Cosatu urges Ramaphosa to hold firm on NHI

While President Cyril Ramaphosa is deliberating on the rollout of National Health Insurance (NHI) and negotiates with the DA on the fine print, ANC tripartite alliance partner Cosatu says it will fight any changes to the NHI Act.

The act has been a point of contention in the government of national unity (GNU). The DA has been pushing against its implementation, while the ANC’s tripartite alliance partners, the SACP and Cosatu, have formed a front to ensure implementation.

Business Day previously reported the ANC and the DA struck a deal to “amend sections of the legislation and allow for the protection of the private healthcare sector in the rollout of NHI”.

Cosatu first deputy president Mike Shingange said that changes to the act would bring instability to the troubled tripartite alliance ahead of the 2026 local government elections.

“We do not see why there must be negotiations with anybody about NHI because the bill was discussed for years before it was signed. Now, it has been passed and changing the law after that sounds unconstitutional because you do not do that unless you go back to parliament,” he said.

Cosatu leadership attended the SA Private Practitioners’ Forum and the Board of Healthcare Funders court case challenging Ramaphosa’s decision to sign the NHI Bill into law in the Pretoria high court.

The organisations are of the view the president might not have considered dissenting views filed by private healthcare organisations and a warning from the National Treasury before signing the bill. In failing to do this, he did not follow his constitutional obligation.

Shingange said the organisations’ dissenting views were defeated in open democratic process when parliament passed the bill.

“The ANC and the president should not be coerced to take bills back to parliament and change them to accommodate people who participated and their views were defeated by the majority in our country. It is not the democracy we struggled for,” he said.

“We do not believe NHI should be declared unlawful. We do not believe NHI is unlawful.”

Cosatu is lobbying for unions and workers to demonstrate and fight against the private sector’s legal challenges to NHI.

“We need to protect the NHI Act and Bela [Basic Education Laws Amendment] Act and all other progressive laws. We think pressure needs to be put and South Africans who stand to benefit from NHI must come out and defend the act.

“They are suffering from unaffordable medical aid schemes; they are the ones struggling to provide healthcare to their loved ones. We cannot allow any political party to reverse all that progress that we have been making since 1994.”

Relations between the ANC and its tripartite alliance partners have been unsettled following the May 29 elections, after which the ANC partnered with the DA. This was done without much consultation with the SACP and Cosatu.

The alliance partners have also not met since the 2024 elections, which resulted in the ANC getting 40.18% of the vote and losing majority power.

In December, deputy president Paul Mashatile said the ANC would meet the SACP and Cosatu. Almost three months after the commitment was made the meeting has not taken place, Shingange said.

Asked whether any possible changes to the NHI would be a dealbreaker for Cosatu, Shingage said it would be “one of many dealbreakers”.

“Several other things have happened thus far, including their coalition with the DA.

“But … we do not know what would be left that is progressive [if NHI is changed]. Our structures will have to decide what happens going forward. It would be a setback in our revolution and our march in the development of this country.”