Under a proposed change to the Health Insurance Act, the health minister will be the person that decides who will receive free medical healthcare and insurance coverage.
Currently, it was the minister responsible for social services, acting on the advice of the director of the Department of Children and Family Services, that determines who, due to a lack of financial resources, is considered ‘indigent’ and therefore is considered to be unable to pay for health insurance or medical services.
A proposed amendment to the act puts the minister of health – currently Katherine Ebanks-Wilks – in charge of deciding whose health care or health insurance coverage should be paid by government.
Another amendment replaces the word ‘indigent’ with ‘medically indigent person’, defining the latter as “a person who is in receipt of financial assistance”. The new definition also proposes to define an individual as a medically indigent person if, “in the opinion of the Minister responsible for health, acting on the advice of the Chief Medical Officer, the person is unable to pay for the person’s health insurance or medical services by reason of inadequate financial resources”.
Premier André Ebanks, in a statement issued on 26 Feb, said this change “reassigns decisions to the Ministry responsible for Health about whether medical services should be covered by Government’s insurance plan”.
‘Urgent’ amendments bypass Parliament’s 28-day publication rule
The statement noted, “Because such decisions are usually time-sensitive and critical for favourable patient outcomes, the proposed amendment removes layers of bureaucracy to provide greater effectiveness and efficiency for Caymanians in times of urgent medical need.”
The Health Insurance (Amendment) Bill 2026, along with related amendments to the Health Insurance Commission (Amendment) Bill 2026, and another bill relating to immigration legislation, are expected to be brought to Parliament at its next sitting, scheduled to begin on 4 March, without going through the normal waiting period.
Ebanks said these bills were “too urgent to permit the usual 28-day publication period before consideration by Parliament”.
The statement noted that, under Section 77(2) of the Constitution, the premier can certify a bill as urgent “where the public interest requires it”.
That provision has been used a number of times since its introduction following the 2020 constitutional amendments, including for financial services revenue measures, public finance legislation and immigration amendments.
Ebanks said using this provision to bring the health insurance and immigration bills to the House as urgent matters is “consistent with established precedent and fully within constitutional authority”.
He said his government, while not required under Parliament Standing Orders, to do so, had sent advance copies of “urgent certification letters” to all MPs, and planned to do if similar situations arose in the future.
“Good governance evolves,” he said. We are committed to transparent parliamentary practice, respectful engagement with all Members, and decisive leadership when Cayman’s interests require it.”
Long-term problem with rising healthcare costs
One of the largest single costs to successive governments in Cayman, has been healthcare and health insurances expenses for ‘indigents. In its last budget, the National Coalition for Caymanians government noted that it planned to spend $28.3 million in 2026 on standard medical care for Caymanians who are unable to afford insurance or medical care, and $25.3 million in 2027.
Over the decades, different administrations have under-estimated the cost of healthcare demands for indigents in their budgets, subsequently having to find additional millions of dollars in supplementary funding.
In an interview on Compass TV’s Forefront show on 26 Feb., Minister for Finance and Economic Development Rolston Anglin said a formal review of Cayman’s health insurance system is underway, with a ministerial committee to examine structural reform.
He indicated that current arrangements unfairly burden government finances and are unsustainable long term.
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This is adding more slip to an already slippery slope. Having one minister responsible for this decision, regardless of which portfolio, opens up possibilities for abuse, subject only to an invidual minister’s integrity.
How do we know that the present situation of public-funded health coverage for dubious recipients wasn’t guided by personal sentiments?
At the very least, there should be a small vetting committee, with the minister included.
The current system of healthcare provision is doomed. I wrote this last month:
“In early February 2026, Tim Ridley, founder of Maples and former member of the first Health Services Authority Board of Directors over a quarter-century ago, returned as HSA board chair to confront what he acknowledged were problems that “still exist today” despite decades of effort.1 His appointment came amid acknowledgment by Health Minister Katherine Ebanks-Wilks that the government hospital was “at capacity” and facing “growing problems”,2 with the government engaging KPMG consultants to diagnose systemic failures in governance, financial management, and operational performance.3
These developments mark not merely another chapter in the HSA’s troubled history, but rather the predictable outcome of fundamental structural defects in how the Cayman Islands delivers public healthcare. This analysis examines the economic foundations of the HSA’s dysfunction, demonstrating that the authority’s failures stem from irreparable design flaws rather than inadequate funding or temporary mismanagement….”
Full analysis: https://paste.rs/LrLQl.md