In the face of growing 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, which is 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.
Ramaphosa has 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 issued on Monday evening, 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 bill “directs the transformation of SA's healthcare system” and would “overcome the socioeconomic imbalances and inequities of the past”, said the statement.
The bill paves the way for the creation of a government-controlled NHI Fund, which will be the sole purchaser of services provided under the scheme. The government has yet to specify how it will be financed, but the ANC has consistently said it intends to redirect the money employers and individuals pay to medical schemes into the NHI Fund by taxation, a proposition 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 critics say is unconstitutional because it will reduce medical scheme beneficiaries' access to care. Section 27 of the constitution places an obligation on the state to progressively expand access to health care.
The private healthcare sector has also expressed concern that diminishing the role of medical schemes would destabilise the industry and render many businesses that depend on it unviable.
Trade union Solidarity and AfriForum are expected to be among the first parties to launch legal challenges against the bill, but organised business and organisations representing healthcare professionals are also expected to push back against its implementation.
Observers will be watching closely on Wednesday for an indication of how the government intends to implement the bill and which sections it will bring into effect first.
Last week the Treasury told the annual Board of Healthcare Funders conference that the bill would likely take many years to implement, due to the current fiscal environment. The budget pressures facing government would make it difficult to generate additional funding for NHI by raising taxes, Treasury's chief director for health and social development Mark Blecher said at the time.
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