Business Leadership South Africa (BLSA) has again expressed concern about the National Health Insurance (NHI) Bill on the eve of its planned promulgation by President Cyril Ramaphosa’s.

Signing the NHI as is into law will discount the significant public comment having been made on the proposed Bill, most of which has found the NHI to be unworkable, economically damaging and contrary to the precepts of the South African Constitution.

BLSA CEO Busi Mavuso laments that public consultation cannot just be a matter of procedure, but must be taken seriously and properly considered, as specified in the Promotion of Administrative Justice Act.

“It is hard to believe [that] there has been proper consideration when the draft legislation has been finalised without change after a comment period,” she states.

She says that, leading up to the election on May 29, there were heightened electioneering and political campaigns that distracted from the business of running the country, particularly as progress on major challenges facing the economy were necessary.

Mavuso added that government was rushing populist policy through Parliament, which could only be seen to be an electioneering ploy, as the significant public input into the Bill and its socioeconomic ramifications had not been considered.

She considers this a destructive move for many stakeholders and relationships at a time when partnerships between government and business are critical to build confidence globally that South Africa is an investable destination.

The bottom line, Mavuso asserted, was that the NHI would not work owing to incapacity to implement it. She expected that as soon as it was promulgated it would be embroiled in litigation on several fronts, including on its constitutionality.

BLSA continues to support universal access to quality healthcare for all South Africa, but not through a poorly conceived and obstructive NHI Bill that will not afford citizens access to quality healthcare in the country.

Trade union Solidarity is also among organisations to have warned of its intent to oppose the Bill through legal means. In a statement issued on May 14, the organisation confirmed that it would start a legal process against the NHI Bill within an hour of Ramaphosa signing it into law.

The organisation plans to ask the court to impose the legal costs on the President himself and Health Minister Dr Joe Phaahla.

Solidarity CE Dr Dirk Hermann echoes the concerns expressed by BLSA in that government would force healthcare in the country to its knees with the ratification of this "substantially flawed Bill".

He also believed the Bill to be populist, irrational and unaffordable, saying it would put the entire country’s health at risk for the sake of votes.

Solidarity will challenge the Bill in court on the grounds of government’s faulty cost analysis and the fact that it will not be free as government has proclaimed.

Hermann explained that South Africa already had a system that ensured access to healthcare, but the system itself has become sick and dysfunctional.

Solidarity issued a letter of demand to the President to immediately stop the legislative process on the NHI, which followed on another letter of demand issued in October last year already, that was never responded to.

The Free Market Foundation (FMF) has condemned the NHI Bill’s signing into law and is also exploring possible legal challenges against it. It agrees with other organisations that the Bill is politically motivated, unaffordable and incapable of delivering better health outcomes.

“In classic socialist terms, the NHI is a policy loaded with grievance, blaming an oppressor – the private health sector – for the failures of the oppressed – the public health sector,” FMF states, adding that consumers will have to foot the new NHI taxes of about R240-billion a year, while being denied their right to purchase their own private health cover.

FMF expects the NHI to lie in limbo for many years given the numerous legal challenges it will face.

Political party the Democratic Alliance (DA) has also tried to stop the NHI Bill from proceeding, including in the form of thousands of public submissions to Parliament since 2019.

The party agrees with Hermann that the current healthcare system is broken in many ways, reflecting the deep inequalities in South Africa in a painful way, however, the NHI is not a solution.

The DA previously listed its concerns about the NHI Bill as its being an enabler for another State-owned enterprise, which had proven to be untrustworthy in the past; that the board to manage the NHI would be appointed by Phaahla, making the process open to political manipulation without adequate checks and balances; and the fact that the pilot projects of the NHI across the country had failed dismally at a cost of R5-billion to taxpayers.

The DA highlighted that, with government having failed to roll out the massive and intricate model at pilot scale showed little hope for capacity in rolling it out officially at national scale.

The party said, in its current state, the NHI was still unclear about the package of services that would be provided under this environment, as well as vague about the roles of medical aids and healthcare providers/funders.

It also did not address the systemic failure of healthcare and the quality of service being offered to people, while the referral pathway that consumers must follow was complicated and took away choice and autonomy of both consumers and healthcare providers, it added.