Mary Wallace (Meath East, Fianna Fail)

I wish to share time with Deputy Blaney.

The legislation before us introduces new arrangements for medical cards for those aged over 70, the net result of which will be that the vast majority of people aged 70 and over will continue to have medical cards under the new income threshold. There are three distinct routes for qualifying for the medical card. First, 95% of people aged 70 and over will qualify on the basis of income. Second, discretionary medical arrangements are in place in cases where a person's health circumstances cause undue hardship. Many people who have terminal illnesses, for example, are granted medical cards, although they do not qualify under the means test. Third, the standard net income means test which applies to people under 70 years takes into account personal circumstances such as high outgoings on nursing home fees. For those now aged 70 or over, or who will be by the end of the month, there will be no new means test. Those who turn 70 in the new year will have a simplified means test.

The Bill before us enables the ending of the special high capitation fees for GPs paid since 2001 in respect of over 70s who received a medical card by virtue of age rather than means, which is the "gold card". I welcome the recommendation of Mr. Eddie Sullivan for a single fee capitation level of €290 which we intend to implement from 1 January.

I also welcome the announcement by the Minister for Health and Children, Deputy Mary Harney, that the new arrangements ensure a person aged 70 or older would not lose their medical card as an immediate consequence of the death of their spouse. All possible solutions to this were explored in recent weeks within the boundaries of what is possible from a non-discrimination point of view between widowed and single persons. I welcome the Minister's introduction of an amendment on Committee Stage to give effect to this objective.

The Minister also outlined that a person who had automatic entitlement to a medical card, and therefore full eligibility, would continue to have full eligibility until 2 March 2009. Consequently, all persons in this category 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 the Bill.

The Government wants to ensure a process of self-assessment for persons covered under these arrangements will be greatly simplified compared to the means assessment process required under the existing hardship-based scheme. The HSE has been asked to ensure that any assistance needed by a person currently over 70 on self-assessment will be made available by it on an administrative basis.

A greatly simplified means test will be put in place for persons who will attain the age of 70 on or after 1 January 2009 to enable them to apply under the new arrangements. The HSE will provide confirmation they meet the qualifying criteria for full eligibility under these arrangements. They will continue to have full eligibility as long as their gross income does not exceed the relevant limit. The Bill also provides for the dependents of those over 70.

The Bill includes a provision to amend the Health Contributions Act 1979 to provide an exemption from the health contribution for any person who is 70 or reaches the age of 70 on or after 1 January 2009. The amendment will exempt everyone over 70 from paying the contribution regardless of whether they fall into the existing categories exempted under section 11 of the 1979 Act. For those now aged over 70, or who will become so by the end of this month, there will be no new means test.

The objective of the general medical services scheme is to ensure the medical card benefit is available for those who are unable, without undue hardship, to meet the cost of health services for themselves or their dependents. Recently I met a 40 year old lady with cancer who was concerned that despite her medical condition and her husband's income being the minimum wage, she did not qualify for a medical card. She queued in a chemist behind two people, whom she described as very wealthy, who were aged over 70 and had medical cards. Speakers tonight may not be in the chemists or at the doctor beside the Tony O'Reilly's of this world, but she was incensed that wealthy people had a medical card while she had to pay for her medication despite her cancer diagnosis. We want to try and protect people like this with medical cards. People with a genuine medical need should receive a card whether they are over or under the age of 70. Those over 70 who do not qualify under the current arrangements can apply for a discretionary medical card.

As we look to future changes in demographics, it can be seen that Ireland has the youngest population in Europe, with approximately 11% of the population aged 65 or over. It is estimated this figure will rise to 20% by 2036 and 29% by 2056. In the years ahead our nation's age profile will change. The number of people in the population aged 70 is approximately 350,000 but this is projected to increase to 535,000 by 2021. We need to plan for this and provide many health services for those aged 55 and over who will form the over 70 group at that time, and use public resources in the most effective and fairest way possible.

The Minister, in her speech, outlined the new arrangements which will form part of the Bill to ensure the vast majority of people aged 70 and over will continue to hold a medical card.

See this speech in context