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Ramaphosa holds the line on NHI as court forces temporary halt
South Africa’s long-running debate over National Health Insurance has taken another turn.
President Cyril Ramaphosa has reaffirmed the government’s commitment to rolling out National Health Insurance, even as the courts press pause on parts of the process. The message from the Union Buildings is clear. The legal fight may continue, but the policy itself is not being abandoned.
Court ruling slows the legal process, not the policy ambition
The latest development comes after the Pretoria High Court ruled that the promulgation of any section of the NHI Act must stop for now. The pause will remain in place until the Constitutional Court delivers judgment on challenges to the Act, hearings that are scheduled for 5 to 7 May 2026.
Earlier this month, on 20 February, Ramaphosa issued a notice undertaking not to promulgate any provisions of the Act while litigation is underway. In a statement released on 24 February, he confirmed that this undertaking will stand until the Constitutional Court has had its say.
The legal challenges centre on the public participation process that led to Parliament adopting the NHI Bill. Various parties have taken the President and the Minister of Health to court, arguing that the process was flawed.
Despite this, Ramaphosa stressed that the timetable for implementing NHI will not be derailed. The Department of Health, he said, will continue working to strengthen the health system and improve the quality of care, in line with its constitutional responsibilities.
Government, he added, remains committed to NHI and will act within the law and judicial process to avoid undue delays.
Solidarity calls it a breakthrough
Trade union Solidarity, one of the parties challenging the Act, has welcomed the High Court’s decision. The union agreed to place its litigation on hold on condition that implementation and further development of NHI stop immediately.
According to Solidarity, the court order means any further implementation must now cease with immediate effect. The arrangement will remain in force until the Constitutional Court rules on the rationality of the President’s 2024 decision to sign the Act into law.
The union described the provisional suspension as a major breakthrough in its opposition to NHI. It also said it had sent a letter of demand to the President, the Department of Health, the National Treasury, and other relevant ministers, warning against any disregard of the court order.
Solidarity has indicated that it will oppose any new budgetary concessions for NHI, particularly ahead of the 2026 Budget speech. The union has also raised concerns about medical aid tax credits, arguing there is no reason to scrap them and that they should, in fact, be increased. Treasury has left these credits unchanged since 2023, while medical aid premiums have continued to rise sharply.
A country divided on healthcare reform
The battle over National Health Insurance is about more than court papers. It reflects a deeper divide over how South Africa should fund and deliver healthcare.
Supporters argue that NHI is essential to address inequality in a system where private healthcare serves a minority, while public facilities carry the burden for the majority. Critics question whether the country can afford such a sweeping reform and whether the administrative capacity exists to make it work.
On social media and in public forums, opinion remains sharply split. Some see the High Court’s intervention as a necessary safeguard. Others fear that further delays will stall reforms aimed at expanding access to quality healthcare.
Solidarity has proposed what it calls workable alternatives, including a Healthcare Funding Reform Bill submitted to Parliament earlier this year. For now, however, the future of NHI rests with the Constitutional Court.
What happens next
All eyes now turn to May 2026. The Constitutional Court’s ruling will determine whether the President’s decision to sign the NHI Act withstands scrutiny and whether the implementation process can move forward without legal obstacles.
In the meantime, the policy remains politically alive but legally restrained. Ramaphosa’s stance suggests that, from the government’s perspective, National Health Insurance is still central to its long-term vision for healthcare reform.
For ordinary South Africans navigating rising medical aid costs, strained public clinics, and economic pressure, the outcome of this legal showdown will shape more than policy. It will shape how healthcare is accessed and paid for in the years ahead.
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Source: Daily Investor
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