South Africa’s main opposition party announced it would go all the way to the Constitutional Court to fight the National Health Insurance (NHI) Bill, aimed at providing universal health coverage, on Tuesday.

Just two weeks out from the general election on May, 29 2024, the Bill would see free healthcare provided at the point for care for all South Africans, whether in public or private facilities. The Bill is described as a material step towards achieving universal access to quality health care services in accordance with section 27 of the constitution, which instructs that “[t]he state must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of each of these rights”.

In an address to the nation, Democratic Alliance leader John Steenhuisen has vowed to take immediate legal action, stating that the party “will enter into evidence to show that the process which led to the adoption of this bill by Parliament disregarded public input and that the bill itself is flagrantly unconstitutional.” Steenhuisen pledged that if the Democratic Alliance is elected on May 29, the party will immediately repeal the Bill. In his address, Steenhuisen describes the Bill as a populist attempt and the African National Congress’s (ANC) “last stand before it finally loses power in less than three weeks”. The ANC has governed South Africa since 1994, the first post-apartheid election.

Furthermore, Steenhuisen criticised the cost of implementing the proposed healthcare system and the working population that would be “taxed to death”. Steenhuisen also criticised the proposed use of a central fund controlled by ANC cadres and the risk of a “looting spree”. He foresees that “the doctors and nurses who should be the pride of our nation, will flee as the sector collapses and their job prospects evaporate.” The Bill also provides for one pool of healthcare funding, covering all South Africans irrespective of socio-economic status.

In his State of the Nation Address, President Cyril Ramaphosa reiterated his promise to bandage South Africa’s legacy of inequities and reform to the country’s two-tier health system by incrementally implementing the NHI to improve access to quality healthcare. The NHI Fund will derive from general taxes, contributions of persons earning above a set amount, and monthly contributions by the employees to the Fund.

While the Bill’s objective to realise universal health care as a means of addressing inequalities has the support of the South African Medical Association Trade Union, public opinion is divided. The Medical Insurance Representatives has warned for the need for clearer accountability guidelines to ward against the risk of corruption, and the need for improved transparency, engagement, and better remuneration of healthcare providers. Business Unity South Africa has signalled its support of legal action against the Bill. CEO of BUSA stated that while they support the idea of universal health coverage, the Bill “in its current form is unworkable, unaffordable, and not in line with the Constitution.”

President Ramaphosa signed the Bill into law on Wednesday.