The Tribune

By RASHAD ROLLE

Tribune Staff Reporter

rrolle@tribunemedia.net

A long-anticipated legal opinion from the Office of the Attorney General complicates the Minnis administration’s effort to create a National Health Insurance (NHI) programme that fits its preferences and will likely limit the administration’s ability to quickly accomplish its NHI goals, Health Minister Dr Duane Sands confirmed yesterday.

As one of its first official acts, the board of the National Health Insurance Authority (NHIA) sought a legal opinion about whether the actions of the National Health Insurance (NHI) Secretariat – established by the previous Christie administration – were legal and potentially binding.

This was because even before the NHI board was established and key provisions of the NHIA were published in a gazette, the secretariat entered into numerous contracts with residents and healthcare providers.

Nonetheless, the AG’s Office has said in its opinion delivered to Dr Sands the secretariat’s actions were essentially legal. 

The NHIA board cannot make significant changes to the programme therefore without considering the legal and financial implications connected to the preexisting arrangements the NHI Secretariat entered into. 

“We requested a review of the decisions made by the secretariat subsequent to April 2017 and certainly while there were irregularities, the basis of the decision making process was consistent with the spirit of what was intended and the Attorney General’s Office was of the opinion that a duly constituted board could rarify even retroactively the decisions made by the secretariat even though at the time there had been no standing for those decisions to be made,” Dr Sands said.

The Bahamas Insurance Association (BIA) and leaders in the insurance community had argued that the secretariat’s actions were illegal and should not be ratified by the board. They called for the board to restart the NHI programme from scratch.

Dr Robin Roberts, chairman of the NHI Authority, also said in November that his board found itself in a dilemma as it awaited the legal opinion and had decided to honour the various contracts that had been established until it received guidance on how it could proceed.

“This significantly complicates things,” Dr Sands said yesterday. “You have existing contracts which afford care for more than 30,000 or so people who have come to rely on that care and you have contracts with providers who provide healthcare; they would’ve signed up in good faith and they have now been utilising or providing services; that has implications in terms of financial commitments, exposure for the board and for NHI and so moving forward we have to project the impact of those commitments on the budget but also on the flexibility of the board which has to roll-out a revised product while its hands are tied by these preexisting arrangements. You have a situation where things were not done entirely legally and yet you’re between the devil and the deep blue sea.”

The NHI board will still consider renegotiating contracts the secretariat previously entered into, Dr Sands said, adding that a final recommendation on this won’t likely be made this fiscal year. During last year’s budget debate, Dr Sands revealed that a medical provider could make as much as $300,000 per year under the scheme established by the secretariat.

“Where is that money going to come from?” he said at the time, adding he had instructed the NHIA to revisit some of the decisions that it met in place. 

Yesterday he said: “Things will remain the same as it relates to primary care. The board finds itself in a peculiar situation because it now has to make big decisions. They are not starting with a blank slate. They have something to fix that was broken. They have an awesome task to provide a realistic budget and a completely revised programme that is more consistent with fiscal responsibility and common sense than what the secretariat, which had seemingly no restrictions whatsoever, did. They have to do this while taking into consideration all the pre-existing arrangements.”

As it awaited an opinion on how it could address the decisions it met in place, the NHI board worked to create a new model for NHI, placing greater emphasis on catastrophic healthcare coverage and on ensuring the programme could be properly paid for. 

Dr Sands said the board will be ready to present its model to the country soon. It is a model that will likely involve imposing some kind of tax.

Dr Sands revealed that to date the NHI Authority has received 34,592 NHI enrollment applications. He said there are 29,539 beneficiaries enrolled in the programme who are able to access primary healthcare services.

Since its appointment, the NHI board, The Tribune understands, has not made many appointments to key administrative positions because it has prioritised preparing a model for the programme.  

Dr Delon Brennen is the acting managing director of the NHI Authority. Key administrative positions include that of benefits manager, facilities manager, organisational development manager, legal clerk, financial controller and technical support officer. However, only one of these is filled by someone directly appointed by the board: Financial Controller Patrick Hanlan. People in the other roles were appointed by the NHI Secretariat and it is unclear how the board will proceed with their contracts. 

The NHIA has advertised a number of key positions in recent months, including for a human resources director, board secretary and a deputy director of information and communications technology, The Tribune understands.