Ramaphosa pauses NHI implementation pending Constitutional Court ruling

PresidentCyril Ramaphosahas paused the implementation of theNational Health Insurance(NHI) Act until the Constitutional Court rules on legal challenges to the law. Ina letter dated 20 February,the Office of the State Attorney in Pretoria confirmed that Ramaphosa will not commence any sections of the Act before the apex court delivers judgment on the “public participation challenges”. The letter follows correspondence sent a day earlier by Health Minister Aaron Motsoaledi, in which he stated that he would not request the president to promulgate any sections of the Act while the Constitutional Court cases are pending.

The challenges were brought by the Board of Healthcare Funders (BHF), an industry body representing medical schemes and by the Premier of the Western Cape, Alan Winde last year. They contend that parliament did not follow constitutional requirements for public participation during the legislative process that led to the adoption of the NHI Act. The legal challenges seek to prevent any sections of the law from being implemented until the court has ruled and argue that procedural irregularities may render parts of it invalid.

Earlier this month, the apex court issued directions removing separate applications for leave to appeal and direct access filed by the president and Motsoaledi, known as the “presidential assent challenges,” from the court roll. The court postponed those applications pending its decision on the public participation cases. The Constitutional Court has scheduled hearings on the public participation challenges for 5 to 7 May 2026 Theletterfrom the Office of the State Attorney notes that the president’s decision to bring legislation into force is influenced by requests from the minister of health and factors including the readiness of the department responsible for implementation.

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“The president undertakes not to promulgate any provisions of the NHI Act prior to the Constitutional Court handing down judgment in the public participation challenges. We reiterate that this is in line with the undertaking previously given by the president that he would not promulgate or bring into operation any provision of the Act until requested to by the minister,” it said. “As previously stated, the president does not act in isolation in considering and determining whether to bring legislation into effect or in determining whether to implement the legislation.” The NHI Act, passed by parliament in 2023 and signed into law by Ramaphosa in May 2024, aims to establish a single, state-run fund to purchase healthcare services on behalf of all South Africans.

It proposes changes to healthcare financing and delivery, including limiting the role of medical schemes once fully implemented. The latest development clearly indicates that sustained pressure against the Act is having the intended effect, said Theuns du Buisson, an economic researcher at the Solidarity Research Institute.

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