President Cyril Ramaphosa signed the contentious National Health Insurance Bill (NHI) into law on Wednesday, 15 May, with opposition parties and the private healthcare industry likely to challenge the Bill in court.

Opposition to the bill includes about 25 000 healthcare professionals, who have released a statement under an umbrella body called the South African Health Professionals Collaboration (SAHPC).

The SAHPC, a national group of 9 medical, dental and allied healthcare practitioners’ associations, says it is profoundly disappointed following the announcement that the President will be signing the NHI Bill into law, and this only 2 weeks before the election.

The body says it made a submission to the President, urging him to refer the Bill back to Parliament on the grounds that it is unconstitutional and not in the best interest of patients and citizens.

But they claim their input and insights were ignored.

Dr. Simon Strachan, a spokesperson for the SAHPC, says its members have made submissions at every stage of the legislative process, dating back to the release of the green paper in 2011.

It is disheartening to see our efforts to contribute to a more robust, workable and patient-centric healthcare system being ignored. Where we are now is unprecedented, and we believe that the NHI, in its current form will reverse, rather than progress, equitable, quality healthcare in South Africa. We have no doubt that the NHI Bill will be challenged in the courts, and we are currently exploring all our options in this regard.

Business Unity South Africa has also expressed concern, saying there are substantive and procedural constitutional flaws in the NHI Bill.

Cas Coovadia, CEO of BUSA, says the legislation, in its current form, is unimplementable and will be damaging to the country’s healthcare sector, to the economy more broadly and to investor confidence.

We fully support the objective of universal health coverage, however, the NHI Bill in its current form is unworkable, unaffordable, and not in line with the Constitution. What is especially troubling is that the President is proceeding with the Bill despite extensive constructive inputs made by a wide range of stakeholders, including doctors and healthcare professionals, civil society, public sector unions, academics and business.

Coovadia says they will consider their options, including taking appropriate legal action, so that the legislation that is finally implemented is in the best interest of everyone.

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Meanwhile, the South African Institute of Race Relations (IRR) has warned that placing South Africa’s entire health care system under government control is likely to accelerate middle-class emigration, triggering a calamitous decline in tax revenue.

The IRR claims middle-class citizens, who currently rely on private health care to avoid the deficiencies of public services, will be most affected.

IRR Chief Executive John Endres says the NHI concept is badly flawed and poses a grave threat to South Africa’s public finances and economy.

That the Ramaphosa administration is now pushing ahead with it, while ignoring the constructive criticism and warnings it has received over recent years, is extremely concerning. The decision speaks to economic recklessness and a lack of foresight that will impose a high cost on South Africa.

The DA says the Bill presents an existential risk to South Africa’s public and private healthcare systems and will impose an unbearable new tax burden on citizens.

Democratic Alliance Federal Leader, John Steenhuisen, announced earlier the party will go all the to the Constitutional Court to challenge the Bill:

According to the Presidency, the Bill ”directs the transformation of the South Africa’s health care system to achieve universal coverage for health services and, through this, overcome critical socio-economic imbalances and inequities of the past.”

READ MORE: The National Health Insurance Bill