Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome the various health insurers. Not much has changed since we last spoke to the insurance companies; circumstances have just become progressively worse. I will say again today everything I have said publicly. If one were to visit this country and examine the policies of the Government, and the Department of Health, in particular, one would assume they are trying to dismantle private health insurance through the various policy changes. The most recent one, concerning the cap on tax relief at source, beggars belief. We must revisit that issue.

There is a lot to be discussed in this area. There is a price spiral and a shrinking insurance market. There is an unbalanced market and a very dominant player with a legacy issue involving a very old cohort of policyholders. There are younger, more nimble and flexible insurers in the marketplace. They all have a story to tell but they do not always coincide with each other in terms of the way forward.

The issue of lifetime community rating is a key issue. It is argued that if the Minister were to pursue lifetime community rating, he might as well admit that his universal health insurance policy concept is aspirational as opposed to real. If there were universal health insurance, lifetime community rating would be a non-issue in the first instance. Perhaps there is reluctance to move in that regard. In the meantime, there are circumstances in which all the insurers will find it difficult to sustain their customers' age profile.

The VHI has outlined the position on compliance with the Central Bank regulation with regard to licensing and the difficulties it will have in getting its ratios and reserves in place. It also has a legacy issue. I have a question for the other insurers, however. Their various insurance products do not exhibit a yearning and policy-driven approach to attract older customers. Could they explain their position on this? Although they are saying the health insurance market requires intergenerational solidarity and community rating, which we all buy into in one way or another, I do not see them actively and aggressively targeting older people with a view to attracting them from the VHI. Could the delegates respond on this?

Another key issue arises. The HIA is the agency charged with oversight. Consider the assumption that the Government takes, or at least receives, advice from the HIA. I do not believe that the Government takes very much advice from it and, if the truth be told, that it does not even take it seriously. I will take this up with the authority later.

This time last year, we were led to believe there would be a number of advanced and non-advanced health care packages, with the latter attracting a lower stamp and rating. However, when the care packages were published in March of this year we found that the vast majority were in the advanced category, thereby attracting the higher rating. I cannot understand the change from what was said in the Dáil last November or December to what happened in March of this year. We must get to the bottom of it because it is critical in terms of analysing the difficulties that occur. People are trading down their packages, for example. They are reducing their cover because of the higher levy and duties associated with advanced care packages, which are no longer affordable.

I find amazing the position taken on the HIA and an independent expert having agreed that the levy for private patients in public beds will, in a full year, bring in €130 million. Without being overtly political, I contend the Department of Health has never been very good on its figures on health insurance. It is incredible that we are talking about €100 million in the difference between the two sides. I hate to say it but that €100 million will not be coming from the insurers because they are obligated to trade in a profitable manner. The money will come from the premium holders, ordinary families throughout the country. We must revisit this very quickly.

The HIA is due to publish its report in a matter of days or weeks. The Minister has it on his desk and it will be subject to redaction.

However, I would like to know what recommendations were made by the HIA to the Department and the Minister concerning the levies.

We may talk about attracting younger healthy people, the debt spiral and inter-generational solidarity, but if the Minister and the Department are reluctant to admit that universal health insurance is now probably more aspirational than possible, do we need statutory change? Is legislation in place that could allow the Minister to implement life-time community rating or will we need primary legislation?

There has been much debate about tax relief at source. Is the Minister satisfied with the figures he published on the costs that insurance companies and premium holders would incur? Was that information independently verified and what is the HIA's view of it?