In a significant legal development, the Pretoria High Court has ordered President Cyril Ramaphosa to provide written reasons for signing the National Health Insurance (NHI) Bill into law on May 15, 2024.
The court’s ruling, issued in response to a legal challenge by trade union Solidarity, declares that Ramaphosa’s decision is subject to judicial review. He now has 10 days to submit the full record of his decision-making process.
Solidarity argues that the NHI Bill is unconstitutional, unaffordable, and unworkable, and accuses the President of ignoring widespread objections and misrepresenting the bill’s consequences to the public and stakeholders. The union contends the legislation could severely damage South Africa’s already strained healthcare system.
The NHI Act seeks to create a single, state-run healthcare fund to provide universal healthcare by merging public and private health spending. While the government touts it as a path to equality, critics — including the Democratic Alliance and several business organizations — warn it could lead to financial instability, loss of medical choice, and an exodus of skilled healthcare professionals.
The Presidency has acknowledged the court ruling and is currently reviewing the judgment, with a possible appeal on the horizon. The case may ultimately be heard by the Constitutional Court, setting up a major test of presidential accountability and public policy in post-apartheid South Africa.
