 The passage of time since our last communication on National Health Insurance (NHI) has necessitated another update. The last update was sent to you on 21 May 2024, and this was just over a week after the NHI Bill was signed into law, on 15 May 2024, by President Cyril Ramaphosa. Our last communication was accompanied by a compilation of Frequently Asked Questions (FAQs) and answers thereto, aimed at addressing questions that you may have had. Our main message sought to relay the following: Do not panic about the NHI Bill having been signed into law. We outlined the reasons why you should not panic. We expressed our disappointment with the Bill having been signed into law but also indicated that we were not surprised. We indicated that what made the signing of the Bill into law even more unfortunate was the fact that the stakeholders (including Bankmed) who are opposed to the NHI Act in its current form, are very much in support of Universal Health Coverage (UHC) as the overarching objective, and believe that collaboration with government could achieve this. However, in our view, the NHI Act in its current form undermines UHC and will be to the detriment of the population of South Africa. The opportunity to collaborate, which would ensure an inclusive and sustainable healthcare solution, was unfortunately not embraced by the signing of the Bill into law. We also indicated that now that the NHI Bill had been signed into the NHI Act, the next avenue available to us is to challenge the Act legally, and that Bankmed would participate in such efforts. So, where are we now? With specific reference to point 5 above, I wish to confirm that Bankmed is part of a collective of 21 schemes and 3 administrators that are finalising its legal action against the NHI Act through the Health Funders Association (HFA). HFA’s legal strategy addresses substantive matters on the constitutionality of the Act and is led by highly regarded Senior Counsels, Adila Hassim and Wim Trengrove. This action is informed by thorough research, along with expert actuarial, economic, and policy analyses. Several stakeholders have initiated similar action through a variety of legal strategies that generally complement one another. The Minister of Health, Dr Aaron Motsoaledi, in his replying affidavit (in November 2024) to legal action instituted in May 2024 by one interested party/stakeholder, stated that: “…This means that medical schemes will still be in operation on a basis similar to that currently in operation for several years during the progressive implementation of the NHI Act. I estimate this to be a period of between 10 and 15 years.” The key takeaway here is that the Minister of Health himself, under oath, estimates that medical schemes will operate as they are for a period of between 10 and 15 years. This confirms one of the reasons why we have advised you NOT to panic, but takes nothing away from the need for legal action to ensure that the NHI Act is changed. There has also been a range of other non-litigious efforts which have sought to propose alternative solutions for consideration by the Presidency (and the National Department of Health). Unfortunately, the government’s lack of responsiveness to several constructive and practical proposals, such as that of Business Unity South Africa (BUSA), has made legal action an avenue that cannot be avoided. Another effort that recently made the news was by the United Healthcare Access Coalition (UHAC), a large coalition of healthcare worker groups, including the South African Medical Association (SAMA), the South African Private Practitioners Forum, and the Progressive Healthcare Forum, which also made a detailed proposal to the Presidency on a health reform pathway that does not include the NHI. There is therefore legal action currently underway against the NHI Act, and, in parallel, non-litigious efforts aimed at finding collaborative solutions. The Government of National Unity (GNU) is another avenue where there seems to be ongoing engagements (based on what we read in the media). Early in February 2025 there were media reports that the ANC and the DA had reached an agreement to remove Section 33 of the NHI Act – the section that prevents medical schemes from offering benefits covered by the NHI. However, as the days progressed, the Minister of Health firmly denied having been part of any such discussions on medical schemes. It is partly for such reasons that a multi-pronged approach against the NHI Act (in its current form), including legal action, is necessary. The above broadly outlines at least three avenues where there is ongoing action and engagement on NHI: (a) Legal action. (b) Non-litigious efforts through which alternative solutions have been proposed. (c) Engagements in the GNU. In a news article on 13 March 2025, it was reported that the Minister of Finance, Mr Enoch Godongwana, when asked how the NHI would be funded, responded that he was not certain whether even the Minister of Health knew how to fund NHI as yet. It was also pleasing to note that the Medical Scheme tax credits were retained in the 2025/2026 National Budget. According to Professor Olive Shisana, the President’s Social Policy Special Advisor, amending the NHI Act would require thorough public consultation and parliamentary scrutiny, suggesting that substantive changes may take years to materialize. We, together with other stakeholders, are committed to staying engaged, and fighting the good fight. NHI is certainly an important matter, and we are giving this all the attention that it requires. We continue to engage with this matter through our industry association, HFA, and BUSA. It serves us best to deal with this matter through these industry bodies as a collective. Yours in good health Bankmed |