South Africa Pushes Ahead With Controversial Health Insurance Bill Despite Opposition

South Africa is moving ahead with the implementation of the National Health Insurance (NHI) bill, President Cyril Ramaphosa announced, despite facing strong opposition from various quarters. The NHI aims to overhaul South Africa’s two-tier healthcare system to provide universal coverage. Ramaphosa signed the bill just before the May election, in which his African National Congress (ANC) lost its parliamentary majority.

“We have highlighted the social and economic value of affordable, accessible, quality health care that is available equally to all South Africans,” Ramaphosa stated during a speech on Tuesday evening at the closing of an ANC policy meeting. “We will therefore proceed with the implementation of the National Health Insurance.”

Health Minister Aaron Motsoaledi earlier confirmed that the transitional mechanisms outlined in the bill would be implemented immediately. This includes setting up advisory committees and amending other health-related laws to align with the NHI. The legislation will gradually limit the role of private insurance, create a public fund to provide free access for citizens, and set fees and prices that private healthcare providers can charge for NHI-funded services.

Supporters hail the NHI as a generational change to reverse the inequalities dating back to the apartheid era. However, opponents, including major local health insurers, argue that the proposed funding model is unworkable. Motsoaledi expressed his willingness to address concerns from stakeholders and emphasised the voices of the intended beneficiaries, stating, “The real poor people who are (set to be) beneficiaries haven’t spoken. Nobody’s carrying their voice.”

The Democratic Alliance (DA), a pro-business party and former opposition leader now in coalition with the ANC, is among the bill’s opponents. DA leader John Steenhuisen noted last month that the NHI remains a contentious issue within the coalition government, with ongoing discussions.

Motsoaledi acknowledged that the bill would be implemented in phases over several years and that legal challenges could potentially delay its roll-out.

Melissa Enoch

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