President Cyril Ramaphosa has agreed to put the National Health Insurance (NHI) scheme on hold, pending the outcome of certain legal challenges to its constitutionality.
Union Solidarity, one of the key parties challenging the NHI, published a letter from the Office of the State Attorney, writing on behalf of Ramaphosa, in full on Friday (20 February).
According to the letter, Minister of Health Aaron Motsoaledi had written to Ramaphosa on Thursday, requesting that the president not promulgate any sections of the NHI Act.
This would be pending the Constitutional Court’s determination of the matter brought by the Board of Healthcare Funders and the case brought by the Premier of the Western Cape.
The NHI Act was signed into law by Ramaphosa in May 2024 ahead of the national government elections; however, the scheme was not put into effect (ie promulgated).
The NHI Act gives the government and the National Department of Health in particular, the basis on which to lay out the foundations of the scheme—such as setting up the NHI Fund—with the actual rollout planned to run over a decade or longer.
In the letter, attorneys also took note of the directions of the Constitutional Court earlier in February 2026, where the court removed the challenges related to public participation on the NHI Act during its drafting.
In that case, the ConCourt deferred the matter until other court challenges had played out, lest they become moot.
Ramaphosa’s lawyers said that, in order to ensure “orderly procedural conduct of the pending challenges and to avoid parallel proceedings overlapping,” the President will not promulgate any provisions of the NHI Act under certain conditions.
“The President undertakes not to promulgate any provisions of the NHI Act prior to the Constitutional Court handing down judgment in the public participation challenges,” the office said.
“We reiterate that this is in line with the undertaking previously given by the President that he would not promulgate or bring into operation any provision of the Act until requested to by the Minister.”
The lawyers said that the president does not act in isolation when considering and determining whether to bring legislation into effect or implement it.
“This decision is, of necessity, influenced, amongst other things, by the readiness of the relevant department responsible for implementing the legislation,” they said.
“This applies with particular force in respect of legislation with the scope of the NHI Act.”
Temporary win
According to Theuns du Buisson, economic researcher at the Solidarity Research Institute (SRI), the development indicates that sustained pressure by litigants is “having the intended effect”.
“It is now time to maintain this pressure, and it provides the Department of Health with an opportunity to reconsider,” he said.
However, he insists that things should never have gone this far in the first place, with multiple parties having long indicated that the NHI is unworkable, irrational, and unaffordable, and is wide open to legal challenges.
Echoing sentiments from economist Dawie Roodt, Buisson said the National Treasury has long been aware of this, having not dedicated much direct funding to the NHI.
He said he hoped the message was now getting through to the Health Minister and the President.
The NHI is facing several legal challenges, with a new challenge launched this 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.
While some litigants are looking to have the laws reworked into something viable, Solidarity wants the Act scrapped and alternative systems to be considered.
“There is a viable alternative to consider, rather than destroying the lives of millions of South Africans through the NHI,” it said.
“Now is the time for the country’s leaders to exercise sober judgement and to consider proposals. We urge them to abandon the NHI now, as it is not workable.”
Solidarity will appear in court again next week when the case concerning the consolidation of various court cases against the government over the NHI is scheduled to be heard.
