Making the Government’s main tax authority a policing agent for National Health Insurance (NHI) is “too much, too soon”, the Chamber of Commerce’s chairman warned yesterday.
Michael Maura told Tribune Business yesterday that using the Department of Inland Revenue (DIR) to enforce NHI contribution compliance threatened to over-burden the agency at a time when itself and the private sector were still bedding in recent tax increases and additional responsibilities.
With the DIR seeking to reduce associated bureaucracy, and make tax-paying less onerous and time consuming for businesses, Mr Maura warned that business “frustration” was likely to increase if the department was further distracted from its mission and goals by extra NHI-related obligations.
“They’re talking about the NHI Authority serving as a policing function,” the Chamber chairman told this newspaper of the NHI Authority’s revised scheme. “The DIR is working extremely hard to implement new procedure, technology to aid with making business easier, but is still a long way away with it.
“Having any additional responsibilities with NHI, it’s too much, too soon. I don’t see how they’re going to be successful with this. It’s going to create a lot more frustration for businesses. Right now, we all - businesses, the Government and the DIR - need to get some wind under our belt before we start making things more complex and more expensive.”
Mr Maura’s concerns were echoed in the Chamber’s official NHI position paper, released over the weekend, which outlined multiple concerns and unanswered questions related to the revised scheme unveiled by the Minnis administration and its NHI Authority, chaired by Dr Robin Roberts.
“The Department of Inland Revenue (DIR) has been identified as one of the main policing agents in the enforcement of the proposed employer mandate,” the Chamber said. “The [Chamber of Commerce] commends the Government’s efforts aimed at leveraging technology to improve the quality of service within the public service and ushering in e-government services in a meaningful way.
“However, it is our view that at a time when the business community remains frustrated with the efficiency of the Business Licence process, it would seem inappropriate to further challenge the DIR. We recommend that these improvements be completed, or significantly implemented, prior to the imposition of additional NHI-related responsibilities on the DIR.
“This will mitigate against the risk of the DIR undermining the worthwhile objectives of the NHI programme. The Government must focus on being efficient and effective before placing further pressure on the DIR and the business community by extension.”
The NHI Authority, in its consultation paper, is proposing that the DIR “validate” that so-called “exempt” or “secondary” employers have made due NHI contributions on behalf of their employees.
The Chamber, meanwhile, reiterated concerns first expressed by The Bahamas Insurance Association (BIA) that the $1,000 annual premium for the Standard Health Benefit (SHB), NHI’s minimum level of care, may be “too low” given the expanded range of primary and secondary benefits/treatments it proposes to cover.
“While the [Chamber] is supportive of initiatives aimed at reducing the cost of healthcare and health insurance premiums in The Bahamas, we are concerned that the NHI Authority may have established the premium for the SHB plan at a level that is too low,” its position paper warned.
“Should the premium level be insufficient to cover the benefits under the proposed plan, there could be undesirable consequences... For example, if the SHB plan is only able to afford a purchase of healthcare mainly in the public system, employers and employees will be unhappy that the plan does not accommodate the cost of care being delivered in private facilities.
“Alternatively, if the buying public is assured access to private facilities, but that was not assumed when setting the cost of $1,000 per annum, then this cost will end up increasing - and possibly increasing rapidly. If that happens, will insurers pull out of the market if the premium is not adjusted an, if the premium is adjusted, will that adjustment/increase be borne solely by the employer?
“Alternatively, insurers may increase the insurance premiums for supplemental benefits to offset any losses on the SHB plan. If the supplemental plans go up in cost, they may become cost prohibitive and have the unintended consequence of reducing the amount of persons with comprehensive insurance coverage, thereby lessening the protection afforded to the country’s residents overall.”
The Chamber urged the NHI Authority to give an “assurance” that any reduction in health provider fees, which Dr Duane Sands, minister of health, has said is necessary for the scheme to work, “will not result in a marked decrease in the quality of medical care in The Bahamas”.
“We are hopeful that all stakeholders will arrive at a position that does not compromise the health of residents of The Bahamas, as the current proposition appears to be an unreasonable expectation, especially seeing that there has been no consultation with medical providers in advance of publishing the [NHI Authority’s] policy paper,” the Chamber added.
“In the absence of specific details surrounding the procedures covered, the facilities via which the services would be provided and the provider network for the services, the [Chamber] cannot reasonably assess the SHB. We therefore request that the NHI Authority provide specific details for our review.
“The NHI Authority is further advised to ensure that the proposed premiums for the SHB are sufficient to provide the benefits outlined under the SHB. Employers would also appreciate definitive commentary from the NHI Authority and private health insurers on the availability, affordability and viability of supplemental/top-up plans once the SHB is launched.”