“Despite the NHI Act being signed into law by President Cyril Ramaphosa in May 2024, Finance Minister Enoch Godongwana has signalled a reluctance to implement key funding mechanisms mandated by the legislation.”
In a recent Medium-Term Budget Policy Statement, the Minister stated he would not remove medical scheme tax credits, arguing that doing so “would be an attack on the middle class”. – Daily Maverick (27 Nov 2025)
“The Minister’s refusal to reallocate the credits appears to stand in direct conflict with the legislation he is tasked with executing. Section 49 of the NHI Act explicitly states that the Fund is entitled to money appropriated annually by Parliament, including the ‘reallocation of funding for medical scheme tax credits paid to various medical schemes’.”
Critics argue that maintaining medical scheme tax credits effectively subsidises high earners at the expense of the public system. Estimates suggest that removing these credits for earners above R750,000 per annum could raise an additional R5bn for the state, supplementing the R70bn already spent on medical scheme subsidies. By refusing to redirect these funds, the current policy framework is viewed by proponents of the NHI as regressive, exacerbating the social exclusion of low-income populations. This legislative clause was not an oversight.