National Health Insurance scheme still 'operating outside the law'


Tribune Business Editor


THE Government was yesterday urged to "go back to the drawing board" on a National Health Insurance (NHI) scheme that is still "operating outside the law".

Tina Cambridge, Generali's regional director, argued that the newly-created NHI Authority "cannot ratify" the actions of the former Christie administration in launching the scheme without having brought its enabling Act and regulations fully into law.

Addressing a Bahamas Insurance Brokers Association (BIBA) seminar, she said the May 10 election outcome presented an opportunity to "reset and get this right without risking destabilisation of the public and private healthcare systems".

Dr Robin Roberts, the NHI Authority's chairman, yesterday told Tribune Business that its "first letter" had been to the Attorney General Office's seeking a legal opinion on how it should deal with previous actions that had no basis in law. These stemmed from the fact that the Christie administration only brought select parts of the NHI Act into effect when it 'gazzetted' them on April 5, 2017. Crucially, no Board was appointed until July 17, meaning that the NHI Authority did not exist and, as a result, the pre-election contracts entered into with medical providers may have been "ultra vires" and outside the law.

The Bahamas Insurance Association (BIA) had warned earlier this year that the Christie administration's rush to roll-out NHI's primary care phase prior to May could place the Authority "in a difficult position" by potentially having to ratify illegal acts - something Dr Roberts acknowledged yesterday.

"This is why the first letter we wrote was to the Office of the Attorney General for a final legal opinion on how we should be proceeding," he told Tribune Business. "We are awaiting that reply. Once we get that, we can inform the public as to how we will be proceeding with regards to the legality."

Dr Roberts said the situation had created a real dilemma for the Authority, placing it in a 'catch-22' or 'damned if you do, damned if you don't dilemma'. While agreeing that NHI's operations and roll-out needed to be conducted within the law, the chairman said the scheme now had obligations to its 25,000 beneficiaries and providers contracted to supply medical care.

"In the interim it's incumbent upon us to honour the contracts that have been made because we are dealing with people's health and people providing a service," he added.

"We also have to make sure that we are looking at all the people that have to be employed under the NHI Authority. We are going to complete the management team and reform the internal structure. We are going to have major changes in terms of the internal structure and management system."

But, backing Ms Cambridge's position, he conceded: "It's not simply a matter of ratifying what was done before. As a country of laws, we cannot do that."

The Generali executive, speaking for the BIA, had earlier pointed out that the only parts of the NHI Act given legal effect by the Christie administration were those that repealed the previous legislation; indicated when the new one came into force; and established the NHI Authority.

Among the sections omitted were those giving authority to enroll persons in NHI; the criteria setting out who was eligible to enrol; and the framework detailing the functions of health care providers and insurers.

"The question for us arises: What has the Board done to ensure the legal framework is addressed?" Ms Cambridge asked. "It is our view that the Board cannot ratify the acts of the past administration, as there is no law to ratify that...

"We are a country of laws. We hope, as Dr Roberts was saying earlier, that the legal framework is addressed. We believe there are loopholes in the Act that need to be addressed. Where are the regulations. They were never gazzetted, and are not in effect. There's a lot of work to be done."

The NHI Secretariat, headed by its permanent secretary, Peter Deveaux-Isaacs, had taken responsibility for entering into contracts with medical providers, and paying and adjudicating claims, prior to the May 10 general election. Dr Roberts, though, conceded that the NHI Act made no provision for a permanent secretary.

Ms Cambridge, meanwhile, questioned whether there was "recognition" that the NHI Authority "cannot act as regulator and administrator of NHI" - as it is now doing - due to the potential conflict of interest.

She also queried whether the cut in NHI's budget, from $120 million to $36 million for the 2017-2018 fiscal year, left the scheme with enough funds to meet its obligations to the 25,000 Bahamians enrolled to-date.

"We are operating NHI currently outside the law," she reiterated, "and we are concerned about budgeting. There are a number of holes in the legislation and regulations that need to be fixed, and you need to manage realistic expectations on benefits."

Dr Roberts yesterday said not decision had been taken on whether to proceed with the creation of NHI's public insurer, Bahama Care, which was to be managed by a combination of Family Guardian and Aetna.

This was another issue raised by Ms Cambridge, who said the Government could make private health insurance more affordable by removing Value-Added Tax (VAT) from premiums and medical bills. She also called for the elimination/lowering of duty on pharmaceutical drugs and medical equipment.

"VAT on health insurance should never have come into play," she added. "All these things that impact the cost of healthcare; if these four things are addressed they are transformed into lower private health insurance premiums that may become more affordable for the masses.

"If you go down that line you are able to get more persons under private health insurance plans, leaving the NHI Authority and government with less persons you have to cover."

The Generali executive added that the 3 per cent tax levied by the Government on insurance premiums was "the highest level of taxation on financial services" in the Bahamas, and reiterated the BIA's suggestion that some of the funds raised be used to finance NHI.

Suggesting that the NHI Authority faced "a mammoth task", Mr Cambridge said the BIA "wholeheartedly" backed the need for it to employ good corporate governance and focus on strengthening the existing public healthcare system.

Calling for the NHI Authority to use its "endeavours" to control healthcare costs, she also urged it to be "honest" in designing an NHI benefits package that the Bahamas could afford.

Ms Cambridge said the Christie administration's version was "too rich for the country to afford, and left nothing for the private insurers to sell going down the road. You have to be cognisant of ensuring the insurance industry survives".


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