Civil society organisations and political parties are threatening legal action following Wednesday’s controversial signing of the National Health Insurance (NHI) Bill.

President Cyril Ramaphosa, who publicly signed the Bill into law amid significant criticism, said the NHI was an opportunity to “break with the prevailing inequality” in South Africa’s health system. He also called on stakeholders to work with government to ensure the NHI operates successfully.

The Organisation Undoing Tax Abuse (Outa) wants Ramaphosa to “return to the drawing board” and work with various industry experts to design a “workable” universal health care model.

Outa said while it fully supported the constitutional right of all South Africans to proper healthcare, it warned that government was creating “false hope” by signing the NHI Bill into law just two weeks before the National Elections and questioned whether it was an election ploy.

South Africa will hold its general election on May 29.

“There is a big disconnect between the dream of the sort of universal healthcare envisioned in the NHI Bill, and the reality of implementing it. Our country is in crisis on so many levels. For a universal healthcare system to work, you need enough funding and proper management, something that is sorely lacking at this stage of the country’s history,” said Outa accountability division executive director Stefanie Fick.

Outa has analysed the NHI Bill, and while it acknowledged the good intention to create a better healthcare system for all South Africans, it has several concerns around funding and management.

Outa explained that the law, in its current form, would put “undue strain” on the country’s fiscus.

“Various role players in the healthcare system have voiced their concerns – from professional bodies representing medical professionals to medical aids, academics, civil society and economists – but it is apparently just ignored. Why the rush with signing the Bill into law,” said Outa.

Meanwhile, official opposition Democratic Alliance (DA) Chief Whip Siviwe Gwarube said that the proposed NHI scheme, touted as the panacea for the country’s healthcare woes, was nothing more than a “political tool” wielded by the African National Congress (ANC) to “manipulate” voters in the upcoming election.

“Contrary to popular belief, the NHI will not equalise our healthcare system. In its current form, it lacks the necessary investment to provide accessible and quality healthcare as mandated by our Constitution. The notion that individuals will seamlessly access private hospitals under the NHI is a fallacy and an intentional lie peddled by the ANC,” said Gwarube.

She said South Africa needed a comprehensive overhaul of the entire healthcare system, using a significant portion of the country’s GDP allocated to healthcare, which she noted the ANC has failed to deliver over the past three decades.

Gwarube stated that the NHI was “a desperate attempt” to deceive the public into thinking that the ANC could remedy a broken system that it perpetuated.

The DA said it would pursue all legal avenues to challenge the NHI and ensure that the rights of all South Africans were upheld.

AfriForum is also preparing for a class action lawsuit against the government, Ramaphosa, Parliament and Minister of Health Joe Phaahla, for “the damage that South Africans will suffer under the unaffordable NHI policy”.

AfriForum confirmed this in a legal letter that was handed over at the Union Buildings.

AfriForum said it would also issue a summons and an interim application for the setting aside of the implementation of the law, pending the completion of the class action lawsuit.

AfriForum campaign officer Louis Boshoff explained that with this case, AfriForum aimed to stop the NHI and force those responsible for this "destructive” policy to bear the consequences of their “ill-considered” actions.

Further, Solidarity has commenced with its legal action against the NHI Act, hours before Ramaphosa signed the Bill into law, describing the Bill as “reckless” and labelling its ratification as “populist and irresponsible”.

It highlighted that government wanted to centralise all healthcare in South Africa, noting that the NHI was not simply a funding model, but a “comprehensive State-controlled looting pit”, that it said would fail.

Non-profit organisation Sakeliga said it opposed the implementation of the NHI, calling it an “unacceptable and irresponsible” legislative proposal.

SUPPORT FOR THE NHI

GOOD secretary-general and MP Brett Herron said his party supported the signing of the NHI Bill, describing it as a tool to address inequality and improve health care services for the majority.

However, he said that it was “regrettable” that the Bill was being signed now, days before an election.

“On the one hand, they [political parties] will use the Bill as a lever to scare privileged communities into believing that the NHI will deprive them of the high level of medical care they presently enjoy and pay for. On the other, they will want people to believe that the NHI is not aggressive enough in redistributing resources from privileged to poor people,” he said.

He noted that run-ups to elections were not conducive environments for rational debate on topics as fundamentally important as universal healthcare.

Herron highlighted that concerns raised by economists and medical professionals must be rationally engaged, and mitigated, prior to implementation, and potential barriers to the NHI’s success, including corruption must be addressed.

Meanwhile, the South African Democratic Teachers’ Union (Sadtu) said it was confident  that the NHI would “go a long way towards ensuring a healthy nation”.

It averred that the signing of the Bill was a “historic” moment, that proved the ANC-led government’s commitment to improving the lives of all South African citizens and to fulfilling its constitutional obligation as contained in the Bill of Rights, which declared that everyone had a right to have access to health care services, including reproductive health care.

Sadtu believes the NHI will ensure that South Africans access the full range of quality health care services irrespective of their socioeconomic status.

It said that the NHI would see to the creation of a public health fund with adequate resources to plan and meet the healthcare needs of the entire population and this would narrow the gap between the poor and rich in terms of healthcare.