The Tribune

By KHRISNA RUSSELL

Deputy Chief Reporter

krussell@tribunemedia.net

PROPOSED policy changes to universal healthcare have come at an increased cost with Graham Whitmarsh, managing director of the National Health Insurance Authority, revealing yesterday implementation next year will cost $130 million.

Last year, Health Minister Dr Duane Sands said roll out of the revamped scheme would cost $100m.

With widespread changes to NHI, projected to officially come on stream across the board July 1, 2020, Mr Whitmarsh said the budget would be refined as the scheme matures.

“In the ballpark, yeah,” he said when asked whether the cost remained in line with initial projection. “We estimate that our programme, it’ll grow overtime. It won’t actually have a cost but the kind of mature programme that we’re looking at here with the amended policy we think it’s around $130m but we’ll refine that as we go forward.”

The increased cost makes room for the expanded standard health benefit, it was suggested yesterday.

“So the premium cost is $1,000 per person per year. Unlike traditional private health insurance that amount will not vary depending on someone’s age gender or any of the other health factors that an insurance company may take into account, so everybody pays $1,000 for that,” Mr Whitmarsh said.

“They’ll get primary health care so access to a family doctor as many times as they need it, laboratory tests associated with those visits - diagnostic imaging so X-rays for example.

“Then the package of high cost care would include a package of cancers so breast cancer, cervical cancer and prostate cancer, which are the major cancers in the country and we’ve added to that paediatric cancers for children under the age of 12, end stage kidney disease, which is primarily from a cost perspective dialysis, and then myocardial infraction, which is heart attacks and pace makers, so those would be what we would call a standard health benefit.”

Among the NHIA’s changes is how the benefits will be paid for.

As exclusively reported by The Tribune earlier this week, the new premium shared costing module moves the monthly income cap to 1.5 percent from the initially proposed 2 percent salary contribution, removing the 50-50 cap on salary deductions to the benefit of lower wage earners. This means higher wage earners will contribute more and up to full monthly premium amount.

Employee earnings will include gratuities, overtime and bonuses such that full wages are accounted for.

Mr Whitmarsh said the NHIA still believes the premium will cost each working Bahamian who opts to enrol about $1,000 per year or $83.33 per month. He noted this money does not go to the government, but to the employer to pay the premium.

At its lowest, an employee earning less than $5,000 will pay $6.25 into the scheme, while the employer will pay $77.08.

Those earning $10,000 or less will pay $12.50 per month and the employer will pay $70.83.

With a yearly salary of $15,000, it is proposed that the worker pays $18.75 against an employer cost of $64.58.

At the $20,000 per year scale, the monthly cost is $25.00 with $58.33 left to the employer to pay.

An employee earning $25,000 will pay $31.25 and the employer will pay $52.08.

A $35,000 per year salary will mean the worker pays $43.75 and the employer pays $39.58. A $45,000 a year and under salary is $56.25 for the worker and $27.08 for the company.

Anyone at $55,000 each year and under is expected to pay $68.75 and the employer $14.58 and $65,000 and lower will pay $81.25 while the employer will pay $2.08.

At its highest, earnings of $66,667 and more will pay the full $83.33 with no cost to the employer.

Another policy change features a raise to the small business turnover exemption to $250,000 per year. This will provide further protection for small businesses and a competitive business environment for entrepreneurship.

There is also to be a national fee schedule for high cost care, which both NHIA and private insurers would reimburse. This allows for the standard premium rate to be more easily adopted by private insurers and would simplify the risk equalisation process.

A common enrolment period for both NHI and approved insurers with specific exemptions to be admitted outside this period is also proposed. This will enable the process of risk equalisation to work in an orderly and efficient manner.

The employer contribution also will be removed and the Department of Inland Revenue would no longer be responsible for compliance, relying instead on NHIA enforcement through periodic audits, employee reporting and reports from private insurers. NHIA will employ a compliance officer to be responsible for enforcement.

The NHIA also wants to implement a short-term contract exemption. Employees who sign short-term contracts, which have a specified start and end date elapsing less than 120 days per year (including extensions) will be exempt. This is to address concerns from highly seasonal businesses.

Last October NHIA officials said in a policy paper that several timelines were set. These included April to July 2019 for the launch of the standard health benefit and NHI expanded coverage; July 2019 for a sugary drink tax and national wellness programme; a January 2020 launch of the employer mandate/two per cent deductions for businesses with 100 or more employees; and January 2021 employer mandate expansion for all employers and deadline for all grandfathered private insurance plans.