Máire Hoctor (Tipperary North, Fianna Fail)

I am happy to have the opportunity to contribute to this important debate. The Bill gives effect to recent Government decisions to end the automatic entitlement to a medical card, irrespective of income, for people aged 70 and over, and to introduce new arrangements in order that the vast majority of these people will continue to have medical cards under a new income threshold. There are good policy reasons for introducing this legislation. In particular, it enables the ending of the high capitation fee for GPs that has been paid since 2001 only in respect of over 70 year olds who received a medical card by virtue of age rather than means. The fee was paid for approximately 38% of people aged 70 and over. People in general are pleased that the perverse incentive this special fee created between different GP practices is being ended. While some people do not want to admit it, GPs were willing to point out there was a high concentration of GP practices in our larger cities where incomes were higher while the number of practices in disadvantaged areas has reduced. This legislation will put an end to that and there will be equal spread of GP practices, which will be near people, and services will be provided to those who need them most.

People aged 70 years and over are more likely to require regular access to health services and it is appropriate that additional support be put in place to enable their access to medical care. At the same time, it is consistent with the general approach of the GMS for many years and with the need to provide for financially sustainable schemes that the scheme should be limited to all but the top 5% of income earners among over 70s. There are, and will continue to be, pressing calls on scarce resources to meet the needs of many people across the range of health services. It is appropriate that we devote taxpayers' funds to meet those needs.

The number of people aged 70 and over in our population is 350,000. It is projected this number will increase to 363,000 by 2011, 433,000 by 2016 and 535,000 by 2021. We need to plan for, and provide, many health services for the people now aged 55 and over who will form the over 70s group at that time and use public resources in the most effective and fairest way to provide those services. It is easy for the Opposition to ignore our growing aging population as people, thankfully, live healthier and longer lives but the Government must address the projected figures and look after those who need care most. We must base the assessment on this and people's ability to pay.

As outlined by the Minister earlier, the continuation of the automatic medical card, and the high capitation fee paid for it, does not represent prudent or fair financial planning. We should concentrate on using resources for those with the greatest medical and financial need. The Bill provides that those who are aged 70 or over before 1 January 2009 and who had full eligibility on age grounds will continue to have full eligibility as long as their gross income from all sources does not exceed the specified limits. The medical card is evidence of full eligibility. These generous limits are €700 per week gross in the case of a single person, excluding any income from savings or similar investments whose principal value is €36,000 or less, and €1,400 per week gross in the case of a couple, excluding any income from savings or similar investments whose principal value is €72,000 or less.

As the Minister said, a person who had automatic entitlement to a medical card, and, therefore, full eligibility, will continue to have full eligibility until 2 March 2009. Consequently, all persons can continue to use their medical card as normal until that date even if their gross income exceeds the relevant income limits set out in this legislation. The Government wants to ensure the process of self-assessment for elderly people will be much simplified compared to that required under the existing "hardship" based scheme. Consequently, the HSE has been asked to ensure any assistance a person who is currently over 70 may need regarding self-assessment be made available on an administrative basis.

A much simplified means test will be arranged for people reaching 70 on or after 1 January to enable them to apply under the new arrangements. They will receive confirmation from the HSE that they have full eligibility and will continue to have full eligibility as long as their gross income does not exceed the relevant limit. The Government is also providing in this legislation for the dependants of people over 70. The Bill also includes a provision to amend the Health Contributions Act 1979 to provide an exemption from the health contribution for any person, who is or reaches the age of 70 on or after 1 January 2009. The amendment will exempt everybody over 70 from paying the contribution regardless of whether they fall into the categories exempted under section 11 of the 1979 Act.

The legislation is designed to give effect to the Government's decision to replace the automatic entitlement to a medical card for persons aged 70 and over with a new arrangement based on gross income limits. As the Minister outlined in her contribution, she has examined a range of options to protect persons aged 70 and over who lose their spouse. I lobbied her to address this because this must be recognised as a difficulty. The medical card should not be lost on the death of a spouse and I understand, on the basis of work on this issue over the past number of weeks, that she proposes to introduce an amendment on Committee Stage in this regard.

Opposition Members are suffering from amnesia. Deputy Enright was quick to quote the contributions of Government Members on this issue in 2001 but Deputy Noonan, when serving as Minister for Health and Children, stated on 19 December 1996:

In those circumstances I do not think that it is justifiable to extend an automatic entitlement to a medical card to all citizens aged 80 and over without reference to their means. I am satisfied the health boards will assess people according to their circumstances.

Thankfully, the HSE continues to do so. Deputy McManus referred to millionaires with medical cards as an "obscenity" in November 2004. She said:

In Ireland millionaires have been created by our economic boom. In 2001 we know now 11 of these millionaires paid no tax at all. If any of these millionaires, whether tax paying or not, is over 70 years of age, they automatically qualify for a medical card. This is an obscenity when compared to the experience of ordinary hard working families.

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