Since the National Health Insurance (NHI) Act was signed into law by President Cyril Ramaphosa in May 2024, eight different groups have challenged it in court, with some filing multiple applications. – Spotlight (29 Oct 2025)
A core argument is that under the NHI, people will have access to fewer health services, or simply a reduced quality of care.
Constitution
“If this was true then the NHI could be in violation of Section 27 of the country’s Constitution, according to which Government has to do what it can to achieve the ‘progressive realisation’ of the right to healthcare services (along with the right to food, water and social security).
“To show that the NHI Act violates Section 27 of the Constitution, litigants will need to prove that it not only limits people’s right to healthcare, but that the Government hasn’t provided good enough reasons for why it is doing this.”
Medical Schemes
Section 33 of the NHI Act states that once the scheme is fully implemented, medical schemes will only be allowed to cover top-up health services that aren’t covered by the NHI.
“Thus, unless someone was able to afford both the mandatory prepayment for the NHI, and complimentary cover from their medical schemes, they would have to switch to relying solely on the NHI for their medical coverage.”
However, the National Health Department’s NHI lead, Dr Nicholas Crisp, denied that people’s coverage would be compromised under the NHI as “the NHI would not need to incur the same total payment obligations as medical schemes in order to cover a comprehensive package of health services”.