Ramaphosa to sign NHI into law

Under mounting pressure from within the ANC, President Cyril Ramaphosa will sign the contentious National Health Insurance (NHI) Bill into law on Wednesday, setting the stage for a protracted fight with business, healthcare professionals and opposition parties. The bill sets in motion the government’s ambitious plans for universal health coverage to create a unified health system that provides patients with care that is free at the point of delivery, whether at a public or private facility.

Under mounting pressure from within the ANC, President Cyril Ramaphosa will sign the contentious National Health Insurance (NHI) Bill into law on Wednesday, setting the stage for a protracted fight with business, healthcare professionals and opposition parties.

The bill sets in motion the government’s plans for universal health coverage with a unified health system that provides patients with care that is free at the point of delivery, whether a public or private facility.

Ramaphosa confounded observers with the delay in signing the bill, which was submitted to him in December last year. In his state of the nation address in early February, he quipped that he was “looking for a pen”, but said nothing further until announcing that he had finally assented to the legislation.

In a statement on Monday night, the presidency said Ramaphosa would sign the bill into law at a public ceremony at the Union Buildings in Pretoria at 2pm on Wednesday. The legislation directed the “transformation of SA’s healthcare system” and would “overcome the socioeconomic imbalances and inequities of the past“.

The legislation paves the way for the creation of a government-controlled NHI fund as sole purchaser of services provided under the scheme. The government has yet to specify how it will be financed, but the ANC has said consistently it intends to redirect the money employers and individuals pay to medical schemes into the NHI Fund by taxation, a proposition that critics say is unviable.

One of the bill’s most controversial aspects is its prohibition on medical schemes covering benefits provided by NHI, a provision that critics say is unconstitutional as it will reduce the access to care of medical scheme beneficiaries. Section 27 of the constitution obliges the state to progressively expand access to healthcare.

The private healthcare sector has expressed concern that diminishing the role of medical schemes would destabilise the industry and render many businesses depending on it unviable.

Trade union Solidarity and AfriForum are expected to be among the first parties to launch legal challenge against the legislation. Organised business and organisations representing healthcare professionals are also expected to push back against it implementation.

Observers will be watching closely on Wednesday for an indication of how the government intends to implement the legislation, and which sections it will put into effect first.

The Treasury’s chief director for health and social development, Mark Bletcher, said at the annual Board of Healthcare Funders conference last week, that the bill would probably take many years to implement, due to the present fiscal environment.

Budget pressures facing government would make it difficult to generate additional funding for NHI by raising taxes, he said.