Dr Nomafrench Mbombo, the Western Cape Health MEC, has raised significant concerns about the National Health Insurance (NHI) Bill and has called on President Cyril Ramaphosa to send the bill back to parliament for further review.

However, the Western Cape has little means to force the government to take their concerns seriously - without control over health policy, the province is but one of nine, the other eight of which are controlled by the ruling party, and provinces have very little power over their own affairs.

The DA has recently refused to endorse legislation which would give them power over such matters, namely the Western Cape Peoples Bill tabled in Provincial Parliament by the VF+, instead choosing to back their own, thoroughly toothless Provincial Powers Bill, which mandates the DA to beg for concessions from the national government.

The Bill is considered a dangerous threat to the private healthcare sector, and likely to bankrupt both the state due the lack of budget considerations, as well as destroying all profitmaking capacity in the private sector, and removing patients' ability to choose their doctor or insurance provider.

In a recent social media post, Dr Mbombo outlined several key concerns, including the centralization of power, governance and accountability of the NHI Fund, the role of provinces, legal issues within the bill, and the potential impact on creating a unified health system. She emphasized the need for these concerns to be addressed, stating, "Mr President, use your power to send the Bill back to parliament."

President Ramaphosa, in his State of the Nation Address, acknowledged receiving the NHI Bill and humorously mentioned, "I'm going through the Bill. I'm looking for a pen!" The NHI aims to provide free healthcare to South Africans across public and private health facilities.

Despite the bill requiring only the president's signature for enactment, Dr Mbombo and Premier Alan Winde previously called on him not to sign it. They urged for the bill to be referred back to the National Assembly for reconsideration, citing major practical and constitutional concerns that need addressing.

"While our country requires health reform to achieve Universal Health Coverage, the Bill in its current form is not the vehicle that will get us there," Dr Mbombo stated.

The NHI Bill's fate now rests with President Ramaphosa, who will decide whether to enact it or consider the concerns raised by Dr Mbombo and other critics.