Mary Harney (Dublin Mid West, Progressive Democrats)

If we have all the exceptions that people are talking about and so many people are going to lose their cards, then the saving will be immense indeed. From what I am hearing, all kinds of people will allegedly lose their medical cards.

Section 3 is the heart of the legislation. We had a discussion earlier about principles and purpose. The essential purpose of the legislation is to withdraw the automatic entitlement to those who reach the age of 70 from getting a medical card and to re-establish an entitlement based on means. The second purpose of the legislation is to allow us to alter the capitation fee paid to general practitioners on foot of what was called the gold card introduced just over six years ago. That fee was negotiated and agreed on the basis of this legislation and can only be altered on the basis of this legislation, notwithstanding reaching agreements with organisations.

We were not and are not in a position in advance of changing the Competition Act, about which the Tánaiste spoke this morning, to negotiate with professionals in the health service on these matters. Even if one were, one would never be in a position, I assume — I would be interested in getting Deputy Reilly's views on this — to get 100% agreement. As Deputy Reilly knows, the contract is with each individual, notwithstanding how one might arrive at agreement on a fee. That contract with each individual general practitioner in respect of those over 70 who got cards based on their age was entered into on foot of legislation passed by the Oireachtas, which is why that needs to be changed too.

Regarding the issues raised by Deputy Shatter, as I said earlier, it is the practice that when a person with a medical card is widowed, regardless of age, the card is not withdrawn at that time and remains with that person until the card comes up for renewal. I wanted to ensure that we put it beyond doubt in the legislation. Other medical cards are given on the basis of an administrative arrangement rather than on the basis of the legislation. This was the only group of medical cards for which there is specific legislation, enacted by the Oireachtas in 2001.

Deputy Barrett asked about disposable and gross income. In 2005, I changed the general medical card regime to take account of disposable income to factor in travel to work costs, mortgage, rent, child care and so on so that we could target those who needed it most and that remains the position. Clearly there are three ways for people over 70 to get a medical card. They can get it on the basis of gross income in accordance with this legislation. They can get it under the general medical card scheme, which would take into account their net income. For example, a person with €40,000 per year nursing home care costs or perhaps other costs of that kind can apply under the regular medical card scheme. The third way is to apply for a discretionary card. The last information I got from the HSE indicated that approximately 70,000 people had such a card regardless of means because of a particular set of circumstances. It could be illness, outgoings or other factors that one cannot anticipate and put in legislation or even in an administrative scheme. That is done all the time. In my time in this House and the other House over the years I have personally helped people who have availed of that discretionary card because of particular circumstances they may have been going through.

Deputy Shatter advanced a view that I remember first hearing when both of us were members of Dublin County Council about whether cohabiting couples were eligible for the same housing entitlements as married couples and so on. I have not heard those arguments and I do not believe that is the argument he is making. I certainly hope not.

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