The cost of South Africa’s National Health Insurance plan is now a major flashpoint before the Constitutional Court.

On Tuesday, justices heard arguments in a case challenging how parliament handled public participation before the NHI Act was signed into law by President Cyril Ramaphosa in 2024.

The Act aims to create one central fund to provide free, universal healthcare for all South Africans. It is meant to buy services from both public and private healthcare providers.

But the Board of Healthcare Funders has taken aim at the process followed before the law was passed. It wants the Act set aside on procedural grounds.

BHF Says Parliament Acted Without Key Details

Advocate Bruce Leech, arguing for BHF, told the court that parliament approved the NHI Bill without knowing the full costs or what the scheme would cover.

He argued that the lack of clear funding information meant parliament could not properly engage the public on one of the country’s most important health laws.

BHF is not challenging the substance of the Act itself. Its case focuses on whether the public participation process was lawful and meaningful.

Leech argued that parliament ignored questions about the cost of rolling out the scheme, making the adoption of the Bill irrational.

Parliament Defends Consultation Process

Advocate Ngwako Maenetje, for parliament, pushed back. He argued that enough information was given to the public to allow meaningful participation.

He said government could not provide one final cost figure because the NHI could take more than 10 years to implement and would depend on changing economic conditions.

Maenetje also said parliament followed advice linked to the World Health Organisation. He argued that the absence of an overall cost figure did not make the process unlawful.

He told the court that government had provided information on funding models, including taxation, and cost figures for different implementation phases.

Public Hearings Drew Thousands

Justice Nambitha Dambuza-Mayosi questioned whether cost and funding details were central to the public process.

Maenetje accepted that funding mattered, saying costing was important because it would affect funding.

The health minister’s legal team argued that parliament did not rush the process. It said the Bill was processed from August 2019 to June 2023.

The court heard that public participation led to 35 changes to the Bill. More than 11,500 people attended meetings, over 950 oral submissions were made and 338,891 written submissions were received.

The hearing continues on Wednesday.