The consultation on NHI has been extended again as the NHIA considers requiring those who make more, to contribute more—as this column suggested weeks ago
The government has hired a new Director of Communications in the Office of the Prime Minister
Public consultation like the one NHIA is currently undergoing will benefit from a more developed communications apparatus
In an exclusive to Eyewitness News, Dr. Robin Roberts, Chairman of the National Health Insurance Authority (NHIA) confirmed that the public consultation on the proposed National Health Insurance (NHI) scheme has been extended again to the end of January.
In the same article, Dr. Roberts also suggested that because of the public consultation process they are considering requiring employees signed up under the new NHI scheme who earn over $30,000 per year to pay more than the previously capped $42 per month.
“…For the employer you know… when they have 100 people employed and you start to multiply the factors, that can be quite an additional expense,” Roberts said.
“We have to be real about this and more so because we have also prorated that amount depending on the income of the individual.
“If we have someone making minimum wage, he’s not paying $42 [per month]; he is actually paying $8 and the employer [pays] that additional amount up to $84.
“We have to be real that in some areas this could be costly.
“In going through our stakeholders and having their input, some of them have made some excellent suggestions.
“Just to give you an idea of what you are looking at, some of them are saying ‘you now have a ceiling of $25,000; Why don’t you increase [it]? What about those individuals who can definitely pay more, like [those] making $100,000 a year?
“So, why don’t you make those individuals pay a little more’.”
It seems as if the NHIA’s public consultation has highlighted two primary concerns related to the proposed NHI scheme—the increased cost of labour to business and the potential for those who earn more to contribute more.
Readers may recall that in this column’s three-part series on the proposed NHI scheme both concerns were discussed at length.
In the first instance, I noted that employee contributions were capped at two per cent or no more than 50 per cent of the total monthly contribution of $84, however, employers weren’t so lucky. They are mandated to pay the difference.
For those businesses that employ minimum wage workers at $840 a month, their employees will pay two per cent of their wages (or about $16.80) into the scheme, while they will be required to pay the difference of $66.20 or over seven per cent of their employee’s wages.
I argued then that this increase in the cost of labour, coupled with last year’s value-added tax (VAT) increase, will no doubt be difficult for businesses to shoulder.
Similarly, in the second part of that same series on the proposed NHI scheme,, I also asserted that, like VAT, the scheme’s contribution mandate was just another form of regressive taxation—that the lowest earners will pay a higher percentage of their income.
Once again, let’s use the example of a minimum wage employee making $840 per month. Because of their low income, they will see a full two per cent of their wages garnished, even with the 50 per cent cap on the NHI contribution.
Alternatively, someone who makes $100,000 per year or about $8,333 per month will contribute a significantly smaller amount of their wage.
This six-figure employee will pay 50 per cent of their contribution, or $42, which is a measly 0.005 per cent of their salary.
Instead, I argued for a more progressive scheme where the highest earners contributed more. This would increase the total amount of contributions collected by the scheme and perhaps even provide for those who cannot contribute themselves, like children and the elderly.
I commend the NHIA for keeping the public informed and for considering a more progressive scheme than originally proposed. However, the constant extensions to the consultation period suggests that there may not have been a strategy for how this consultation process would be managed.
In the past, these public consultation processes are rarely executed with any clear or comprehensive strategy for engagement. More often than not, a policy document or proposals are released to the public without clearly defined avenues to submit criticism or concerns. A series of townhalls or disparate conversations happen across stakeholder groups and this passes for public consultation. In many ways, townhalls, in particular, have become a source of entertainment or venues for petty political spin.
Lastly, during these public consultation periods, those leading the effort often fail to update the public on the suggestions they receive and how policies may evolve because of these suggestions.
I am hopeful that this will change considering the government’s announcement that it has appointed Erica Wells Cox as the Director of Communications for the Office of the Prime Minister
As the Cabinet Office’s press release revealed, Ms. Wells will be responsible for the overall coordination and management of strategic communications within OPM and with communications officials in other ministries and agencies, as well as with external communications consultants.
This hopefully signals a more strategic approach to all government communications, including public consultation.
Most people think of government communication as a vehicle to inform and persuade, but government’s also have a responsibility to consult. To do this strategically, governments must engage in building what some social scientists are now calling ‘architectures of listening’.
This means that as the new Director of Communications builds a communications structure across the landscape of government, this communications apparatus should, in part, be focused on creating a government-wide culture that is “open and receptive, as well as policies, resources, skills, systems and technologies that allow the [government] to receive, process, consider, and respond to stakeholders and publics,” as lead architecture of listening researcher Prof. Jim Macnamara phrases it.
To achieve this the government can seize the opportunity to engage social scientists and public opinion researchers, along with communications and policy professionals, to lay out truly strategic public consultation efforts.