President Cyril Ramaphosa's recent statement at the ANC's 112th-anniversary rally, asserting that the National Health Insurance (NHI) Bill will be introduced and signed into law despite significant opposition, has sparked controversy in South Africa. Speaking at Mbombela Stadium in Mpumalanga on January 13, 2024, the president emphasized the inevitability of the NHI Bill's implementation, despite concerns about its constitutionality.

The National Council of Provinces (NCOP), dominated by the ANC, officially passed the NHI Bill on December 6, 2023, and it is currently awaiting the president's signature. Notably, the Western Cape was the only province to vote against the bill, with Provincial Premier Alan Winde urging President Ramaphosa to reject it in its current form.

Winde argued that the NHI Bill, aimed at achieving Universal Health Coverage (UHC), requires substantial amendment as its current iteration falls short of addressing the challenges faced by the health system. The Western Cape Government (WCG) expressed dissatisfaction with the bill's hasty development.

Their concerns include insufficient consultation, constitutional conflicts, fragmentation of healthcare services, and funding issues. The Western Cape government asserts that the current version fails to address the challenges in the health system and may lead to decreased provincial funding, making it unaffordable and impractical. The NHI Bill's impact on achieving Universal Health Coverage (UHC) is questioned, and the government emphasizes the need for coordinated efforts across public, private, and civil sectors for effective healthcare reform.

Nevertheless, Winde underlined the party's commitment to a socialist medical insurance model in principle, merely rejecting technical aspects:

“We, as a provincial government, wholly subscribe to the objectives of Universal Health Coverage (UHC) and for the development of a mechanism that allows for greater allocation of resources from both public- and private sectors so that the health needs of the population can be equitably addressed and financial hardship is removed at the point of contact. This is what the NHI Bill intends to achieve. The current iteration of the Bill will only change how money is spent without addressing the challenges which the health system is facing. As such, we strongly believe that it will not achieve the UHC which our residents deserve - and that it requires substantial amendment"

Various organizations, including The South African Health Professionals Collaboration (SAHPC), Business Unity South Africa (Busa), and Business for South Africa (B4SA), have called for a review of the NHI Bill. SAHPC, representing over 25,000 healthcare workers, urged the NCOP plenary to send the bill back to the committee on procedural grounds.

The Health Funders Association (HFA) has petitioned President Ramaphosa to withhold assent to the bill, citing constitutional and procedural concerns. HFA Chairperson Craig Comrie stated the association's preparedness to escalate the matter to the Constitutional Court if necessary.

Business Unity SA (Busa) and Business for SA (B4SA) underscored the financial implications of the NHI Bill, estimating that the government would need to raise an additional R200 billion in tax revenue to fund it. They urged the president to return the bill to Parliament for further consultations, emphasizing the need for affordability and avert legal entanglements.

The controversy surrounding the NHI Bill highlights the challenges and disagreements surrounding its implementation, with various stakeholders advocating for careful consideration and revisions before its enactment.