When policy shifts, people feel it first

When policy shifts, people feel it first  

By Nishan Pillay, Managing Director: Employee Benefits, ASI Financial Services 

Recently, the Board of Healthcare Funders wrote to Duncan Pieterse, Director-General of Treasury, requesting urgent clarity on government’s intention to phase out medical tax credits to help fund the National Health Insurance (NHI) Act. 

This development has placed many employers and more importantly, many employees on uncertain footing. 

It’s the kind of headline that makes South Africans pause. Because behind the policy debates are real people who rely on these benefits to keep their families healthy and financially secure. 

For those of us working in employee benefits, this isn’t just another technical policy shift. It’s a reminder of how deeply personal our work truly is. 

I’ve sat across from employees who depend on their medical aid not just for peace of mind, but for survival. Parents who budget carefully around monthly contributions. HR professionals who fight to preserve benefits even when margins are tight. These are the human stories that don’t appear in parliamentary memos, but they are the heartbeat of this debate. 

Some projections suggest that removing the medical tax credit could cost a household of four upwards of R14,000 per year if no compensatory measures are introduced. One recent publication noted that the state currently provides nearly R34 billion in credits to members and beneficiaries of medical schemes. 

The potential removal of medical tax credits will inevitably reshape how both employers and employees approach healthcare benefits. For companies, the challenge will be sustaining meaningful cover in a more constrained affordability environment. For employees, it will raise deeper questions: “Does my employer still see me? Do they still care about my wellbeing?” 

These are the moments that test the strength of every benefits strategy. 

They ask: Are our benefits built for compliance or for compassion too? 

Employee benefits were never meant to be a static checklist. They are a living expression of how employers show care. And as the ground shifts beneath us, we must rethink how we preserve that care through smarter financial planning, transparent communication, and a renewed focus on wellbeing. This thought process must also consider the diversity that is in our workplaces now, both from an age and culture perspective.  

Until the NHI is fully implemented and clearly defined, private medical schemes will continue to play a critical role. We must work strategically with schemes and other healthcare providers to co-create solutions that are right for our employees.  

If anything, the current debate around medical tax credits is a wake-up call. At ASI, we continuously open the dialogue and debate around the NHI implementation with clients, providers and schemes.  

What this moment demands of benefits leaders 

As the policy landscape shifts, employer-strategists must respond not with panic but with purpose. Here’s what should guide us: 

• Keep the conversation human Don’t issue a memo titled “Benefits changes ahead.” Instead, say: “Here’s how we’re staying committed to your wellbeing even as things change.” 

• Audit your benefit-value story Employees value clarity more than complexity. What’s the current value of your medical scheme? What could change? Be transparent. 

• Scenario-plan ahead If tax credits are removed, what are your options? Will you restructure employer vs. employee contributions? Revisit scheme design? What does the worst-case scenario look like? 

• Support financial wellness too Benefits go beyond healthcare. In uncertain times, employees need guidance, support, and options especially when personal finances are under pressure. 

This debate isn’t just about fiscal policy. It’s about whether our benefits architecture remains anchored in people. 

As we navigate the road ahead with the NHI, employers don’t need to wait for certainty. 

Start now. show up. ask: “How can we ensure our benefits reflect not just compliance but care?” 

Because when policy shifts, people feel it first. And how we respond will define the trust we earn and need.