---
title: "Business organisations call on Ramaphosa to return NHI Bill to Parliament"
description: "To ensure the NHI Bill passes constitutional muster, President Cyril Ramaphosa should return it to Parliament to fix ‘substantive and procedural constitutional flaws’, business organisations Busa and B4SA said on Sunday."
type: "NewsArticle"
publisher: "Daily Maverick"
site: "https://www.dailymaverick.co.za"
section: "‘CONSTITUTIONAL FLAWS’"
author: "Marianne Merten"
author_url: "https://www.dailymaverick.co.za/author/mariannemerten/"
canonical_url: "https://www.dailymaverick.co.za/article/2024-02-04-business-organisations-call-on-ramaphosa-to-return-nhi-bill-to-parliament/"
published: "2024-02-04T21:06:00"
lang: "en-ZA"
word_count: 783
---

# Business organisations call on Ramaphosa to return NHI Bill to Parliament

> To ensure the NHI Bill passes constitutional muster, President Cyril Ramaphosa should return it to Parliament to fix ‘substantive and procedural constitutional flaws’, business organisations Busa and B4SA said on Sunday.

By Marianne Merten · Published 4 February 2024, 23:06 SAST

## Key points
- Business Unity South Africa (Busa) and Business for South Africa (B4SA) have submitted a formal petition to President Cyril Ramaphosa, urging him to consider the long-term impact and risks of signing the National Health Insurance (NHI) Bill into law, which they argue flouts the Constitution and fails to meet criteria for affordability and implementation. While the government remains firm in its support for the Bill, critics have raised concerns about dilapidated healthcare facilities, potential corruption, limited patient choice, and the end of medical aid schemes. The Bill is expected to be a key issue in the upcoming general election, with the possibility of it being signed into law before May. However, Busa and B4SA are calling for a constitutionally compliant law that provides clarity, certainty, and universal health coverage.
- Business Unity South Africa (Busa) CEO Cas Coovadia has urged President Cyril Ramaphosa to consider the long-term impact and risks of assenting to the National Health Insurance (NHI) Bill, which Busa believes flouts the Constitution. Busa has submitted a formal petition to the President expressing its concerns.
- Busa and Business for South Africa (B4SA) have criticised the NHI Bill for not meeting the criteria of being underpinned by the Constitution, affordable and implementable. They have also raised concerns about dilapidated public healthcare facilities, potential corruption in centralising procurement, and limiting patient choice.
- Despite widespread criticism, the government has remained firm in its support for the NHI Bill. Health Minister Joe Phaahla sees its passage as an indicator of his performance agreement with Ramaphosa.
- With a general election looming, the NHI legislation is expected to be a key issue. The Bill could be signed into law before the elections, but Busa and B4SA are calling for a constitutionally compliant law to be put on the statute books. They believe the current form of the Bill will have devastating consequences for the country and its people.

## Content

‘We hope that the President considers the long-term impact and risks of assenting to a Bill that so clearly flouts the Constitution,” Business Unity South Africa (Busa) CEO Cas Coovadia said on Sunday, adding that the organisation had submitted a detailed formal petition to President Cyril Ramaphosa in late November.

“What the country needs is an NHI underpinned by the Constitution and which is affordable and implementable. This Bill does not meet these criteria and is not ready to be signed into law.”

The National Health Insurance Bill has been in Ramaphosa’s in-tray since it was passed on 6 December in the National Council of Provinces. The vote was [delayed for a week](https://www.dailymaverick.co.za/article/2023-11-29-nhi-bill-vote-delayed-amid-backroom-political-twists-and-last-minute-business-lobbying/) following Busa and Business for South Africa’s (B4SA’s) approach to the Presidency.

After that vote, the DA also said it would ask Ramaphosa not to sign the Bill into law and was briefing lawyers on potential legal challenges in the Constitutional Court.

**Read more in Daily Maverick:**[NCOP passes NHI Bill in face of widespread condemnation by health professionals, business and opposition](https://www.dailymaverick.co.za/article/2023-12-06-ncop-passes-nhi-bill-in-face-of-widespread-condemnation-by-health-professionals-business-and-opposition/)

The Constitution, in section 84(2), allows the President to return legislation to Parliament if there are concerns about constitutionality or procedural issues. The President can also submit the legislation to the Constitutional Court for a decision on whether the legislation is compatible with the Constitution.

While no one opposes equal access to quality universal healthcare — only 16% of South Africans can afford private medical insurance — the NHI Bill has been sharply criticised by doctors, health facility providers and health insurance companies.

Such critique includes dilapidated public clinics and hospitals that do not meet basic cleanliness and other standards, centralising the procurement of medicine, health products and equipment through a government-administered fund — the potential for corruption has been flagged — limiting patients’ choice by prescribing the healthcare access route and, ultimately, ending the role of medical aid schemes once the minister decides the NHI has been fully implemented.

The government has stood firm in its support for the Bill, as indicated by Health Minister Joe Phaahla immediately after the NCOP vote in December. Getting the Bill passed was one of Phaahla’s assessment indicators in his [performance agreement](https://www.dailymaverick.co.za/article/2024-01-27-clear-as-mud-ministers-fly-by-the-seat-of-their-pants-on-ramaphosas-fuzzy-performance-measures/) with Ramaphosa.

After the roughly 16 years it took the governing ANC to get to this point, the NHI Bill is strongly supported by its alliance partners, the SA Communist Party and the labour federation Cosatu.

#### **Election year**

With a crucial general election coming up this year, the NHI legislation is set to feature strongly; at the ANC’s 8 January Statement Ramaphosa as party president went off script to underscore the NHI Bill would be implemented, “whether they like it or not”.

According to [*Bloomberg*](https://www.news24.com/fin24/economy/ramaphosa-to-sign-off-nhi-bill-before-elections-20240201), the Bill could be signed into law before the elections — which are widely expected to be held in May. The international news service quoted Minister in the Presidency Khumbudzo Ntshavheni as saying, “We think it’s a priority that it must be signed during this period so that the full implementation can take place.”

B4SA and Busa are not unaware of such electioneering dynamics, but their call is to ensure a constitutionally compliant law is put on the statute books.

As B4SA steering committee chairperson Martin Kingston put it, “We recognise that the country is in pre-election mode and that the adoption of the NHI Bill is a cornerstone of the government’s policy platform and its election campaign.

#### **‘Devastating consequences’**

“However, the weaknesses and the material negative implications of the NHI Bill, in its current form, will have devastating consequences for the country and her people for generations to come.”

The Bill has been steeped in speculation, most recently that the President may sign only some sections of it into law. Busa and B4SA are opposed to piecemeal implementation, which would not provide clarity and certainty, would “hamper collaboration”, undermine healthcare sector investment and “impede initiatives” towards universal health coverage, according to Sunday’s joint statement.

Aside from procedural concerns, including the lack of a socioeconomic impact assessment of the Bill and inadequate consideration of public participation, Busa and B4SA in Sunday’s statement also raised questions over the constitutionality of accessing healthcare — that path is prescribed, effectively taking away patient choice — and of appealing against medical treatment decisions.

In addition, the lack of milestones for the implementation of the NHI was raised, and the funding of the NHI, for which the National Treasury, not the Department of Health, could be responsible for raising taxes and levies.

“Busa and B4SA are confident that in a constitutional democracy, these views will be taken into account by the President when he assesses the constitutionality of the Bill prior to his assent,” Kingston said. **DM**