Huge development for medical aid members in South Africa: report

South African medical aid members may soon find relief amid growing concerns over the National Health Insurance (NHI) Act, following reports of an informal agreement between key political figures within the Government of National Unity (GNU).

Planning, Monitoring and Evaluation Minister Maropene Ramokgopa reportedly disclosed to News24 that the African National Congress (ANC) and the Democratic Alliance (DA) have reached a compromise that could ease fears about the future of private medical schemes under the NHI.

According to the newsgroup, certain sections of the NHI Act that specifically threaten the existence of medical aids—such as section 33 disallowing medical aids from covering services the NHI will cover—could be changed.

NHI opponents, including healthcare groups, medical professionals, business organisations and the DA, found this particular section of the laws to be the main problem with the Act.

Speaking to News24, Ramokgopa said that the ministers involved—health minister Aaron Motsoaledi and DA leader (and agriculture minister) John Steenhuisen—were consulted over possible changes.

They reportedly agreed on a proposal ensuring that the NHI would not dismantle medical aid schemes.

Additionally, they proposed the establishment of a ministerial advisory council to oversee the integration of the NHI with existing healthcare structures.

BusinessTech asked the Department of Health, Minister Ramokgopa, and Minister Steenhuisen to comment on the reported discussions but did not receive a response by the time of publication. Comment will be added if and when received.

Words of war

Changing or even removing section 33 from the laws would signify a dramatic shift in the NHI.

Motsoaledi, in particular, has been a firm advocate for section 33, viewing it as fundamental to the NHI’s success.

He believes it is a key part of the NHI and previously compared removing it to building a house without a foundation.

The minister has been a fervent proponent of the NHI laws as they stand and has taken an adversarial and aggressive stance against critics, media houses and anyone who has questioned the Act, especially regarding medical aid and funding.

However, he has also expressed openness to discussing the laws and inviting proposals on how to collectively deal with South Africa’s healthcare issues. But the funding aspect has been immutable.

“There is no law on earth that is cast in stone, that never changes. I want to make that clear,” he told Bhekisisa in an extensive interview in August 2024.

“(But) I won’t sit with anyone who does not want any reform of healthcare financing. That will be a complete waste of time,” he said.

More recently, addressing a panel at the World Economic Forum in January 2025, the minister said that the government was fighting “a big war” against those who are opposing the NHI through the courts.

The NHI is facing three main legal challenges, with more expected to come. The path to implementation is wrought with uncertainties as a result.

President Ramaphosa signed the NHI Act into law just two weeks before the national elections.

Following the elections, the ANC lost its majority in Parliament and had to form a Government of National Unity (GNU) with other parties, including the DA and the Inkatha Freedom Party (IFP), who don’t support the NHI.

Because of this new partnership, the government has to make some compromises to keep things running smoothly.

Motsoaledi has previously clarified that the GNU is not an alliance but rather a pragmatic partnership driven by political necessity.

“We are not in an alliance with the Democratic Alliance. We just went into a government of national unity with them because the situation demanded it.

“We know their policies are market-related and business-oriented. We knew there would be such contradictions,” he said.

Despite these ideological differences, he emphasised the importance of dialogue and negotiation to resolve policy disputes.

One of the biggest problems with the NHI is that the rules aren’t very clear, particularly concerning the timeline and extent of medical aids’ role once the NHI is fully operational.

While Section 33 notes that medical aids cannot cover services funded by the NHI, the act does not clearly define when the NHI will be considered “fully implemented.”

This ambiguity has fueled public anxiety, with critics arguing that it leaves too much room for interpretation and potential overreach.

The reported informal agreement between the ANC and the DA offers a potential pathway to address these concerns without derailing the NHI entirely.

By retaining medical aid schemes alongside the NHI, South Africa could adopt a more flexible, hybrid healthcare model that accommodates both public and private healthcare needs.

Alternative systems pitched to the government by business and healthcare groups have proposed making medical aids mandatory for those who are employed.

This system would remove millions of people from depending entirely on public healthcare—lessening the burden on the state—while also giving the private sector a more functional role in sharing the load.