National health insurance
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Quick guide: NHI and the law-making progress
What is the NHI Bill?
A bill is a draft of a potential law that either suggests a brand-new law, or changes to an existing one. The National Health Insurance (NHI) Bill is a draft for a new healthcare law.
Usually, government departments create most Bills with guidance from ministers or deputy ministers. The Bill was conceived by the ruling ANC.
What is the aim of NHI?
NHI is the ANC’s attempt to implement a universal healthcare financing system in South Africa. However, the NHI Bill as it currently stands amounts effectively to the nationalisation of the healthcare industry, creating yet another state-owned monopoly.
Why is the NHI a bad idea?
While NHI is often promoted as offering “free healthcare,” the reality is that quality healthcare services come at a cost. As the saying goes: “There is no such thing as a free lunch.”
NHI, which will be controlled by the office of the Minister of Health, intends to provide free healthcare. Funding will come from the government’s annual healthcare budget and a new NHI tax. The responsibility for funding this free healthcare will fall on an already shrinking taxpayer base, and this poses a very real potential burden. As it is, taxpayers already receive very little in return (i.e., service delivery, governance or accountability), and NHI will most likely be no different.
The current reality is that even if you pay for private health insurance, you will still pay NHI tax. Under NHI, the government wants to “redirect” the money that you spend on private healthcare and compel you to spend it on an additional tax contribution. With this additional tax contribution, it means you will have little (if any) money left to spend on private healthcare. Given their dismal track record, the ANC cannot guarantee that public healthcare will improve – and yet they are bent on diminishing the role of the private healthcare industry.
The ANC will also have full control over all the supply of medical goods and services. For example, they will dictate where doctors can work, or which doctors you may visit. They will even dictate how many times you can visit a doctor.
Key figures at the helm of NHI have already been implicated in corruption scandals (which also involved the former Minister of Health) and there is no guarantee that the funds directed towards NHI will be immune to corruption or the effects state-capture. ANC cadres will most likely be placed in key positions, while funds that will be allocated towards the NHI will potentially become a honeypot for tenderpreneurs.
What type of bill is the NHI Bill?
The NHI Bill is a Section 76 Bill which affects provinces. This means that the NHI Bill must be considered and approved by both the National Assembly (NA) and the National Council of Provinces (NCOP).
What has happened so far?
The NHI Bill was passed by the NA on 13 June 2023. 205 members of the NA voted for the Bill while 125 voted against it. The Bill was passed despite opposition from various parties, including AfriForum. The Bill is now at NCOP, where AfriForum will continue to oppose it.
How does this Bill become an act?
The process of how a bill becomes a law in South Africa involves several stages in both the NA and the NCOP. This process is illustrated in the diagram below.
Public participation 1
Public participation 2
Public participation 1
| Date | Actions and main events | Link |
|---|---|---|
| 15/07/2019 | AfriForum slams minister's R30 billion for NHI. | Read more |
| Written comment | ||
| 07/08/2019 | AfriForum ready to submit comments on destructive NHI Bill. | Read more |
| 02/09/2019 | AfriForum encourages the public to submit comments against the destructive NHI. | Read more |
| 12/09/2019 | AfriForum submits comments against NHI at parliament buildings. | Read more |
| 01/10/2019 | AfriForum encourages the public to submit comments against the destructive national health insurance (NHI) bill. | Read more |
| 11/10/2019 | Public comment is scheduled to close. | |
| 09/10/2019 | AfriForum requests American NGO to withdraw NHI award to Ramaphosa. | Read more |
| Public hearings | ||
| 16/10/2019 | AfriForum mobilises communities to attend public hearings. | Read more |
| 23/10/2019 | Community of Secunda attends AfriForum community meeting. | Read more |
| 24/10/2019 | NHI: Community of Middelburg attends AfriForum community meeting. | Read more |
| 01/10/2019 | AfriForum receives confirmation that the period for the submission of comments on the national health insurance (NHI) bill has been extended to 29 November 2019. | Read more |
| 25/10/2019 | Community of Nelspruit attends AfriForum community meeting. | Read more |
| 29/10/2019 | AfriForum expresses its displeasure at the procedural unfairness of the process so far. The parliamentary portfolio committee for health held these hearings in Mpumalanga from 25 to 28 October 2019 where there were several procedural problems. | Read more |
| 30/10/2019 | Community of Kimberley attends AfriForum community meeting. | Read more |
| 31/10/2019 | Community of Upington attends AfriForum community meeting. | Read more |
| 01/11/2019 | Community of Springbok attends AfriForum community meeting. | Read more |
| 12/11/2019 | AfriForum sends a letter to President Cyril Ramaphosa, the Minister of Finance, Tito Mboweni, and the Minister of Health, Zweli Mkhize, in which the civil rights organisation warns that the implementation of the NHI could ultimately lead to the downgrading of the country's credit rating to junk status. | Read more |
| 18/11/2019 | NHI violates the Constitution: AfriForum is going to charge the health departments with misappropriation of R5,8 billion. | Read more |
| 18/11/2019 | AfriForum’s report entitled “Deceiving the public: a critical analysis on the impact assessment on the National Health Insurance White Paper” points out unconstitutionality of NHI. | Read more |
| 1/12/2019 | AfriForum sends a letter to President Cyril Ramaphosa to put him on terms about this legislation and the organisation argues that NHI will be unaffordable in the long term. | Read more |
| 1/12/2019 | AfriForum comments on the NHI Bill in the Nelson Mandela Metro. | Read more |
| 18/11/2019 | AfriForum files complaints about wasted R446 million against the Free State's Department of Health. | Read more |
| 19/11/2019 | AfriForum files complaints about wasted R170 million against Limpopo's Department of Health. | Read more |
| 19/11/2019 | AfriForum files complaints about wasted R1,2 billion against North West's Department of Health. | Read more |
| 20/11/2019 | AfriForum files complaints about wasted R23 million against the Western Cape's Department of Health. | Read more |
| 21/11/2019 | AfriForum files complaints about wasted R256 million against the Eastern Cape's Department of Health. | Read more |
| 21/11/2019 | AfriForum files complaints about wasted R1,4 billion against KwaZulu-Natal's Department of Health. | Read more |
| 22/11/2019 | AfriForum files complaints about wasted R344 million against Mpumalanga's Department of Health. | Read more |
| 22/11/219 | AfriForum comments on NHI. | Read more |
| 28/11/2019 | AfriForum encourages the public to send their comments to Parliament, and also to give the civil rights organisation their mandate to oppose this destructive bill. | Read more |
| 29/11/2019 | Participation for public written comments closes. | |
| 30/11/2019 | AfriForum presents a report that indicates that the NHI is unaffordable. | Read more |
| 29/01/2020 | Community of Centurion attends AfriForum community meeting . | Read more |
| 10/02/2020 | AfriForum requests a meeting with Health Minister Dr Zweli Mkhize to highlight the civil rights organisation's objections and concerns about the government's planned national NHI. | Read more |
| 02/06/2020 | AfriForum condemns President Cyril Ramaphosa's statements that the COVID-19 pandemic is a building block for the implementation of the NHI. | Read more |
| 2020/11 | AfriForum launches a report that investigates private health insurance as an essential service. | Read more |
| 26/05/2022 | AfriForum sends a letter to President Cyril Ramaphosa and the Minister of Health, Dr Joe Phaahla, in which we request that the government reconsider the implementation of National Health Insurance (NHI). This follows after Phaahla recently confirmed that the country has a shortage of doctors with a doctor-to-patient ratio of 0,32 to 1 000. | Read more |
| 05/08/2022 | AfriForum condemns the appointment of NHI workers; possible legal action to follow. | Read more |
| Oral presentation | ||
| 15/02/2022 | AfriForum strongly condemns NHI in Parliament. | Read more |
Public participation 2
| Datum | Aksies en hoofgebeurtenisse | Skakel |
|---|---|---|
| 06/09/2023 | AfriForum submits comprehensive written comments opposing the catastrophic proposed NHI Bill | Lees meer |
| 15/09/2023 | Communities must oppose draconian NHI Bill at provincial public hearings | Lees meer |
| 15/09/2023 | Western Cape residents must oppose draconian NHI Bill at public hearings | Lees meer |
| 19/09/2023 | AfriForum demands that NHI public hearings be stopped until details are properly communicated | Lees meer |
| 21/09/2023 | AfriForum before parliamentary committee: NHI will cripple SA healthcare | Lees meer |
| 22/09/2023 | AfriForum opposes NHI bill in Southern Cape | Lees meer |
| 02/10/2023 | NHI: AfriForum and public want to voice their opposition, but government gives too little opportunity | Lees meer |
| 17/10/2023 | AfriForum staan NGV-wetsontwerp teen tydens openbare verhore in Oos-Kaap | Lees meer |
| 24/10/2023 | AfriForum and several interest groups reject the NHI bill at Krugersdorp public hearing | Lees meer |
What happens if the President signs the Bill into law?
Once the NCOP passes the NHI Bill, it will be sent to the President, who will then decide whether to sign the Bill into law. If the President does, the NHI Bill will become an act of parliament. The President can also send the Bill back to parliament. The Bill would then be known as a remitted bill.
