The long-awaited National Health Insurance (NHI) Bill will soon be submitted to parliament, President Cyril Ramaphosa promised in his state of the nation address (Sona) on Thursday night.

However, he did not say that the fiercely contested bill had been approved by Cabinet, which suggests further work may still be done on it before it is considered by SA’s legislators.

“This year, we will take a significant step towards universal access to quality healthcare for all South Africans. After extensive consultation, the NHI Bill will soon be ready for submission to Parliament,” Ramaphosa said in his speech.

“By introducing the NHI together with a multipronged quality improvement programme for public health facilities, we are working towards a massive change in the healthcare experience of South Africans,” he said.

Even if the bill is poised to be tabled in parliament, MPs will not have enough time to process it before the upcoming election in May, as it will have to be considered by both the National Assembly and the National Council of Provinces. Both houses of parliament are expected to hold public hearings on the bill.

The ANC-led government has been pushing NHI, its policy for achieving universal health coverage, since 2009, but has yet to drive through any concrete reforms to breathe life into its vision. The bill is significant because it is the government's first piece of enabling legislation for NHI. It aims to establish a fund that will purchase services from accredited public- and private-sector providers, and has potentially far-reaching implications for the entire healthcare system. 

The NHI Bill was released for public comment in June, and became mired in controversy towards the end of 2018, after a leaked Treasury letter exposed an attempt by Ramaphosa’s adviser, Olive Shisana, to make sweeping changes to the draft bill. A revised version was rejected by the cabinet in early December, and then reconsidered at its most recent sitting on January 30.

Ramaphosa briefly mentioned the Presidential Health Summit he convened in 2018 to discuss the problems confronting SA's health system, but did not provide any details of what it had achieved so far. Nor did he announce any new and immediate steps to tackle the crisis, an omission likely to disappoint activists who earlier this week called on him to focus on fixing the crisis in SA’s health system, rather than driving policies that had yet to bear fruit.