The National Council of Provinces (NCOP) select committee on health and social services has advanced the controversial National Health Insurance (NHI) Bill will be voted on without modifications, dealing a blow to the expectations of the private healthcare sector.

Hopes for a softening of provisions on the role of medical schemes have been dashed, bringing the bill one step closer to final approval by the ANC-dominated NCOP.

The proposed legislation, advocating sweeping reforms to South Africa's healthcare system, includes the establishment of a single NHI fund to procure healthcare services for eligible patients, placing all medical insurance under direct access and control of the ANC, and forbidding independent medical insurance.

Despite extreme public criticism from the public, the private sector and opposition parties, the committee refused all suggested changes. Public hearings were conducted in all nine provinces, and the NCOP received 106 written submissions from stakeholders, with over 23,000 additional written submissions from the provinces.

Business Unity SA (BUSA) Chair Cas Coovadia warned that if enacted, the bill's provisions could weaken the health system and increase the risk of a healthcare professional exodus, stating, “We have consistently said we don’t have a problem with NHI itself [but] certain sections need to be changed. Our submissions have fallen on deaf ears.”

Last week, BUSA and Rothschild-owned Business for SA (B4SA) said they were optimistic about potential changes to section 33 of the bill, allowing medical schemes to cover only services not provided by the NHI. However, the select committee's decision maintains the bill in its original form.

B4SA Chair Martin Kingston expressed cautious optimism, anticipating possible amendments before the bill receives presidential assent. The president retains the authority to refer bills back to parliament for further consideration.

Nicholas Crisp, the health department’s deputy director-general for the NHI, had urged the committee to consider aligning the bill with a recent high court judgment on the rights of pregnant women and young children to free healthcare, regardless of nationality.

All provinces except Western Cape, voted in favor of the bill without proposing amendments. Committee chair Edward Njadu refused the Western Cape's request for an extension to consider extensive input received during public hearings.

The DA’s Mbulelo Bara suggested that the ANC instructed ANC-led provinces to support the bill and ensure its passage before parliament adjourns in December.

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