Opposition voices outcry against NHI Bill: legal wrangling expected

President Cyril Ramaphosa signing the National Health Insurance Bill into law at the Union Buildings on Wednesday. Picture: Jacques Naude / Independent Newspapers

President Cyril Ramaphosa signing the National Health Insurance Bill into law at the Union Buildings on Wednesday. Picture: Jacques Naude / Independent Newspapers

Published May 15, 2024


Opposition parties and medical groups have voiced their disapproval to the National Health Insurance (NHI) Bill, with some indicating their intention to challenge it in court.

These objections surfaced shortly after President Cyril Ramaphosa formally signed the NHI Bill into law on Wednesday at the Union Buildings.

DA leader John Steenhuisen described Ramaphosa’s move as destructive before the elections, which according to him, was borne out of fear of losing the elections.

Steenhuisen vowed that the DA would go all the way to the Constitutional Court to challenge the bill.

“Our legal team was briefed months ago and will file our legal challenge against this devastating legislation without delay.

“We have built up reams of correspondence, including with Ramaphosa himself, we will enter into evidence to show the process which led to the adoption of the bill by parliament disregarded public input, and the bill itself is flagrantly unconstitutional,” he added.

The DA leader said the move was like an increment of Value Added Tax (VAT) from 14% to 21.5%, increasing personal income tax by 31%.

This, he said, was imposing an additional payroll tax of R1 500 per month on every working person, or a combination of all of the above.

Steenhuisen took exception to the fact that the bill funds would be deposited into a central fund controlled by what he termed “one almighty ANC cadre”.

He said that meant empowering the health minister to be directly involved in the day-to-day management of “the biggest pile of taxpayer money that has ever been accumulated in South Africa”, which the DA was against.

Section27 executive director Sasha Stevenson also raised concerns on how the the NHI fund was governed, saying that it was all centred around the health minister, who will in turn appoint an ad hoc committee that will decide who should be on the board.

Stevenson, however, said the NHI was one of the country’s greatest idea, as that was exactly what the country’s Constitution required.

She also said the organisation was calling for some key changes to the Bill to allow proper implementation across the health sector.

“Our concern is the way the NHI is framed doesn’t take us into that direction, in fact, that causes a lot of risk to the health system public and private health system as it stands today.

“NHI is not the universal health care but it’s the way we have been stuck on for many years and the real unfortunate thing is the focus on NHI and getting this bill from green paper to white paper ultimately to a bill through Parliament has really taken away reforms in hospitals that are desperately needed to prove health services that are so much needed across the board,” Stevenson said.

Speaking with the publication on Wednesday, South African Health Professionals Collaboration (SAHPC) spokesperson, Dr Simon Strachan, said their suggestions and ideas have been overlooked by Ramaphosa and that they had no doubt that the NHI Bill would be challenged in the courts. They too, he said, were exploring the possibility of challenging the bill legally in court.

“SAPHC also believes its members' concerns and recommendations throughout the parliamentary process were systematically ignored, raising serious questions about the fairness and effectiveness of the democratic process.

“SAHPC members, representing a diverse array of healthcare specialities, have consistently advocated for policies that prioritise the well-being of patients and ensure the sustainability of the country’s healthcare system,” said Strachan.

According to the Department of Health (DoH), the NHI is a fund that will be used by the government to purchase healthcare services from commercial and public sector providers for South Africans.

Briefing the media after the signing ceremony, Health Minister Dr Joe Phaahla told scores of reporters that the NHI was “doable”, saying that the department would target low-hanging fruits to help fund the rollout (among other strategies). The roll out will be in phases.

Meanwhile, while presenting the bill, Ramaphosa said the real challenge in implementing the NHI laid not in the lack of funds, but rather from the current misallocation of resources, which disproportionately favours the private health sector over public health needs.

“The NHI is an opportunity to make a break with the inequality and inefficiency that has long characterised our approach to the health of the South African people. Let us work together, in a spirit of cooperation and solidarity, to make the NHI work.

“The NHI is an important instrument to tackle poverty. The rising cost of health care makes families poorer. By contrast, health care provided through the NHI frees up resources in poor families for other essential needs. The NHI will make health care in the country as a whole more affordable.”