The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Chamber of Commerce’s chairman yesterday voiced fears that the already-strained private sector will have to “fill the gap” if National Health Insurance (NHI) gets its sums wrong.

Michael Maura told Tribune Business that the business community remains worried it will be subject to ever-increasing taxation if the scheme’s annual $1,000 Standard Health Benefit (SHB) premium proves inadequate to cover its costs, resulting in a significant funding shortfall.

Reiterating that the private sector cannot be viewed as a lifebelt, or bail-out option of last resort, if NHI falters, Mr Maura said the insurance and healthcare industries must be allowed to assess how the government determined the $1,000 SHB premium was sufficient to cover the scheme’s benefits package.

The NHI Authority, which oversees the scheme, has revealed that it is proposing to expand NHI’s medical services/benefits to include pediatric cancers without any increase in premium to cover the resulting rise in costs. This has already concerned observers, who yesterday argued the move needs further explanation to ensure the scheme does not become an unsustainable burden.

Mr Maura, meanwhile, said the newly-raised $250,000 annual revenue exemption threshold - below which companies do not have to purchase SHB insurance for their employees - was still “too low” for the private sector’s liking.

He added that companies impacted by the “sugary drinks tax” proposal, which the Government believes could raise up to $8-$10m annually to finance NHI, were still fiercely opposed to the idea.

Speaking after the NHI Authority yesterday gave a presentation on proposed adjustments to the scheme, the Chamber chairman said it had pledged to develop key performance indicators (KPIs) to measure its success and whether it was hitting its targets.

Mr Maura added that he had suggested to Graham Whitmarsh, the NHI Authority’s managing director, that it also issue an annual questionnaire to around 50 companies to measure whether one of the scheme’s purported benefits - improved productivity from better employee health and reduced sick days - was actually materialising.

“We as a private sector remain extremely concerned that we will be the ones to fill the gap if this does not pan out the way they hope,” he told Tribune Business. “The Government has said it will cover retirees, the unemployed and persons too young to work. The question is: Are we going to find that ends up presenting itself in additional taxes some place?

“We remain concerned that we don’t know, and they don’t know, what the consequences and end result of this programme will be to business. We don’t know that. They don’t know what portion of staff are going to decline the more substantial health coverage employers offer today and move to the SHB that offers a $1,000 a year premium.

“We don’t know what the risk profile will look like, and what the resulting insurance premium will be. We remain concerned..... Everything seems to be lining up where business is going to be carrying, or at least absorbing, the greater share of the cost to meet this objective.”

Mr Maura said yesterday’s meeting with the NHI Authority focused largely on the scheme’s design, rather than its cost and price estimates, and whether these were accurate enough to ensure the scheme does not become an unsustainable burden on the backs of businesses and Bahamian taxpayers alike.

“What we have not done, and I’m not privy to, is it would be interesting to bring the insurance industry and medical professionals together to report on the financial analysis,” he added. “That needs to happen as a second step. Show us how you came up with your numbers.”

Mr Maura, while expressing “confidence and faith” in the NHI Authority’s intentions and its work to-date, said the proposed scheme was still effectively a state-owned enterprise (SOE) that successive governments have shown a repeated inability to manage efficiently.

“The fact is this is another version of a state-owned enterprise that the Government has not, does not, and never had a very good track record of managing value-oriented businesses efficiently,” he told Tribune Business. “This is why we were so insistent that KPIs be developed and included in their annual report so they hold themselves accountable, celebrate wins and correct deficiencies.”

While more small businesses will be exempt from making NHI contributions, due to the threshold’s increase from $100,000 to $250,000, Mr Maura said the adjustment - while welcome - still meant that micro enterprises and start-ups face being caught in the net.

“A business earning only $250,000 a year in turnover is an extremely small business,” he explained. “I believe it’s still too low. It’s hard enough for those businesses to make it. It would have been better, notwithstanding the fact they did listen, that they accepted our recommendation and start at $500,000 and work from there.

“There’s a concern that $250,000 is too low still, and the burden too great potentially for those small businesses.”