Ramaphosa hailed the new law as a major step towards a more just society two weeks before an election that is expected to be fiercely competitive.

South African President Cyril Ramaphosa has signed a controversial bill that aims to provide universal health coverage into law, hailing it as a major step towards a more just society two weeks before an election that is expected to be fiercely competitive.

“The provision of healthcare in this country is fragmented, unsustainable, and unacceptable,” Ramaphosa said Wednesday afternoon during the signing ceremony at the Union Buildings, the seat of government in Pretoria.

“For those who would like to see (their) privileges continuing, sorry, you are on the wrong boat. The boat we are on is about equality,” he added.

The National Health Insurance (NHI) Act takes aim at a two-tier health system, in which a publicly funded sector that serves 84% of the population is overburdened and run-down while those who can afford to pay for healthcare have access to better treatment through their insurance.

The legislation will gradually limit the role of private insurance, create a new public health fund to provide free access for South African citizens, and set the fees and prices that private doctors and healthcare suppliers can charge for NHI-funded benefits.

Despite the excitement Ramaphosa exuded as he signed the bill, critics said the plan would drain already stretched public finances, limit patient choice, undermine the quality of care, and drive talented doctors out of the country.

Opponents have vowed to challenge the new law in court and described it is a ploy for votes – which the presidency denied – ahead of an election in which Ramaphosa’s governing African National Congress (ANC) is fighting to retain its parliamentary majority after 30 years in power.

The main opposition party, the Democratic Alliance (DA), said the law was an unaffordable, populist move aimed at preventing the ANC from losing its overall majority. It said Wednesday that it would legally challenge it.

Build One South Africa, another opposition party, released a statement shortly after the signing, saying: “We cannot allow this new law to go unchallenged.”

The party accused Ramaphosa of using the bill to boost his party’s chances at the polls on May 29.

The Health Funders Association (HFA), an organisation representing stakeholders involved in funding private healthcare, said it would take significant time before the law comes into effect.

“There will be no immediate impact on medical scheme benefits and contributions nor any tax changes. The HFA is well prepared to defend the rights of medical scheme members and all South Africans to choose privately funded healthcare where necessary,” its spokesman said.

The May 29 elections are expected to be one of South Africa’s most highly contested. The ANC faces the possibility of receiving less than 50% of the vote for the first time since it came into power in 1994.