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

I move:

That Dáil Éireann:notes that:

- there is an ongoing and persistent increase in the cost of private health insurance, with a crisis of affordability for both individuals and families developing;

- the increase in private health insurance premiums is significantly ahead not only of inflation generally, but health sector inflation as well;

- an average of six thousand consumers leave the private health insurance market every month;

- there is little incentive for younger people to take out health insurance;

- the haemorrhage of younger, healthier policy holders is threatening the sustainability of the private insurance market by generating further upward pressure on health insurance premiums for those who remain; and

- many of those who remain have downgraded their level of cover; and

calls on the Government to:

- act speedily to reduce costs in the delivery of both public and private health care as undertaken in the programme for Government;

- introduce lifetime community rating;

- revise the legal definition of non-advanced plans so that the 300,000 holders of lower level plans will not face a substantial rise in their health levy;

- defer the increase in the health levy which is scheduled for the end of March;

- remove children from liability to the levy;

- ensure patients who have private health insurance and pay their taxes do not lose their universal entitlement to public health care funded by the State;

- work with insurers to develop industry standard clinical pathways;

- permit public hospitals to negotiate with health insurers; and

- use its position and purchasing power as a VHI shareholder to negotiate a reduction in consultant fees.

We are moving this motion because over a number of years there has been a massive increase in private health insurance costs, creating significant difficulties, with families dropping out of health insurance or lowering the benefits they have from the portfolios offered by health insurers. Critically, the sustainability of the private health insurance market is also at risk, which is a clear difficulty for the Government. In many respects, it is a difficulty of its own making.

Inflation costs in private health insurance are many multiple of the broader consumer price index inflation and health sector inflation. Health insurance premia have gone through the roof in the past number of years, and as a result it is critical that the Minister takes a hard look at policies and the legislative framework base in underpinning a move to universal health insurance. We have spoken about the issue on numerous occasions and the Government does not seem to understand the difficulties out there, with families dropping out of health insurance plans, as outlined by the Health Insurance Authority. Over 70,000 people left health insurance in 2012.

When 34,000 people left health insurance two years ago, the Minister described it as a crisis and was apoplectic with rage, frothing from the back teeth on a continuous basis about the need for strategic policies around the issue of private health insurance. Nothing has happened since except the opposite to what was required. The Minister of State is aware that there should have been non-advanced plans but none exist. All the people paying for lower benefit health insurance schemes will now subsidise those on more expensive plans. That was outlined at a health committee meeting some weeks ago by health insurers. The people who can only afford basic plans and cover will now subsidise those people with the Rolls-Royce of private health insurance, which is clearly unjust and unfair.

The Government must rethink the issue very quickly. When the Minister dealt with Second Stage of the risk equalisation Bill last year, he indicated non-advanced plans could be available and exempt from the higher levy. We were led to believe by the Health Insurance Authority that there would be approximately 47 non-advanced plans. The legislation has been passed but there are no non-advanced plans, which means we are asking people hanging on by their fingertips to private health insurance and are dropping benefits. That means they can no longer avail of day case procedures or MRI scans or will have to pay for them. Health insurers have indicated that benefits must be removed from plans to ensure they qualify for the non-advanced category.

We are asking people to choose whether to fill a tank with heating oil, pay a gas bill or pay for insurance. These people must now subsidise a person with a €4,000 premium plan and who is staying in five star accommodation. That is clearly unjust and the Government must examine it. If the Government does not understand the advice it gets from the authority and officials, it will be at clear odds with the facts in the market. The four insurers have indicated clearly that this will be a result of the risk equalisation levy and the lack of non-advanced plans available to the many families struggling on a daily basis.

Every party and Government over the years has encouraged people to take out health insurance. There was tax allowance for the VHI for many years and such incentives still exist. There has been a policy of encouraging people to take out private health insurance. We are saying to those who have been paying for private insurance for generations - since the foundation of the VHI - that because of the legislation to redesignate beds in public hospitals, if a person is referred through an accident and emergency department to any public hospital in the country, health insurance customers will foot the bill to be treated in a public hospital. These people would have already funded the hospital through general taxation but they would receive no extra benefits. It is completely unacceptable to ask a person who has worked and made sacrifices in paying health insurance and contributing to the Exchequer - which funds public hospitals - to accept an indirect charge when they are in an accident and emergency department and a private health insurance card is found in their pocket. As health insurance companies will foot the bill, the expense will be passed to private health insurance customers, which is an unacceptably low practice in funding the country's health services.

This is a form of double taxation and a mean attack on middle Ireland. The Government must examine the matter again. This year and last year it was factored into the Government's accounts and I ask it, at this late stage, not to go down the road of placing double taxes on people who work hard and try to lighten the burden on this State in providing health care. These people will now have to pay twice when they enter a public hospital. That arises from Government policy.

The Government's amendment contains a slap on the back for this double taxation on people who can barely afford health insurance as it is. It states that the Dáil "endorses the Government's policy of generating additional income for public hospitals, by addressing the present subsidy enjoyed by health insurers in respect of their private patients who occupy public hospital beds". This is not a subsidy as the health insurers must pass on the cost to those who are consumers of private health insurance. Health insurance companies are obligated to run a surplus and cannot run a deficit, as they work under regulations from the Central Bank. They are obliged to pass such costs directly to the consumers, or the basic policyholders who already find it difficult to hold on to the very lowest type of plans offered by health insurers. This is a nasty double taxation on middle Ireland and I urge the Government to revisit the matter as quickly as possible.

We have raised another issue on numerous occasions. The figures indicate that younger, healthier people are opting out of private health cover by no longer taking up private insurance or dropping plans. Demographics indicate that there is an increased number of people on the other end of the scale. If we are to have intergenerational solidarity, with one generation contributing to the welfare of another - the idea behind community rating, which we have all bought into - there must be some lifetime community rating to encourage young people into the private health insurance market. The figures, as published by the Health Insurance Authority, back this up.

In 2008, there were 334,000 people between the age of 18 and 29 with health insurance but last year there were 267,000 people in that group. It is a massive drop. On the other end of the scale, the group between 60 and 69 had 185,000 people in 2008, whereas in 2011, the group had 207,000 people. Such a dynamic is completely unsustainable. The Government is pretending there is a market that will provide vibrancy and competition when universal health insurance is imposed on the people.

There has been no great discussion so far because we are still waiting for the famous model and for the commission on universal health insurance to publish its findings. In the meantime, the laissez-faireapproach to encouraging people to take up health insurance is simply untenable. In the longer term, it will endanger elderly and sick people because there will not be a healthy swathe of young people taking up private health insurance to cross-subsidise those who most need it.

I ask the Minister of State, Deputy Alex White, to reconsider the three issues about which I have spoken. I will be elaborating on them in greater detail tomorrow evening. This amendment is an extremely farcical exercise in slapping oneself on the back for single-handedly destroying private health insurance and driving over 140,000 people out of the market since the parties opposite took up Government.

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