Business groups Business Unity South Africa (Busa) and Business for South Africa (B4SA) are planning to submit a formal petition to President Cyril Ramaphosa to send the controversial National Health Insurance (NHI) Bill back to Parliament for amendments on the grounds of unconstitutionality.   

The NHI Bill, which is expected to provide universal healthcare to all South Africans, passed in the National Council of Provinces (NCOP) without any amendments, on Tuesday.

The groups believe that the Bill, in its current format, is not only unworkable, unimplementable and unaffordable, but also unconstitutional, both on substantive and procedural grounds.

According to the Constitution, under Section 79, once a Bill is adopted, the President must either assent to and sign the Bill or, if the President has reservations about the constitutionality of the Bill, refer it back to the National Assembly for reconsideration.

B4SA Steering Committee chair Martin Kingston said that Busa and B4SA have concerns, recommendations, research, data and inputs, in addition to those made by a wide range of experts and affected stakeholders. They claim this information has been ignored by the Parliamentary Portfolio Committee on Health and the NCOP, which are legally mandated to ensure that the NHI Bill passes constitutional muster and is properly configured to give healthcare the best possible chance of success.

Kingston cited the concern that no amendments were made including those suggested by the Department of Health itself. 

“The consequence of passing this Bill, unamended, is devastating. It will materially delay access to universal health coverage, lead to disinvestment in the healthcare sector, further damage our already fragile economy, and create significant risks for the country in terms of the quality, management and governance of healthcare,” he warned.

Meanwhile, the National Education, Health and Allied Workers’ Union (Nehawu) has welcomed the passing of the Bill and condemned the delay in passing it.

Nehawu says the NHI Bill has gone through extensive debate and scrutiny and almost two decades of refinement, clause-by-clause deliberation and comprehensive public participation processes across all nine provinces.

“The influence of capitalist, private sector medical health insurance companies in delaying this Bill must be condemned, these companies have no interest in the health and wellbeing of workers and society at large, their sole motivation is driven by profit, not our people,” it said.

The South African Communist Party (SACP) has also welcomed the passing of the NHI Bill and said it marked a significant milestone towards aligning South Africa’s healthcare system with the principles of equality and social solidarity.

However, it stressed the importance of redistributing more from high incomes so the “surplus that the wealthy appropriate from the economy” delivers quality universal healthcare coverage.

Welcoming the passing of the Bill, the Congress of South African Trade Unions (Cosatu) has said that government cannot continue to place the profit margins of private industry above the needs of society. 

It said South Africa spends 8.5% of its gross domestic product on healthcare which is higher than many industrialised and peer nations.

“However, half of this is spent on the 16% of society fortunate enough to have medical aid. The other half is spent on public health care for the 84% dependent upon the State. As a result, we have first-class but under-utilised private health care available for 16% but charged at exorbitant prices and public health care overwhelmed with long queues, critical post vacancies, aging infrastructure and shortages and thus battling to provide basic health care for the 84% of society,” said Cosatu.

Solidarity has warned that it is ready to launch a full-on assault against the Bill and urged the public to support its actions against what it called a destructive scheme.

The union believes that the NHI Bill "is now yet another step closer to being passed as law after the ANC used its large majority in the NCOP to pass the Bill unaltered. Should one last appeal to Pres Cyril Ramaphosa to halt the NHI fall on deaf ears too, we will be heading to court about the NHI where Solidarity will go all out to stop it".