Understanding the law-making process: The journey of the NHI Bill

Picture: 89Stocker

Picture: 89Stocker

Published May 20, 2024


On Wednesday, President Cyril Ramaphosa officially signed the National Health Insurance (NHI) Bill into law during a ceremony at the Union Buildings in Pretoria.

This historic moment follows five years of intense debates and public hearings since the Bill was tabled in 2019. The new law aims to provide universal healthcare coverage, particularly benefiting millions of disadvantaged South Africans, the elderly, and veterans.

The legislative process in South Africa is meticulous and involves several critical steps.

Green Paper

The initial stage involved drafting a Green Paper by the relevant Ministry, outlining the preliminary policy ideas for the NHI. This document was made available for public comment, gathering input from various stakeholders.

White Paper

Based on the feedback received, a more refined policy document, the White Paper, was developed. This White Paper underwent further scrutiny and amendments by parliamentary committees before being finalised.

Bill Introduction

The NHI Bill was then introduced in Parliament in 2019. It was published in the Government Gazette, inviting public comments, and subsequently referred to the relevant parliamentary committee for detailed examination.

Committee Review and Public Participation

The parliamentary committee held extensive debates and public hearings over five years. This stage was crucial for incorporating diverse perspectives and making necessary amendments to the Bill.

Parliamentary Approval

The Bill had to pass through both Houses of Parliament—the National Assembly (NA) and the National Council of Provinces (NCOP). For Section 75 Bills like the NHI, which do not affect provinces, approval by the NA was followed by concurrence from the NCOP.

Presidential Assent

After being approved by both Houses, the Bill was sent to President Ramaphosa for his signature. The President's assent marked the final step, enacting the Bill into law.

The signing of the NHI Bill represents a significant milestone in South Africa's legislative history with Ramaphosa highlighting its importance, stating, "In signing this Bill, we are signalling our determination to advance the constitutional right to access healthcare as articulated in Section 27 of the Constitution."

The NHI aims to eliminate the parallel inequitable health system by ensuring that all citizens, regardless of their financial means, have access to quality healthcare. This is in line with Section 27(1)(a) of the Constitution, which guarantees the right to healthcare services, including reproductive health care, and asserts that "no one may be refused emergency medical treatment."

The legislative process of the NHI Bill has not been without its challenges. Critics have pointed out the lengthy debates and public hearings as evidence of the complexities involved in passing such a transformative piece of legislation. There are also concerns about the implementation and management of the NHI system.

President Ramaphosa addressed these concerns, urging the public not to fear the NHI. He assured that the government has plans to improve the effectiveness of healthcare provision, requiring all health facilities to meet minimum quality health standards.

"We are committed to making the lives of the people better," he affirmed.

The enactment of the NHI Bill is a critical step towards achieving universal healthcare coverage in South Africa, addressing long-standing socio-economic imbalances and ensuring that no citizen is left behind in accessing essential health services.