Health minister Aaron Motsoaledi has rubbished claims that National Health Insurance will cost South Africa over R1 trillion to fund—and says the government won’t budge on laws choking private healthcare funding in South Africa.
Speaking to Bhekisisa in an extensive interview this week, the minister clearly laid out his position on several hot-topic issues around the NHI that have been floating around since the NHI Act was signed into law ahead of the 2024 elections and his appointment following the formation of the Government of National Unity (GNU).
President Cyril Ramaphosa signed the NHI into law two weeks before the election, but his party, the African National Congress (ANC), lost its majority in the election soon after.
The ANC was forced to enter into a GNU with a host of other parties, including the DA, IFP and others who are fully against the NHI.
Motsoaledi does not seem to be shaken or deterred by this twist of fate, however.
Speaking to Bhekisisa, the minister said that GNU is not an alliance and that the partnership is opt-in – meaning anyone who is opposed to the NHI—which is government policy—could always elect to leave.
“When we went into the Government of National Unity, we knew very well who we were going with. No one said that people who go into the GNU are alliance partners,” he said.
“We are not in an alliance with the Democratic Alliance. We just went into a government of national unity with them because the situation demanded it. We know (their) policies are market-related and business-related. We knew there would be such contradictions.
“We will sit down with them and resolve them. If anybody believes that, because of this ‘misunderstanding’, the government of national unity must collapse, then that will be very unfortunate, but what can we do? That will have been their choice.”
Medical aids are out
When it comes to the question of universal healthcare, the minister said he is willing to listen to anyone who has ideas or proposals for healthcare reform.
Those who have said they support universal healthcare but not in the form of the NHI, “In which form do (they) want it? I want to listen, maybe I can learn something that I never knew about,” he said.
However, repealing the Act or talking about removing section 33—which is related to medical aids—is not part of this.
“I won’t sit with anyone who does not want any reform of healthcare financing. That will be a complete waste of time,” he said.
Section 33 of the NHI Act explicitly and concertedly moves to remove medical aid in South Africa as they currently operate.
While the Act doesn’t eliminate medical aids in South Africa entirely, it severely reduces their involvement in healthcare by stating that, once the NHI is in effect, they cannot cover anything the NHI covers.
This reduces their role to top-up funding for unknown extra services sometime down the line. This won’t be immediate, and everything is still muddied and obscure—a testament to how vaguely the NHI Act has been worded.
According to the Act, only once the NHI is “fully implemented” will medical aids not be able to provide cover for services that are paid for by the NHI.
As it stands, however, there is no indication in the laws what “fully implemented” means, nor is there any indication what services will be covered by the NHI.
Until these are cleared up, no one really knows what will happen, though the medical schemes themselves have assured members that it is business as usual.
Regardless, Motsoaledi said section 33 is crucial to the NHI, and removing it would be akin to building a house without a foundation—it would simply collapse.
But this doesn’t mean the NHI as a whole is set in stone. He alluded to the NHI Act being amended, saying that he has never seen a law that has not been changed.
“There is no law on earth that is cast in stone, that never changes. I want to make that clear,” he said.
The minister said that the department is also preparing for a slew of court cases arising from the NHI.
This will prove to be another major stumbling block to getting the laws anywhere, and was something the Health department anticipated.
Motsoaledi said teams are gathering all the data and information that they can and will present it to a judge when challenged.
“If we are wrong, we will accept it. If other people are wrong, they must also accept it. But it is quite unfortunate that we must even rush to court,” he said.
The cost
When asked about the NHI roadshows and their role in further consultation on the scheme, the minister simply asked: “Consultation for what?”
The minister said that the roadshow wasn’t a push from the government to consult on the NHI but rather a call from stakeholders for the government to clear up confusion about the NHI.
Confusion, he said, which has been driven by the media and industries opposed to the NHI.
He said, for example, that claims from Momentum Health that the NHI could cost the country upwards of R1.5 trillion was “rubbish”, calling it “hooliganism” to even entertain the idea.
“We need to stop this kind of hooliganism,” he said, “It’s unacceptable; we can’t build a nation through that by scaring people off.”
Notably, the minister did not discuss the cost of the NHI further or provide any figures to counter the claim.
Read: The R630 billion question no one can answer
