Nineteen court cases mount against NHI

The Western Cape Government will challenge the National Health Insurance Act (NHI) in the Constitutional Court, bringing the total number of cases against the NHI to 19. 

The controversial NHI Act aims to achieve universal health coverage by creating a pool of funding for both private and public healthcare practitioners from taxpayer money.

The goal is to narrow the gap between the rich and the poor in terms of standards of healthcare. This includes the integration of the private and public healthcare sectors.

The Western Cape government will challenge the new laws on the grounds that the National Council of Provinces (NCOP) failed to consider the views of the people of the Western Cape. 

The Democratic Alliance (DA) stated that the council, therefore, failed to meet its obligation to facilitate meaningful public participation in the legislative process. 

Western Cape Minister of Health and Wellness, Mireille Wenger, said that the legislation was rushed through the NCOP without any deliberation or debate.

“The NHI is likely one of the most significant and controversial statutes in South African democratic history,” she said. 

The Western Cape Government applied to the Constitutional Court on 3 September to have the NHI Act declared unconstitutional and invalid due to the flawed public participation process. 

“We are standing up for the right of every South African to have a meaningful voice in how laws are made,” said Western Cape Premier Alan Winde. 

“This is not just a Western Cape issue — it is about preserving a cornerstone of our democracy: that Parliament must be willing to listen.”

This is not the first legal challenge the NHI has faced. According to court papers, the NHI currently faces five separate legal challenges. 

There have also been interlocutory applications made during the bigger cases, resulting in a total of 18 different substantive applications against the bill before the Western Cape’s case.

Eight are in the Constitutional Court and ten are in the Pretoria High Court. According to the Sunday Times, Health Minister Aaron Motsoaledi applied to have the nine High Court Cases consolidated and put on hold earlier this month. 

Deputy Director General Responsible for the NHI, Nicholas Crisp, said that the high court cases alone are of “unprecedented volume, factual density and constitutional complexity”.

“Vague, irrational and unaffordable”

To defend them all separately would involve extensive financial, time, and human resources. Crisp argues this would be unnecessary if the act is declared unconstitutional in the Constitutional Court.

The DA spokesperson on health, Michele Clarke, said that by May 2025, Minister Motsoaledi had already spent almost R9.7 million defending the NHI in court. 

The Board of Healthcare Funders (BHF) took the Ministry to the North Gauteng High Court in May 2025 to have the court declare that President Cyril Ramaphosa should not have signed the NHI bill into law.

The board argued that the presidency received numerous submissions challenging the bill, and should have referred it back to parliament. 

“Instead, the President proceeded to sign the Bill into law in May 2024, setting in motion legislation that we contend is vague, unaffordable, and ultimately unworkable,” the board said. 

The court ruled in favour of the BHF, and ordered that the president make a full record of the decision-making process available. 

The president has, however, been granted leave to appeal the judgment. The presidential legal team argues that the court does not have the authority to review presidential decisions. 

“The assent to and signature of a Bill are obligations that lie exclusively with the President in terms of section 79(1) and 84(2) of the Constitution,” said Mphaphuli

Other challengers to the bill include the Solidarity union, Sakeliga, the South African Private Practitioners Forum, the South African Medical Association, the Hospital Association of South Africa and the South African Health Funders Association (HFA).

The HFA said it launched its case against the NHI in the Constitutional Court because the bill is “fiscally impossible and operationally unworkable.”

The association argues that it violates the constitutional right of citizens to choose how to access or fund healthcare beyond what the state provides.

This was one of the first major cases to challenge the constitutionality of the entire scheme and not just aspects of the bill.

Dr. William Oosthuizen, Head of Legal for the South African Medical Association, said on the TimiaAfrica podcast that the NHI could lead to the collapse of the healthcare system. 

“The act is very vague. There are many sections that make no sense, they are contradictory. It’s very difficult to have legal certainty in those circumstances,” he said. “It’s also irrational, and unaffordable.”