Ramaphosa dangles NHI in front of workers as election date draws near

 ·2 May 2024

President Cyril Ramaphosa has again indicated to workers in South Africa that he will sign the controversial National Health Insurance (NHI) Bill into law, with the days to the 2024 national elections counting down.

Speaking to Cosatu members at the union federation’s Worker’s Day rally this week, Ramaphosa said that the ANC government had processed many policies and laws which were demanded by South Africa’s working class.

Among these is the National Health Insurance Bill, which the president said workers advocated for over the years.

“You advocated for years, for you wanted all our people to be treated equally when it comes to healthcare,” he said. “The National Health Insurance Bill has now been passed, and it’s coming to my desk,” he said.

Ramaphosa said he was approached by Cosatu leadership, who told him, “If you don’t yet have a pen, Cosatu has a pen, and we are going to give it to you today so you can sign this law into operation.”

The comment references the president’s statement during his February State of the Nation address, where he said he was “looking for a pen” to sign the NHI into law.

In the three months since then, Ramahosa has signed several bills into law as the government moves with haste to finalise many of the bills it has been working on over the last five years before the end of the sixth administation.

Some of these new laws include the National Veld and Forest Fire Amendment Bill, the Agricultural Product Standards Amendment Bill, the Correctional Services Amendment Bill, the Judicial Matters Amendment Bill and the Eskom Debt Relief Bill.

However, the NHI—arguably one of the biggest pieces of legislation the Ramaphosa administration could pass —has not yet received the president’s signature despite being passed by both the National Assembly and National Council of Provinces at the end of 2023.

Since expressing his intent to sign the bill in February, Ramaphosa has used the bill as an electioneering tool at various ANC political rallies, repeatedly promising that it will be signed into law.

He made similar comments at a recent ANC rally in KwaZulu Natal, where he said the NHI bill would end “healthcare apartheid” in South Africa.

However, he has not committed to any specific timeframes.

Fight back

Given the repeated promises, it is becoming increasingly likely that the president will sign the NHI Bill into law before the election.

However, this will go against advice and urging from legal experts, business groups, the private healthcare industry and even worker unions to delay it.

The Public Servants Association (PSA)—which represents some 235,000 members of the public service—became the latest group to call for the president to ice the bill until funding mechanisms for the scheme could be ironed out.

The bill, as it currently stands, does not lay out any funding processes for the R200 billion-plus NHI, except to say that it will be done through budget reprioritisation and various taxes sometime in the future, as determined by the Treasury.

Various business groups, private healthcare representatives, and opposition parties have declared their intent to challenge the bill in court once it becomes law on constitutional grounds.

Key constitutional issues being flagged are the removal of choice of healthcare, with the NHI positioning the government as the sole purchaser of healthcare services in South Africa.

Other concerns that have been raised around the NHI are public sector corruption and maladministration, and deep trust issues with putting a multi-billion rand fund in the hands of a government with a dismal track record of managing such funds.

The health department has previously waved off these concerns, saying that the scheme will be properly managed and that critics cannot call the system corrupt before it even exists.

Read: The NHI will end ‘healthcare apartheid’ in South Africa: Ramaphosa

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