Business Maverick


Business organisations call on Ramaphosa to return NHI Bill to Parliament

Business organisations call on Ramaphosa to return NHI Bill to Parliament
Illustrative image, from left: President Cyril Ramaphosa; Business Unity South Africa CEO Cas Coovadia | National Health Insurance Bill. (Photos: Pete Marovich / The New York Times | Flickr / World Economic Forum / Benedikt von Loebell | Kyra Wilkinson)

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.

‘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 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

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 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, 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


Comments - Please in order to comment.

  • Thinker and Doer says:

    The Bill is definitely going to be signed into law by the President, the only option is for an extremely sound constitutional challenge in the courts.

  • Con Tester says:

    When has the ANC *ever* listened to reason? 🤔

  • Karl Sittlinger says:

    Normally very much against the stalingrad legal tactic, a strategy some of our illustrious leaders love to implement, but I hope the stalingrad legal strategy is used on the government on every syllable of the bill. It’s sad that the most vulnerable will pay the price, because all the ANC will do is blame those resisting this corruption milk machine and pretend that it’s not the ANCs catastrophic serial failures, while not fixing the current failung health system.

    And the masses will believe them without question. It’s becoming difficult to support those who’s decisions a d votes are literally going to kill you.

    • Steve Davidson says:

      The very fact that the bill is obviously unconstitutional shows what a bunch of total incompetents the ANC are, and the sooner they are kicked out the better. But I think your use of the negative ‘Stalingrad’ description is wrong – the court actions would be simply confirming that the bill is a complete load of bollox in the first place.

      • Karl Sittlinger says:

        The longer we keep the ANC busy with litigation, the less likely they will be able to make a new plan to ram through the NHI. The ANC is doing its usual trick here, to try and push through the impossible, and then act all magnanimous by then settling for a little less. This is one of the times we need to fight back with all we can, and that should include for once wasting their time.

    • J vN says:

      The cANCer is counting on this Marxist idiocy being challenged in the court. It knows very well the NHI is never, ever going to work, to the extent that SA’s Treasury is not even interested in attempting to price it. But, it WANTS the court challenge, so that it can point to those doing the challenging and tell its voting fodder: “See! It’s the racists who are stopping us from providing you with free stuff.”

  • Henri Christie says:

    The useless anc will try anything to boost its votes, even to the detriment of the once prosperous SA.

  • Craig A says:

    Since the NHI will be funded by one source, the taxpayer, why don’t we as taxpayers just refuse to pay for it? Maybe it is time to apply the golden rule – he who has the gold, makes the rules. They ANC government have no gold, it is ours. And we should have some say in how it gets spent (and stolen).

  • Alan Watkins says:

    The ANC could say Ramaposer is going to sign the bill right up till election date, and either do it or not do it. The real indicator will be what is in the budget speech. Probably nothing indicating no real advance on NHI irrespective of whether Ramaposer signs it or not. Because the finance minister cannot present a budget with significant NHI expenditure because SA simply does not have the money.

  • Rae Earl says:

    Thabang Sarah, please get the hell off this forum. It is not an advertising space for crooked and dishonest Ponzi schemes etc.

  • Rae Earl says:

    The ANC has wrecked the government run health industry. An industry which worked very well for many years in both the black and white communities before democracy came along and allowed the ANC to take control. They proved that in their hands this once excellent facility, was beyond their capability. How on earth do they now expect to now take on the mess they’ve made here and turn it around with the NHI? This is simply another exercise in corruption as the NHI will extract billions from tax payers every year and give the ANC another conduit to allow some of these tax payer proceeds to end up in private pockets within the ANC.

  • John P says:

    This is nothing but a rushed through election stunt by the ANC, hopefully a lot of empty barrel noise will be made prior to the election and then it will crawl into a corner and die.

  • Vincent Britz says:

    Let’s be honest people!! The president(ANC government) have no other choice but to sign the NHI into law. They are in desperate need for a new piggy bank(SOE) to loot and destroy, as they have looted and destroyed every last piggy bank(SOE) that this country has to offer. So it’s 100% guaranteed the NHI will be signed into law, SA government thugs & criminals(ANC, family & friends) billions are becoming less.

  • Bob Fraser says:

    Bob. February 5th 2024
    It must be hoped that Ramaphosa is not as thick as all intelegent voters believe him to be. Of course he has all his loudmouthed underlings whispering in his ear as they run scared knowing full well that once the ANC no longer controls the government and parastatals they will be out of their jobs and no longer have access to funds to steel.

  • Dragon Slayer says:

    Do not forget the upcoming elections – like free schooling – this is desperation by the ANC to garner its plummeting support. If after the election the NHI is overturned by the courts they are banking on still have four more years to plunder. The long suffering tax payer will also have to foot that legal bill.

  • Henry Coppens says:

    Two reasons for NHI signing: vote catching and part of the ANCs NDR which aims to crush private enterprises and what better one to kill than the private health care system.


    What we all fail to see is the scorched earth policy…the ANC knows that they have a very strong chance in losing their 50+ majority. So they doom every sphere of government, national, local, SOE and foreign policy to failure. That way, any new party, coalition or not, that comes to power has failed before they ascend the throne. It will take more than 4 years to fix but a small percentage of the destruction they have caused. This will give them the ammunition later to say “look, we lost power, but the new governing party has done very little…vote us in again to fix it…” I don’t see getting this country back on track will take anything less than 30 years of pain and suffering from all…sad sad situation

  • Barrie Lewis says:

    Interesting that GEMS is the first medical aid to be transferred to the NHI. Poor public servants will get it in the neck again. Not surprisingly the ANC didn’t suggest starting with ParMed.

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