Following an agreement from President Cyril Ramaphosa to put the promulgation of the National Health Insurance (NHI) Act on hold, the Pretoria High Court has granted an order to the same effect.
Trade union Solidarity, one of the key litigants challenging the NHI on several grounds, announced that it received the court order on Tuesday (24 February).
The union said the order came as it had agreed to place its litigation against the NHI on hold, but only on the condition that the implementation and further development of the NHI cease immediately.
“This arrangement will remain in force until the Constitutional Court has delivered a ruling on the rationality of President Cyril Ramaphosa’s decision to sign the NHI Act in 2024,” the union said.
Ramaphosa’s legal team agreed to the arrangement.
Doubling down on its opposition to the NHI, Solidarity has now sent a letter of demand to the president, the Department of Health, the treasury, and the relevant ministers, warning them against any disregard of the court order.
This specifically targets the upcoming budget speech, with Solidarity demanding that no further budgetary concessions be granted in respect of the NHI.
The union said it intends to institute legal proceedings against the government if it fails to comply.
Notably, the National Treasury has not provided much direct funding for the NHI over the years, with most funding going to the underlying public healthcare system that lays the foundation for the scheme.
According to renowned economist Dawie Roodt, the National Treasury has not shown much faith in the scheme.
He said that, at face value, South Africa is spending around R20 billion a year on the NHI, but this is not direct financing for the scheme.
In the broader context, the budget does not allocate or provision much for the NHI, which is the Treasury’s way of saying that money could be better spent elsewhere, he said.
Mounting court challenges
The constitutional matter that is currently holding up the rollout of the NHI is only one of many points of conflict with the scheme.
The NHI is facing several legal challenges, with a new challenge launched last week by lobby group AfriForum, taking on multiple constitutional issues with the laws.
This adds to the list of litigants, which includes Solidarity, the Western Cape government, industry bodies representing hospitals, healthcare funders, medical professionals and business groups.
The cases target almost everything related to the NHI, from public consultation processes during law drafting to the rationality of signing the laws, and multiple constitutional grounds, such as removing freedom of choice in healthcare provision and funding.
Experts, analysts and even the government itself have warned that the litigation risks pushing the already decades-long rollout of the NHI back even further.
While some litigants are looking to have the laws reworked into something viable, Solidarity wants the Act scrapped and alternative systems to be considered.
In its notice, Solidarity specifically calls for renewed and substantive engagement on viable alternatives to the NHI.
“This court ruling is a major breakthrough in our opposition to the NHI. It is beyond comprehension that taxpayers’ money is being used to establish a system that faces such extensive litigation,” said Theuns du Buisson, economic researcher at the Solidarity Research Institute (SRI).
“The NHI will never be realised. It is simply unworkable, unaffordable, and irrational. It is deeply concerning that anyone could regard it as a sound policy, particularly given that billions of rands have already been spent on it.”
