BIA: revised timeline for NHI still “very difficult”

BIA: revised timeline for NHI still “very difficult”

Association to complete substantive review of new NHI structure


NASSAU, BAHAMAS – While expressing support for the government’s efforts to develop a sustainable universal healthcare coverage platform, The Bahamas Insurance Association (BIA) contended yesterday that the timeline for the implementation of NHI is still “very difficult” to achieve.

During a press conference at the Nassau Yacht Club to announce Insurance Month, BIA Deputy Chair of Life and Health Tina Cambridge expounded on the National Health Insurance Authority’s (NHIA) restructured proposals for NHI, which includes a major overhaul of the employer/employee contributions and a six-month push back of the employer mandate.

Cambridge noted that the authority has yet to gain government approval; release amended laws and regulations and the full benefit design of the standard benefit package (SHB) and catastrophic coverage.

She said the authority must also complete negotiations with healthcare providers and finalize the requirements with private health insurers – all before April/May of this year.

“They will essentially have to do all of that work; get systems in place both for themselves and PHA (Public Hospitals Authority), all by April/May of 2019, in order for stakeholders to be ready for July 2020,” she said.

“We haven’t had the collaboration in earnest yet with the NHIA around this new proposal, and so that needs to happen so we have a fuller understanding of what it is they are asking the public health insurers to do in helping to administer this.

“We are hoping to start that process very soon, so that we have a better understanding of what’s to come.

“But certainly, the collaboration and tying down of all those various components would have to happen very, very quickly. Those negotiations would have to happen in order for us to know whether the proposals in full, as it’s written, could happen in the timelines that have been set.

“Now, let’s be honest about this in that the NHIA is just now presenting or expecting to present that proposal to Cabinet within the coming weeks.

“If Cabinet doesn’t take on the full proposal then we have a chance to scale back and maybe 2020 will work, but if the government decides it can afford the proposal in full, I think it’s going to be very difficult to meet that July 2020 deadline.”

The NHIA has proposed to fund the program through government contributions; earmarked allocation of value-added tax (VAT) collected on private health insurance; an employer mandate, which would see employees and employers directly contribute on a sliding scale depending on salary; a sugary tax on unhealthy products, namely sugar-filled drinks; and funds from the risk equalization fund.

In its policy paper “A Shared Responsibility” released last October, the NHIA proposed a date between April and July 2019 for the launch of the expanded NHI coverage SHB package that would be guaranteed under NHI and private insurers.

The SHB premium is estimated to cost $1,000 per year per beneficiary.

The BIA recommended the premium for SHB package be scaled back to $500 per person per year.

The SHB would include an expanded primary care package and high-cost care program, which provides comprehensive coverage for select conditions or treatments, including a range of high prevalence diseases.

The employer mandate, if approved, would now be introduced on July 1, 2020.

It was originally set to be introduced for businesses with over 100 employees in January 2020.

In its latest proposal, the premium would no longer be shared 50/50 between the employer and employee.

For example, an individual who makes $10,000 a year, which equates to minimum wage, would contribute $12.50 per month, while their employer would contribute $70.83 per month.

The employee contribution increases per income bracket, of which there are 10 ranging from $5,000 per year to over $66,667 per year.

On the higher end, employees who earn $65,000 per year would contribute $81.25 per month.

In this scenario, the employer would only contribute $2.08.

Under the previous NHIA proposal, an employee in this income bracket would contribute $41.67 per month, while their employer contributed the same.

The NHIA has also projected NHI enrollment at 170,000 people, while over 123,000 people will remain privately insured and nearly 85,000 people will be captured under the employer mandate.

Cambridge noted that the BIA plans to do an in-depth study of the proposed changes to the plan once the NHIA completes and shares with stakeholders, the proposed fee schedule and complete benefits.

She said, “We will make a full position paper available sooner rather than later, but I think it is safe to say at this juncture that unless the NHIA are able to do a number of things very quickly there will likely be an issue with the July 1, 2020 rollout.”