 2019 to 24 February 2020. The public hearings were attended by 11 564 members of the public and various stakeholders across 33 district municipalities. A total of 961 oral submissions were heard by the Committee during these hearings. Additionally, the Committee conducted virtual public hearings from 18 May 2021 to 23 February 2022. The Committee received oral submissions from individuals and various groups. In addition to the provincial and virtual public hearings, the Committee received approximately 338 891 written submissions from the public. The written submissions were submitted electronically, via email, and in hard copies. National Assembly Rule 286(4)(i) required that the Committee must consider a motion of desirability on the subject matter of the Bill.
Read full Report: ATC220518: Report of the Portfolio Committee on Health on the National Health Insurance Bill [B11 -2019], dated 18th May 2022
Ms M Sukers (ACDP) said that as an Alternate Member, she did not have voting power in the Committee, but she would like to have the opportunity to be heard once the voting had taken place.
Dr S Thembekwayo (EFF) asked that after the voting had taken place that the Chairperson allow Ms Chirwa to engage on some matters on the NHI Bill.
Mr P Van Staden (FF+) commented on point 7 of the document presented, which was about the 338 891 written submissions which had been received from the public. He had asked a question in February in this Committee and had not received an answer. How were Members going to have access to those submissions that were handed to Parliament via email or in hardcopy? How many submissions were for or against the Bill? He had also asked a question on what happened to the written submissions with the fire in Parliament? The Committee needed some clarity on that matter.
Ms N Chirwa (EFF) said that Dr Thembekwayo had addressed what she wanted to raise.
Mr T Munyai (ANC) said that the Chairperson had provided very clear guidance on what needed to happen going forward. The Chairperson had said that after he presented the motion, the Committee Secretary would clarify who was eligible to vote in the Committee. That had not yet been clarified. He would appreciate if that happened.
Ms E Wilson (DA) said that she was not sure what procedure was being followed now. There were many Members who wanted to comment before the voting took place. She asked that the Chairperson put the Members on a list because she also wanted to say something.
Ms H Ismail (DA) asked that she be allowed to comment on the motion after the voting had taken place as she was an Alternate Member of the Committee.
The Chairperson said that today the Committee was only voting on the motion of desirability of the Bill. It would do one of two things. If the Committee voted that the Bill was not desirable, then it would have to go back to the National Assembly. The Committee would have to provide a record of what had transpired. The Committee would then have to indicate to the National Assembly that the Committee had decided that the Bill was not desirable. Should the Committee vote in favour of the desirability of this Bill, then it would move to the next step. All the documentation that the Members requested, all the reports that had been written and the Bill itself would be forwarded to all the Members. Members would be able to access the documents through the Committee Secretary. The next process would start. That process was the clause-by-clause deliberations on the Bill. That would be a physical meeting so that the Members would be able to see each other after a long time and so that the Committee could start this process in a particular manner. That was the next step that would happen after the voting. The Committee would sit and go through the Bill clause by clause. All the inputs of all the Members would be taken on all the clauses of the Bill. Today’s meeting was one of the processes which took place to give the Committee an understanding of what it would do next with the Bill. It was one of the standard procedures of Parliament. Today did not allow for discussion before the voting. The Committee would go straight into the voting. Thereafter, if Members still wanted to raise comments then the members would be welcome to do so. Comments could be raised after the voting.
The Chairperson asked the Committee Secretary to read through the list of Members who had voting rights. Members would be called on one by one and would say if they were in favour or not in favour of the Bill. The Committee would then follow the next process as it went along.
The Committee proceeded with the voting of the motion of the desirability of the Bill.
The Chairperson voted in favour of the motion on the desirability of the Bill.
Mr Munyai voted in favour of the motion on the desirability of the Bill.
Ms Gela voted in favour of the motion on the desirability of the Bill.
Dr X Havard (ANC) voted in favour of the motion of the desirability of the Bill.
Mr E Siwela (ANC) voted in favour of the motion on the desirability of the Bill.
Mr N Xaba (ANC) voted in favour of the motion on the desirability of the Bill.
Ms M Clarke (DA) rejected the motion on the desirability of the Bill.
Ms Wilson rejected the motion on the desirability of the Bill.
Dr S Thembekwayo (EFF) rejected the motion on the desirability of the Bill.
Ms M Hlengwa (IFP) voted in favour of the motion on the desirability of the Bill.
Mr Van Staden rejected the motion on the desirability of the Bill.
The Committee Secretary tallied the votes. Seven Members voted in favour of the motion. Four Members rejected the motion.
The Chairperson said that the motion on the desirability of the Bill was adopted by the Committee. He thanked Members for voting.
The Chairperson noted that there were Members who wanted to raise some points after the voting. He would provide those Members with an opportunity. He said that earlier on he had not heard what Dr Thembekwayo had said.
Dr Thembekwayo said that Ms Chirwa wanted to comment. The permanent Members had an opportunity to vote either in favour or to reject the motion. She asked that the Chairperson allow the Alternate Members an opportunity to speak and exclude the permanent Members from the discussion.
Ms Wilson said that she objected to that proposal. She did not want to be turned away from commenting.
Ms Gela said that the permanent Members also had a right to speak in the Committee.
Dr Thembekwayo said that the permanent Members’ views had already been recorded.
The Chairperson said that he agreed with Dr Thembekwayo. There was a process after the voting, as he had explained earlier. He would only give the Alternate Members an opportunity to comment on the motion. Then the Committee would go to the minutes of the previous meetings, for consideration and adoption. The Committee would have a lot of time together to discuss what it was planning to do in the future with the Bill. The Chairperson thanked Dr Thembekwayo for the insightful comment.
Ms Sukers said that given the ACDP did not have a voting Member on the Committee it wanted to record its total rejection of this Bill. The state lacked the institutional capacity to procure in a transparent and strategically effective fashion, as was highlighted throughout the Covid crisis. This was evidenced by the late procurement of vaccines. No consideration was given to the procurement of ethically derived vaccines. The Department had ignored legitimate concerns. There was a lack of attention to therapeutics. She noted the debacle of the missing No-Fault Vaccine Injury Fund, which she had put in letters to the Chairperson. She and the Committee were seeking answers in vain. These incapacities had led to an unprecedented distrust in the Department. This was evidenced by the over 200 000 comments on the Health Regulations. The last time she checked it was 300 000. Added to this was the corruption that was the consequence of an incapable State. The inflationary impact of the Bill in a post-Covid environment had not been calculated. The taxpayer could not be further burdened at this time. Money could not be funnelled into a Department that was synonymous with corruption, where the previous Minister had to step down because of corruption. A prerequisite of the NHI was the transparent reform of the Department and provincial departments, under the scrutiny and control of communities. That was the prerequisite. The communities themselves needed to have control.
The Chairperson said that there was another process that was to follow where the Committee would be able to have endless deliberations on the Bill clause by clause. He did not want anything said to provoke any Member. In the interest of fairness, the Alternate Members were being allowed to say a few things. In the next step in the process, all the Members of the Committee would participate. He asked that the Members accept his ruling. He had agreed with Dr Thembekwayo that he would only allow Alternate Members to comment.
Ms Ismail said that the DA rejected the Bill. The Bill would not reach its intended objectives. It was not compliant with key constitutional principles or rights. She would reserve all other inputs for when the Committee went through each clause of the Bill. The DA totally objected to the Bill.
Ms Chirwa thanked the Chairperson for the opportunity given to Alternate Members. She expanded on the EFF’s rejection of the current Bill. In its current format, it was presented under the guise of achieving universal healthcare coverage that was not mired by the separation of quality between the public and private healthcare sectors. However, the EFF was of the position that the NHI Bill primarily sought to enrich the privately-owned healthcare sector at the compromise of the people of South Africa. Contrary to popular belief, the country was being misled. The Bill was a disingenuous attempt at dealing with the collapsed healthcare system. The NHI would not resolve the crisis of infrastructure of public facilities in rural and township areas. It would merely open the gates of private hospitals at a higher cost. Government intended to outsource its duty, to provide healthcare, to the private sector. This would result in permanent excess by the private sector into the coffers contributed to by the South African people with no evident transformation of the healthcare system to the benefit of the poor. People in rural settlements and township areas would still be exposed to the current public healthcare facilities as the NHI referral system stipulated in the Bill people had to go to the nearest healthcare facility for medical intervention. This would effectively mean that the NHI stood to benefit only those in cosmopolitan and urban areas. People who already afforded their own healthcare through medical aids. While the poor would still utilise the debilitated facilities in redundant and abandoned areas and provinces. Persons living in remote parts of rural provinces with a low footprint of private healthcare facilities would still be required to travel for hours to access healthcare facilities that were capacitated enough. The NHI was not for the poor. It was for the rich, those living in cosmopolitan areas and those who acquired profit in the private healthcare sector. A healthcare system that depended on the private sector to make decisions of integrity when it pertained to money and health was doomed from the start. Persons who utilised private healthcare had heaps of evidence to prove that the priority in these institutions was profit and not primarily healthcare. The private sector spent R250 billion to cater for the needs of 10% of the population. This was almost equal to the amount of money spent on the public sector which catered for 80% of the population. The NHI failed to outline the possibilities of pooling adequate funds for this purpose as what was currently spent needed to be exponentially increased to the benefit of the private sector and not achieve universal healthcare coverage. This cost did not centre the poor in rural and township areas. The EFF supported the pooling of funds for the purpose of directing those funds into the betterment of infrastructure and attaining medical equipment as the maintenance of vital equipment remained a challenge to date in public facilities. The EFF supported the pooling of funds with the intention of ensuring that more hospitals and clinics were built that opened and functioned for 24 hours and seven days a week in rural townships and informal settlements. Primary healthcare prevention education is needed to become the pillar of the healthcare system. The NHI did not offer the benefits of universal healthcare coverage for the poor. It was an extension of existing funds to the pockets of private owners of healthcare facilities. The EFF rejected the NHI Bill in its current format.
The Chairperson said that what had just happened was not what was intended. He knew that the other Members were now provoked to respond but it would be wrong for the Committee to go down that road today. There had been a particular purpose for this meeting. There were those Members who said that they were in favour of the motion and there were those who said that they were against the motion. He had not stifled any inputs. He had allowed even the Alternate Members an opportunity to say something which was not even initially intended. He asked the Members to not misconstrue what he was doing. He ruled that there would be no more talk on the matter. The matter was closed. The Members would have an opportunity and would be informed of the next meeting timeously. The Members would have to look at the online systems, in response to Mr Van Staden. All the documents would be found on the online systems. The Chairperson informed Members that he had talked with the Committee Secretary the previous day about forwarding the different reports to the Members. The Members would also receive another copy of the NHI Bill.
The Chairperson asked the Committee Secretary to flight the minutes.
The Chairperson reiterated that the purpose of today’s meeting was not for the Committee to deliberate on anything pertaining to the Bill.
Consideration and adoption of minutes of the meeting of the Portfolio Committee of Health on 20 April 2022
The Chairperson took the Committee through the minutes.
Ms Gela moved for the adoption of the minutes.
Mr Siwela seconded the adoption of the minutes.
The minutes of the meeting of 20 April 2022 were adopted.
Consideration and adoption of minutes of the meeting of the Portfolio Committee of Health on 04 May 2022
The Chairperson took the Committee through the minutes.
Mr Van Staden moved for the adoption of the minutes.
Ms Gela seconded the adoption of the minutes.
The minutes of the meeting of 04 May 2022 were adopted.
Other matters
The Chairperson announced the visit of The Elders on 25 May, next week Wednesday. There was an agreement with the presiding officers of Parliament for the meeting to be held in a special boardroom in the Taj Hotel next week Wednesday at 17h30 pm. It would be a physical meeting and the Chairperson hoped that the Members would avail themselves to attend the meeting. Parliament would be attempting to move some of its meetings to be physical, in-person meetings. The Elders would be addressing the Committee on its understanding of health systems. It was a good opportunity for the Committee to see how things worked in other countries. The Chairperson noted that at some stage the Committee would hold a meeting to deal with all outstanding matters.
The meeting was adjourned.