South Africa

Government playing political games with NHI signing

Many political analysts say the government knows the National Health Insurance (NHI) scheme will be tied up in courts for years and only signed the Bill to win votes.

This is according to Bureau for Economic Research chief economist Lisette IJssel de Schepper, whose comments come after President Cyril Ramaphosa signed the NHI Bill on Wednesday, 15 May.

The government has been discussing implementing NHI in South Africa for years, with the NHI Green Paper released in 2011. However, the NHI Bill was only introduced to Parliament in 2019.

Last year, the Portfolio Committee on Health approved the Bill, followed by the National Assembly and the National Council of Provinces. It was passed on to the President in December 2023.

The NHI Act aims to transform South Africa’s healthcare system to achieve universal coverage for health services and, through this, overcome critical socio-economic imbalances and inequities of the past. 

On 15 May, Ramaphosa enacted the Bill with no amendments despite widespread criticism of the plan.

NHI critics – including industry roleplayers – have argued that the government’s proposals haven’t been properly costed, are unconstitutional and could be successfully challenged in court.

IJssel de Schepper said she does not question the worthy goal of universal healthcare coverage.

However, she said the NHI is not implementable in its current form, given funding, infrastructure, capacity and administrative constraints. 

In addition, she said the timing—the Bill being signed just two weeks before the election—and the public fanfare around the signing event are telling. 

“Indeed, many political analysts have argued that the Presidency is aware that the Bill will be tied up in courts for years and that there is unlikely to be any economic fallout from signing it into law now,” she said.

However, she warned that the NHI Act could hurt the relationship with the business community.

Bureau for Economic Research chief economist Lisette IJssel de Schepper

The government has said it is ready to defend its NHI scheme in court against challenges levelled by business groups and political parties calling the NHI Act unconstitutional.

Business groups, such as Business for South Africa (B4SA), have said the proposed NHI has no practical funding model, does not pass Constitutional muster, and will be tied up in the courts. 

Business Unity South Africa CEO Cas Coovadia said that, in response to the NHI becoming law, the organisation would consider its options, including legal action. 

“Our subsequent actions will be guided by our belief that it is essential that we get the NHI right through all means still at our disposal, including appropriate legal interventions,” Coovadia said. 

Trade union Solidarity has already taken the National Department of Health to court once before over the NHI late last year and has promised to challenge it by all means necessary. 

South Africa’s main opposition party, the Democratic Alliance, has also said it would take the government to court over the implementation of the NHI. 

Minister of Health Joe Phaahla has said the government is ready to defend the NHI in court and understands that some corners of South Africa are willing to engage in ‘lawfare’ to prevent the scheme from being implemented. 

He said the threats of legal action are nothing new as throughout the Parliamentary process business groups, civil society, political parties, and trade unions threatened legal action. 

“We will be ready to engage with aggrieved parties in the courts, but our hope is that we will be able to begin implementing the Act as soon as possible,” he told Newzroom Afrika. 


Top JSE indices