Beverley Flynn (Mayo, Fianna Fail)

I welcome the opportunity to speak in the debate. The record of the Fianna Fáil Party on services for the elderly during the 11 years I have been a Deputy is a proud one. I am particularly proud to have been a member of a party that increased pensions to their current substantial levels. In 2001 when the universal medical card was introduced for the over 70s I saw it as recognition for people in the latter days of their lives who worry very much about their health and as a very positive development at the time.

As everybody knows we are now in different economic circumstances and it is difficult to make decisions of this type. This one was particularly difficult and I, like all other Deputies in the House, received hundreds of phone calls from constituents who were very concerned. At the time they were concerned because there was a lot of misinformation and inadequate information in the public domain. When I contacted the hundreds of people who made contact with me and explained the new thresholds to them, all but a few cases were covered by the new threshold limits and people were satisfied.

The initial worry and concern imposed upon people is regrettable. I apologised on my local radio station for the concern caused to many people who should not have had to go through that. I am conscious of elderly people and as a Deputy I have spent a lot of time over the years handling the queries of elderly people and going to active retirement meetings. They are a group of people I have always been very careful to try and look after to the best of my ability.

We must point out the realistic features of the Bill. The most important one is that 95% of all people over 70 will continue to have a medical card, and that cannot be highlighted enough. Of the people who contacted me, in all but a few cases they qualified for a medical card. I am happy the Bill makes allowances for people who are now 70 or will be 70 before 1 January. It puts them in a position where, if they are below the income threshold, no further action on their part is required. They will be entitled to use their medical card after 2 March, do not need to communicate with the HSE and business continues as normal. The vast majority of people who contacted me fell into that category.

Those who currently have the universal medical card but, will now be above the income threshold, will lose their medical card after 2 March. That is regrettable, there are scarce means available to us now and few people are affected. There are 350,000 people who are 70 and over, and of these approximately 330,000 will retain the medical card after 2 March. It is important to highlight that and not worry people unnecessarily.

Many questions were asked in the House on why the means test applies to gross income. It is important the means test be kept as simple as possible and it is something for which the Minister has made allowance in the Bill. It is simple in that gross income for a single person applies at the amount of more than €700 and more than €1,400 for a married couple. Dealing in gross income allows for a simple means test and is something about which I am happy.

Those who turn 70 in the new year and whose gross income falls below the new threshold will apply to the HSE and will receive their medical card after the simple means test. Those whose income is over the threshold will not be eligible. However, there are a number of categories. In addition to the new income thresholds the discretionary card is also available. It is something I have used extensively in my constituency over the years, based on medical information.

People over the age of 70, as has been referred to by a number of Deputies, tend to become ill more and have serious health issues, and special cases can be referred to the HSE to enable such people to get a discretionary card. I will ask the HSE to deal in a fair and balanced way throughout the country with all those who apply for the discretionary card. I would like to see as many people as possible eligible for it. People can also apply under the previous net means test, which is a third option. Those that do not qualify on any of those grounds can benefit from the drugs payment scheme, which ensures no individual or family unit has to pay more than €100 for drugs or medicines each month.

There have been many references made to investments and a Deputy mentioned that investments at the present time are very volatile. A single person can still have investments of €36,000 or a married couple €72,000 which are completely disregarded. Only the income or interest from savings above those figures will be considered for a means test. In a time of low interest rates, this enables people to have a substantial amount of money on bank deposit and still be in a position to qualify for a medical card.

There are many people, even within my constituency, who have emigrated over the years and have built up a nest egg for their old age. I am conscious of this as I dealt with people who had money to invest in my previous career. These people need this money; it is a cushion and a safety valve for them. Many of them will never spend their money but they have worked very hard to be able to put a few pounds away. It is important that those in a position to have some savings are not at a disadvantage in dealing with their medical card. The income thresholds set for savings represent a fair amount of savings for a married couple or a single person, without it being taken into consideration. I welcome the inclusion of this in the Bill.

I also welcome the annual review of income thresholds to take into account cost of living increases over the lifetime of this Government. I am concerned that 95% of people — the best estimate available to the Department based on the figures available — will qualify. It will be important over the coming years to keep the income thresholds at a level to maintain the 95% figure throughout the lifetime of the Dáil.

There are many quotes from Members of the House, even dating back to the Labour Party document in 2004 where reference was made to medical cards to over 70s. It stated that those over 70 do not qualify on income grounds and are the highest earners in that category. People from both sides of the House referred to the fact that those over 70 were not being means tested and perhaps the money might be better spent, and spent in a more equitable way. They said that no-one wants to see millionaires with a medical card.

We are in very tight economic circumstances. We all know families with young children and want to see the resources available directed to where they are most needed. I have found the issue of medical cards for the over 70s very difficult and do not pretend that it was not difficult for every Deputy. It is always difficult when one has something and it is taken away. Giving something in the first place is always good news, and in 2001 it was very good news. It is a difficult situation and has happened because of the economic circumstances we find ourselves in. The income thresholds, as they are currently set, with a provision for savings, represent a fair mechanism whereby the vast majority of people will qualify for a medical card.

I felt the fees paid to GPs in the past for participation in the universal medical card were unacceptable. The average person I discussed this matter with over the last number of weeks and months was shocked when they became aware of the amount paid to GPs for a person who availed of the universal medical card. Maintaining that level of fees was unsustainable. I welcome Mr. Sullivan's recommendations on the new single capitation fee to be paid to GPs for medical cards for the over 70s, which at €290 is fairer than the €640 paid heretofore. When that is compared to the fee paid for a person availing of a means tested medical card people did not find it acceptable. Members on both sides of the House recognised that point.

One positive development concerns men over 70 lucky enough to be married to women who are 65 or younger — the reverse is probably not as common. Because they are availing of the higher thresholds, many younger women who did not qualify for a medical card in the past will now benefit. I made this point on radio in the last number of weeks and received a significant response. There are many people who will enjoy a medical card for the first time because of the higher thresholds. In making that point I ask the Minister to examine the issue. I have heard the point made by Members of the Opposition about widows. While some are now receiving the medical card because of the new system in place, a widow who is slightly above the €700 threshold may not qualify. The Minister should re-examine that issue. We should be compassionate in the decisions we make. I do not believe it was the intention of the Minister to subject people to hardship when she removed universal entitlement to the medical card. It might be possible to look at this issue in the Bill at a later stage, especially when there is a category receiving medical cards who did not previously enjoy them.

I commend the Bill to the House and look forward to the matter being discussed on Committee Stage.

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