National Health Insurance in South Africa: Is the NHI Act in Force? (October 2026 Update)
Originally published 15 May 2024 · Updated 27 October 2026
Quick answer: The National Health Insurance (NHI) Act is law, but it isn’t in force. President Cyril Ramaphosa signed it on 15 May 2024, but in February 2026 he agreed to delay proclaiming any section until the Constitutional Court rules on the challenges against it. Your medical aid and the public system work as they did before. Judgment was reserved in May 2026 and may not come until early 2027. Why South Africans can trust the Constitutional Court’s NHI ruling — whichever way it goes – Bhekisisa +2
NHI at a glance
| Key detail | What you need to know |
|---|---|
| Signed into law | 15 May 2024, by President Cyril Ramaphosa. |
| Is it in force? | No sections of the National Health Insurance (NHI) Act have been proclaimed to commence. |
| Health Minister | Aaron Motsoaledi. |
| What is the NHI? | A proposed healthcare financing system based on compulsory membership, under which a government fund would purchase healthcare services from accredited public and private providers. |
| Main court case | The Board of Healthcare Funders and the Western Cape government challenged the parliamentary process used to pass the Act. The Constitutional Court heard arguments on 5 and 6 May 2026, with judgment reserved at the time of reporting. |
| Related court ruling | On 18 May 2026, the Constitutional Court struck down the certificate-of-need provisions of the National Health Act. |
| What does this mean for you now? | Your existing medical aid membership and access to public healthcare remain unchanged solely because the NHI Act was signed into law. Read Bhekisisa’s explanation of the Constitutional Court case. |
What is National Health Insurance?
NHI is the government’s plan for universal health coverage. The idea is to pool funds in a single national fund that buys healthcare for everyone from accredited public and private providers, ending the divide between a small, well-funded private sector and an overstretched public one. Before it can take effect, Parliament must still pass further legislation, including laws on how it will be funded. bhekisisa
Timeline
| Date | What happened |
|---|---|
| 15 May 2024 | Ramaphosa signs the NHI Act, ahead of the general elections, despite opposition from parts of the health sector, business and opposition parties |
| 2024 to 2026 | Multiple legal challenges are launched, including by the Board of Healthcare Funders (BHF), the Western Cape government and others |
| February 2026 | Ramaphosa agrees to delay proclaiming any part of the Act until the Constitutional Court resolves the challenges |
| 5 to 6 May 2026 | The Constitutional Court hears the BHF and Western Cape applications, which argue Parliament failed to ensure meaningful public participation, and reserves judgment |
| 18 May 2026 | A unanimous Constitutional Court declares sections 36 to 40 of the National Health Act, the certificate-of-need provisions, unconstitutional |
| Late 2026 to early 2027 | Judgment on the NHI Act itself is awaited Constitutional Court strikes down key NHI provision, dealing blow to national health plan +2 |
What did the May 2026 Constitutional Court ruling decide?
The court ruled that the certificate-of-need sections were irrational and unjustifiably limited the right to choose a trade, occupation or profession. Those rules would have required healthcare professionals and facilities to get government approval before setting up, expanding or moving. The sections were passed 23 years ago but never brought into effect. novanewsnovanews
Two sides, two readings:
- Government’s view: The Department of Health says no part of the NHI Act was declared unconstitutional and the judgment doesn’t relate to it. Minister Motsoaledi says it does not halt or invalidate the NHI programme. dailymaverickiol
- Critics’ view: ActionSA notes that the Department’s own lawyers called the scheme a “central pillar” for implementing NHI. The DA says the ruling is a precedent against centralised control of healthcare. actionsada
The key point: the ruling is about the National Health Act, not the NHI Act. The NHI Act’s own fate depends on the separate case, which is still undecided.
What does NHI mean for your medical aid right now?
Nothing changes today. No part of the Act is in force, so you can keep your medical aid, and public hospitals and clinics work as before. Any move to NHI would take years and need further legislation and funding. If you’re deciding about cover, speak to a licensed broker or your scheme.
Who supports and who opposes NHI?
Supporters say it would fix the deep inequality between private and public care and extend access to people who can’t afford cover.
Critics, including parts of the medical profession, business groups, unions and several political parties, raise concerns about cost, how it will be funded, state control and the risk of mismanagement. The health department has put aside R74 million for legal costs, with about 15 court cases reported as hindering the process. iol
What happens next?
- Constitutional Court judgment on the BHF and Western Cape challenges, possibly in early 2027
- If the challenges fail, the government can proclaim parts of the Act and Parliament must still pass the funding legislation
- If a challenge succeeds, the Court may declare the Act invalid, and Parliament would have to run public participation again before reintroducing it bowmanslaw
- Further court cases and the debate over funding
The original May 2024 report (kept for the record)
In May 2024, President Cyril Ramaphosa signed the NHI Bill into law, saying it would level the healthcare playing field and address disparities between the public and private sectors. The government pressed ahead despite opposition from the healthcare sector, business groups, unions and legal experts. At the time, medical aids and analysts predicted no immediate changes, with a full rollout expected over years or decades. The then Health Minister, Joe Phaahla, said the process would involve consultation and public participation, and that the NHI Fund was anticipated within six to twelve months. That timeline has not materialised.
Frequently asked questions
Is the NHI Act law in South Africa?
Yes. President Ramaphosa signed it on 15 May 2024. But no part of it is in force yet.
When will NHI start?
No start date has been set. The Constitutional Court’s judgment on the challenges is awaited, possibly in early 2027, and further funding legislation is needed.
Will NHI replace medical aid?
Not now. Your medical aid works as it does today, and the Act is not in operation.
What did the Constitutional Court rule in May 2026?
It declared sections 36 to 40 of the National Health Act, the certificate-of-need provisions, unconstitutional. It did not rule on the NHI Act itself.
Is the NHI Act unconstitutional?
Not yet determined. The Court heard the challenges to it on 5 and 6 May 2026 and reserved judgment.
Who is challenging the NHI Act?
The Board of Healthcare Funders and the Western Cape government, among others.
Did Ramaphosa delay NHI?
Yes. In February 2026 he agreed to delay proclaiming any section until the Constitutional Court rules.
Who is the Health Minister?
Aaron Motsoaledi.
How would NHI be funded?
Funding legislation still has to be passed. The details aren’t settled.
Do I have to join NHI?
The Act provides for compulsory membership once it is in operation. It isn’t operating yet.
