The National Health Insurance Plan (NHIP), which will mark its two-year anniversary on April 1 this year, has been a serious concern to residents since it was brought into being by the Michael Misick administration, and initiated by then finance minister Floyd Hall, health minister Lillian Boyce and chief medical officer, Dr Rufus Ewing.
The NHIP costs include the primary care clinics, secondary care provided by contractor InterHealth Canada, the cost of two new hospital buildings and equipment, and necessary overseas referrals.
Originally, a levy of 5 percent was to be imposed on workers currently employed in the TCI. Almost immediately, this was extended to include those on pensions. The plan was also originally designed to provide full coverage for all legal residents, including foreign workers on work permits.
During debates in House of Assembly meetings at the time, the Progressive National Party (PNP)-led government was cautioned by then opposition leader Floyd Seymour that the 5 percent tax would immediately prove to be inadequate.
Nevertheless, the plan was approved and this approval was ratified by former Governor Gordon Wetherell.
At the time of approval, Wetherell and Colin Roberts, director of the Overseas Territories for Britain’s Foreign and Commonwealth Office, indicated there was no problem because “the Turks and Caicos Islands is a rich territory.”
Years later, it was discovered by Wetherell that, due to massive debts and obligations, including the NHIP and a bloated civil service, increased taxation would be required to balance the budget.
Increases in customs duties, fuel taxes, vehicle and business licenses, as well as newly imposed taxes on insurance and bank transactions, have raised the cost of living. Also, large increases in work permit fees have seen many foreign workers either leave the country or go underground.
Last week, a new tax increase relating to the NHIP was published and, while islanders expected only a 1 percent tax increase, to be shared by employees and employers, it appears the fees and minimum charges that accompany the increase will fall most heavily on the lowest paid workers and larger families.One early minimum imposed was the $250 per month minimum charge for all self employed workers. The NHIP is now imposing these minimum charges on business managers who have employees and who also receive their wages in the form of a payroll check from the company in which they share partial or full ownership.
An example is a small retail shop owner with part and/or full time employee(s), who themselves earn less than $1,000 per week. Because of the minimum charge, such small shop owner being paid $500 per week is being taxed at a rate of at least 12 percent, not the advertised 6 percent.
A husband and wife both self employed are being charged $500 per month minimum, or $6,000 per year. This is a serious concern when one self employed person is only working part time but is being charged the $250 monthly minimum.
Other new charges are that all residents are now subject to a $50 per person minimum monthly tax. Spouses must now pay $25 and $10 each per month for each child up to three children.
This makes the obligation for a family of five or more at least $110 per month ($1,350 per year) no matter how little they earn.Also remaining in place and added to the overall costs are the co-pays, which are $10 per person per visit. Additional $10 co-pays apply, including ambulance and emergency room services, as well as clinic- or hospital-dispensed medications. Therefore, a resident delivered to the emergency room, who receives medications and a hospital stay may be subject to a $40 co-pay for each occurrence.
It has also been reported that foreign workers (who are subject to the same tax rates) will be stabilized in the event of sickness or injury and returned to their native country and will no longer be referred to overseas specialists, as is the case for belongers who are members of the plan.
Many here who are reviewing the implications of the new charges are considering boycotting the plan or simply avoiding registration and health care visits.
