Margaret Murphy O'Mahony (Cork South West, Fianna Fail) | Oireachtas source

Fianna Fáil will support this Bill, which is somewhat akin to the finance Bill or the social welfare Bill, as it arrives in November every year. The measures within it are designed to support risk equalisation and to sustain community rating in the health insurance market so that older citizens and people with illnesses can afford health insurance and are not discriminated against in favour of younger healthier people. We have always supported risk equalisation and community rating. There will be a small increase in the levy for advanced cover with reductions for non-advanced cover. The average annual health insurance premium increased from €935 in 2011 to €1,197 in 2018. The levy for advanced cover increased from €205 to €444 in that time. We welcome the reduction on the non-advanced levy. That is only reasonable as these plans are meant for entry level and provide less coverage. However just 9% of insured people had non-advanced plans in 2018. The levy for advanced cover for adults will increase from €444 to €449 and for under 18s it will go from €148 to €150. Levies for non-advanced cover will reduce from €59 to €52 for under 18s and from €177 to €157 for over 18s. The increase in the advanced levy, while not large does highlight one of the difficulties with the levy. Currently, the cheapest advanced plan is just over €700 and the most expensive advanced plan is more than €7,000 and they are both expected to pay a levy of €449. Both these members could be aged over 70 yet the burden on one plan far exceeds the burden on the much more expensive plan.

Yet again, the report of the HIA, which always precedes the Bill, has not been published so we do not know whether the Minister followed its recommendation. Does this not leave the Oireachtas in the dark as to why the levies are as they are? This has been a recurring theme for years. The Minister receives the report of the authority in September or October and there is ample time to produce a redacted version that can be published with the Bill. Of course, a Fine Gael Minister is for the ninth year running legislating for something the party opposed in the past. The Sunday Independentonce reported: "Fine Gael leader Enda Kenny has said he is opposed to the introduction of 'risk equalisation', the Government scheme that would see BUPA hand over €161 m[illion] in the next three years to its competitors, the State-owned health insurance company, VHI." In 2009, Fine Gael again expressed fears that a levy of €160 would "make private health insurance unaffordable". The party also claimed that a €160 levy was "anti-competitive and it is a means to prop up the State dominant player. VHI remains super dominant in the health insurance market".

The 2009 Bill introduced a €160 levy. In 2019, the Government is providing for a levy of €449. The levy was effectively doubled by a former Minister for Health, Senator James Reilly. During his tenure as Minister there were consistent declines in the number of under 60s with health insurance while the number of over 60s increased. However, between mid-2017 and mid-2019 the market increased by more than 100,000 and now stands at more than 2 million. The proportion of the market that is aged over 60 continues to edge upwards. Although it fell slightly after lifetime community rating was introduced, it was 22.1% in June 2019 while in December 2010 it was less than 17%.

Since last year's Health Insurance (Amendment) Act, we have been presented with a document that could have a significant impact on the health insurance industry, especially given the demographics of the market. The recent Dr. Donal de Buitléir report on removing private practice from public hospitals stated that it is difficult to predict with a high degree of certainty or accuracy what the full range of consequences for health insurance in Ireland might be if private practice is removed from public hospitals. Dr. de Buitléir anticipates that the number buying health insurance will decrease. For a start, the 10% of total health insurance policies that are currently classified as non-advanced plans could become defunct. These are less expensive plans that mainly provide a lower level of benefit in public hospitals. He also anticipates that it is very likely that if the health insurance market shrinks because of the removal of private practice from public hospitals, the market will also age. It can be anticipated that those more concerned about their health and their healthcare, namely, older people and less healthy people, will be more likely to retain their insurance cover, compared to younger or healthier people. He points out that a change in the demographic balance in the market would have implications both for the cost of premiums and for the stamp duty rate to sustain a community-rated market. Indeed, more broadly, and not connected with the removal of private care from public hospitals, in the coming decade, health insurance in line with healthcare overall may well experience significant increases in cost due to our ageing population and predicted claims inflation.

The risk of a shock to the health insurance market with the removal of private practice from public hospitals should be mitigated by the progressive and phased approach recommended for the removal of private practice. This approach lets demand for health insurance decline naturally in response to improvements in public care. Perhaps the Minister of State will outline in his reply what discussions he has undertaken with insurers on how an orderly transition can be managed alongside the implementation of the de Buitléir report.

We will support this Bill because we are firm in our view that the principle of solidarity should apply in private health insurance, as well as in public health services. More than 2 million people in the country have private health insurance cover and almost 471,624 are aged 60 and over. Many have been paying for health insurance all their adult lives. They have an entirely fair expectation that we act to ensure fair play and risk equalisation for them in the health insurance market. That is the reason we will support the Bill.

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