Setback for NHI in Cabinet tussle

The Democratic Alliance (DA), former opposition party now in the Government of National Unity (GNU), won its first battle in the Cabinet last Friday when President Cyril Ramaphosa ordered that the implementation of National Health Insurance (NHI) be postponed for further negotiations. Sources say DA Ministers and Health Minister Aaron Motsoaledi were involved in a heated argument. DA Cabinet members reportedly objected when ANC Ministers wanted to include the proposed NHI in its current form in the medium-term development plan, which would effectively destroy private medical funds by 2029. The plan outlines the priorities and interventions of the GNU for the next five years. Deputy DG of Health Nicholas Crisp led the presentation on the immediate implementation of the NHI to the Cabinet. City Press reports that sources say DA Ministers pointed out to their ANC colleagues that, in terms of the GNU’s declaration of intent, the NHI in its current form could not proceed because there was not ‘sufficient consensus’ in the Cabinet. The declaration of intent, signed by all parties belonging to the GNU, stipulates that sufficient consensus on government decisions and policies is only achieved if parties with 60% representation in Parliament agree. The ANC (with 40.2% support) can only achieve sufficient consensus if the DA (with 21.8%) also agrees, as the other parties in the GNU have too low a percentage of support.

Motsoaledi, who is a strong supporter of the NHI, reacted angrily to the DA Cabinet members’ demands, said an ANC source. ‘He was furious and shaking with anger towards us. The NHI was a war between the rich and the poor for him. We eventually had to calm him down and ask him to relax,’ said a second ANC source. City Press notes that Ramaphosa finally ordered that the medium-term development plan be sent back to the various committees in the Cabinet for further negotiations. Feedback must be given at the next Cabinet lekgotla in January. Besides Motsoaledi, Mineral Resources Minister Gwede Mantashe also wanted the medium-term development plan for the NHI to be accepted in its current form. ANC sources said that the DA should not consider Ramaphosa’s concession as a victory.