NHI bill faces widespread legal backlash

President Cyril Ramaphosa on Wednesday signed into law the National Health Insurance (NHI) Bill, saying it presents an innovative approach to funding universal health care based on social solidarity.

However, the backlash started almost immediately after the bill was signed, with trade union Solidarity saying it had started legal action against NHI, while the DA said it was a political tool wielded by the ANC “to manipulate voters in this upcoming election”.

After signing the bill at the Union Buildings in Pretoria, Ramaphosa said equal access to health care regardless of a person’s social and economic circumstances was necessary.

“The NHI takes a bold stride towards a society where no individual must bear an untenable financial burden while seeking medical attention. This vision is not just about social justice. It is also about efficiency and quality. The provision of health care in this country is currently fragmented, unsustainable and unacceptable,” Ramaphosa said.

There was an imbalance as the public sector serves a large majority of the population, but faces budget constraints while the private sector serves a fraction of society at a far higher cost without a proportional improvement in health outcomes, he said.

“Addressing this imbalance requires a radical reimagining of resource allocation and a steadfast commitment to universal health care, a commitment we made to the United Nations.”

Solidarity said the NHI is irrational and unaffordable. The union’s deputy chief executive of legal matters, Anton van der Bijl, said the government is unable to fund the NHI and ordinary South African taxpayers will have to pay for it.

“The NHI is going to cause unprecedented damage to taxpayers, not to mention the South African economy.

“That is why the NHI must be declared unconstitutional, and this is what we will try to achieve through the courts.”

Solidarity’s legal team had the necessary court documents ready and “the legal battle against the NHI has officially begun”, he said.

DA chief whip Siviwe Gwarube said universal health care is a necessity, but the NHI in its current form lacks the necessary investment to provide accessible and quality health care as mandated by the Constitution.

“The notion that individuals will seamlessly access private hospitals under the NHI is a fallacy and an intentional lie peddled by the ANC.”

She said the cost of the NHI – estimated at R300 billion annually – will fall disproportionately on taxpayers.

“South Africans simply cannot afford to pay more tax and we will see tax emigration en masse as a result.”

The Hospital Association of South Africa said for NHI to work, the country would require a “fully functioning and capacitated public health-care system –for instance, producing sufficient numbers of nurses and doctors and specialists – working closely and competing with a world-class private health-care system, as is the case in the UK and elsewhere.”

Health Funders Association (HFA) chairperson Craig Comrie said despite NHI being signed into law, it would have no immediate impact on medical scheme benefits and contributions, or tax changes.

“There is a very long way to go towards building confidence in the public health system and the state’s capacity to effectively manage a single pool of funds as envisaged in the NHI Bill,” he said.

“Currently, state clinics and hospitals are overwhelmed, struggling to deliver the most basic care, often inadvertently risking lives. If private health care can no longer alleviate at least some pressure on the public system, the NHI’s promised reforms will not be realised,” he said.

Lee Callakoppen, principal officer at Bonitas medical scheme, said the NHI is still a long way from being fully implemented with unanswered questions with regard to legalities and practical implementation.

“Bonitas will continue to pursue all avenues actively, to address the unanswered questions and practical implications of the (bill) in the best interests of our members,” said Callakoppen.

Labour union Health and Allied Workers Indaba Trade Union welcomed the signing of the bill and called for the nationalisation of private hospitals to support the roll-out of the NHI.

The Mercury