Business Unity South Africa (Busa) has welcomed finance minister Enoch Godongwana’s call to end the conflict over National Health Insurance (NHI) and said it hopes for a meeting with the presidency to discuss its proposals in the first quarter of the year.
Busa is South Africa’s biggest umbrella body for organised business and while it is not directly litigating against the NHI Act, many of its members are. Busa put an alternative proposal to the NHI Act to President Cyril Ramaphosa at his invitation in late 2024, which until recently appeared to have been ignored.
“We welcome the minister’s statement and we would be keen and ready to engage when the government reaches out to us,” Busa CEO Khulekani Mathe said on Wednesday.
In a debate in the National Assembly last week, Godongwana urged the parties litigating over the NHI Act to negotiate a settlement.
A meeting between Busa and the presidency planned for late last year failed to transpire, but the presidency indicated it would be rescheduled, said Mathe. “We are hoping that meeting will be reinstated in the first quarter of the year,” he said.
Ramaphosa’s spokesperson, Vincent Magwenya, confirmed the presidency intends to schedule a meeting with Busa in this period.
NHI is the ANC’s blueprint for universal health coverage and proposes sweeping reforms aimed at ensuring all eligible patients are provided with care that is free at the point of delivery. It paves the way for a government-controlled fund that will purchase all services provided under NHI, with additional finances to be raised by increasing taxes and redirecting the medical scheme subsidies at present provided to public servants. One of its most controversial measures is the prohibition on medical schemes covering services offered by NHI.
The first piece of enabling legislation for the planned reforms, the NHI Act, was signed into law by Ramaphosa in May 2024 and faces legal challenges brought separately by eight organisations.
These include trade union Solidarity; the Board of Healthcare Funders and the Health Funders Association, representing medical schemes; the South African Private Practitioners’ Forum, representing specialists; the South African Medical Association, representing doctors; the Hospital Association of South Africa, representing private hospitals; and business lobby group Sakeliga.
Unlike the Universal Healthcare Access Coalition (UHAC), which published its proposed alternative to NHI in late 2024, Busa has kept the details of its suggestions to the president confidential.
“We felt it was necessary to give the president time to consider our proposal, and once we have had the meeting with the presidency [we will] make it public,” said Mathe.
Amendments
He reiterated Busa’s position that the NHI Act needs to be amended as it considers the legislation to be unworkable in its present form.
Busa lobbied hard against the NHI Act when it was before parliament and petitioned the president not to sign it into law after it was approved by the legislature in December 2023. It has consistently said it supports NHI’s goal of universal health coverage but believes the NHI Act will have a detrimental effect on healthcare, taxpayers, the economy and investor confidence.
UHAC represents more than two dozen healthcare organisations, including bodies representing healthcare professionals, businesses, academics and patient advocates.
It previously said its plan was practical and evidence-based and could be designed to work within the country’s existing finances instead of raising taxes. It proposed a hybrid funding model in which medical schemes continue to play a role and suggested mechanisms for improving governance in the public sector.
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