Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

We know very well what it says about entitlement to the medical card and the care this entails. We must remember it is all about health. The Minister for Health, Deputy James Reilly - I do not need to remind Minister of State, Deputy White, of the picture I painted which is absolutely accurate - has come full circle, from IMO opponent of universality for over 70s, to IMO beneficiary of it, to vociferous Dáil opponent of change to it, and now to imposing a further restriction on the scheme leading to thousands of older people losing their medical cards. This is some journey.

Again and again in opposition, the Minister, Deputy Reilly, quite rightly pointed out that restricting action to primary care was penny wise and pound foolish, because older people would suffer poorer health outcomes and require more hospital visits, inpatient care and residential nursing home care. Time after time these were his words, yet now in the very same manner as the people he condemned time and again, namely, his Fianna Fáil predecessors, he brings forward a Bill to restrict medical card access, a so-called savings measure which will undoubtedly, as the Minister believed when in opposition, adversely affect the health of our older citizens, a view I still hold.

Just as the Fianna Fáil row-back on the over 70s did in 2008, this Bill will cause confusion and distress to many older people. The question is what other categories, based on income or otherwise, are to follow. That is a valid question to ask. Heretofore we have been told that it will be the category of over 70s with an income in excess of €600 and others. Who are these others?

Already we know that the HSE is tightening up on the issuing of discretionary medical cards. I learned today of a mother with a young child who has Down's syndrome and a serious heart condition. He is entitled to a long-term illness card but also had a discretionary medical card based on medical need. The mother has now been told that her child is no longer entitled to the medical card, even though his condition and circumstances have not changed and will not change in any way through his lifetime.

Another mother with a child who has a rare condition decided not to fight what is for many a long and weary battle for a discretionary medical card. She chose instead to await the promised extension of free primary care to long-term illness patients. She is still waiting and, sadly, will continue to do so.

The main provisions of this Bill will reduce the income threshold for assessment for an over 70s medical card from €700 per week to €600 per week for a single person and from €1,400 per week to €1,200 per week for a couple. Those in the €600 to €700 weekly income bracket will be assessed for an over 70s GP visit card, as the Minister of State indicated.

This Bill does not implement the programme for Government, but rather the will of the troika as interpreted by this Government in the contents of its budget for 2013 and in the HSE's so-called national service plan for 2013. It is not a service plan but could be more accurately described as a plan for slashing services. Of the total of €721 million in cuts in this plan, a massive €383 million - not the €323 million as suggested earlier - is being cut from primary care. That is a huge cut which, in the minds of any reasonable person, makes a mockery of the Government's so-called reform programme which it claims has primary care at its centre. That incredible claim holds no water any more.

The Minister, Deputy Reilly, signed off on a plan that will deprive some 40,000 people of medical cards in 2013. How many more people will be similarly deprived thereafter as the income criteria for receiving a medical card are changed? This is a further attack on people on low incomes. In his reply, perhaps the Minister can indicate how many people the Department of Health estimates will lose medical cards as a result of this Bill. If it falls short of the 40,000 figure that has been signalled repeatedly, including in the HSE's national service plan, where will the others come from? Will they include that young child I described earlier who rightly had succeeded in securing a discretionary card based on medical need?

No doubt we will be told that the numbers of people with medical cards is increasing and is at an all time high. We are all aware of that but I understand the reasons. It is because people's incomes have plummeted with mass unemployment and a prolonged economic recession brought on, I acknowledge, by the last government and prolonged - all too sadly and despite all the promises - by the current Fine Gael-Labour coalition. Even at the current low income threshold for a medical card, the numbers are increasing. This Bill and other measures no doubt being contemplated by the Government are designed to restrict access where possible. What cards are they still holding to their chests? This is exactly the opposite of what was promised by this Government when it took office. It is nothing but a further health cutback from a Government whose health policy is in total disarray.

We still do not know what shape the Government's proposed universal health insurance scheme will take or how it is to be funded. We know it will be based on competing private, for-profit insurance companies. I find it incredible that Labour would even countenance that. Far from bringing us fundamental reform, this Government is continuing the regime of health cuts and health privatisation of its predecessors.

The other provisions in this Bill relate to cohabitants to bring the law into line with the provisions of the Civil Partnership and Certain Rights and Obligations of Cohabitants Act 2010. These are necessary and welcome. We do not have a difficulty with the other provisions in the Bill regarding the exchange of personal data information between Departments and the Revenue Commissioners, nor with the data protection provisions. These latter provisions could easily have been made in a separate Bill and are essentially extraneous to the main purpose of this Bill. They are not a neat fit. The main purpose of this Bill is, without question, to further restrict access to the medical card entitlement. On that basis, Sinn Féin will oppose the Bill's passage at every Stage.

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