The study sought to examine the factors that impacted the formulation of the National Health Insurance Scheme in Ghana and hypothesized that policy formulation is characterized with negotiation, bargaining, compromises, conflicts and struggles. Using the desktop research approach, data were sourced from both primary and secondary sources, the study identified the president, legislature and the Trades Union Congress (TUC) as the actors involved in the formulation process. Inputs were made into the bill by interest groups represented by the TUC but not all the inputs were considered. The formulation process was characterized by series of conflicts and struggles including the minority in parliament boycotting the debate sessions. The study found that policy formulation in Ghana’s parliament is a game of chairs and the political party with the highest number always wins.