As South Africa moves towards a long-awaited National Health Insurance (NHI) system, new debates are unfolding about social provisioning, citizenship and the public good. NHI is a central financing mechanism which will be funded by mandatory health insurance contributions and government subsidies, giving people access either to public or private facilities based on their need while funded from a central pot. Widely applauded as a transformative plan to redress entrenched inequalities of access to healthcare, discussions about NHI are also fused with nationalist discourses, forging the way for new alliances with the leading African National Congress. Moreover, while many have celebrated this progressive agenda, its implementation will entail a host of challenges and must reckon with the forces of neo-liberalism: those of fiscal austerity, labour devaluation and casualization. The paper addresses experiences of work in this contradictory setting. How do health workers navigate these oscillating agendas, which are often in deep tension with one another? And with what implications for their experiences of professionalism, citizenship and their future aspirations?