Business slams ‘unconstitutional’ NHI Bill as they are prepare petition to give to Ramaphosa

In its current form, organisations say the NHI Bill will have a devastating impact on the country’s ability to deliver quality health care. Photo: Supplied

In its current form, organisations say the NHI Bill will have a devastating impact on the country’s ability to deliver quality health care. Photo: Supplied

Published Dec 8, 2023


Business Unity South Africa (Busa) and B4SA are preparing to submit a petition to President Cyril Ramaphosa, requesting that he refer the NHI Bill back to the National Assembly for amendment.

Business groups said yesterday that the bill, in its current format, was not only unworkable, unimplementable and unaffordable, but also unconstitutional on substantive and procedural grounds.

The bill was adopted by the National Council of Provinces, without any amendments, on Wednesday.

The South African Constitution, under Section 79, provides that once a bill is adopted, the president must either assent to and sign the bill or, if the president has reservations about the constitutionality of the bill, refer it back to the National Assembly for reconsideration.

Martin Kingston, the B4SA steering committee chair, said Busa and B4SA had, throughout the entire NHI Bill legislative process, highlighted the deficiencies in the bill, including the unconstitutional provisions that required clarification and amendment.

"Our concerns, recommendations, research, data and inputs, as well as those made by a wide range of experts and affected stakeholders, have been summarily ignored by the Parliamentary portfolio committee on health and the NCOP, which are legally mandated to ensure that the NHI Bill passes constitutional muster and is properly configured to give health care the best possible chance of success.

“No amendments were made at all, including those suggested by the Department of Health itself, which is deeply concerning for our country and democracy,” Kingston said.

The consequence of passing this bill unamended would be devastating.

"It will materially delay access to universal health coverage, lead to disinvestment in the health-care sector, further damage our already fragile economy, and create significant risks for the country in terms of the quality, management and governance of health care,” Kingston said.

Procedurally, the business grouping noted that Parliament’s socio-economic impact assessment process was inadequate, that the Nedlac process in respect of the bill were not followed through, that public participation inputs were not properly considered and that multiple constructive inputs from business and other stakeholders had been ignored.

Busa/B4SA also noted that section 33 was unconstitutional in giving the Health minister unfettered power to determine the restricted role for medical schemes, especially as this power was unnecessary for achieving the policy objectives of the bill.

Cas Coovadia, the CEO of Busa, said: ”We have not rejected the bill in its entirety, and have consistently supported its policy direction towards universal health coverage. Our inputs have been intended to remedy the constitutional, funding and practical deficiencies in the bill … For these reasons, it is our strong belief that the president must refer it back to the National Assembly for amendment."

The Health Funders Association (HFA) said there was time to fix the NHI Bill, adding that it was also going to petition Ramaphosa.

Craig Comrie, the chairperson of the HFA, said that in adopting the bill in its current form, Parliament has failed to take proper cognisance of the implications for citizens’ constitutional rights, health care as a whole and the South African economy. “In short, it has failed South Africa and its citizens.”

The South African Health Professionals Collaboration, which represents more than 25 000 private and public sector health-care workers, is also calling on the president to refer the NHI Bill back to Parliament for reconsideration, saying if it was implemented in its current form, it would have a devastating impact on the country’s ability to deliver quality health-care.