Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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During the Easter recess, Members of the Oireachtas received an email from the HSE informing us that further restrictions in medical card eligibility were being introduced in April. In the communication the HSE told us it was amending the eligibility criteria relating to medical cards by removing home improvement loans and excluding the first €50 per week from travel to work expenses from the standard medical card means test assessment. The exclusion of travel to work costs relates to removing the weekly amount of €50 allowed to cover standing charges such as depreciation and running costs used when considering travel to work costs as an outgoing where public transport is not available or suitable and a car is required. The HSE says it will continue to consider the standard mileage and transport costs when assessing eligibility.

The impact of these changes will be significant, there is no getting away from that. The home improvement loan repayments have been a factor in the qualification of a number of people currently depending on the medical card. The added restriction with the removal of that first €50 will impact greatly, especially on rural Ireland, where there is no public transport service. In my constituency there is almost no public transport service and that dependency on travel to work costs being met is crucial.

These further restrictions follow the recent legislation that lowered the income threshold for medical card qualification for people over 70 years of age that we addressed in the week prior to the Easter recess. I asked repeatedly for details of where the other 20,000 who would be impacted by the HSE's service plan for 2013, which projected the loss of 40,000 medical cards in 2013, with 20,000 of those belonging to over 70s. Is this what was planned but could not be exposed here a week before Easter but was slipped out during the Easter recess? These further measures represent another cut to health services and I deplore the matter in which this was communicated. The cover note made no reference to the information that was contained therein, referring only to the eligibility criteria for over 70s, something we thought we had already addressed prior to Easter, with the unsatisfactory outcome I have already described.

It is regrettable the Minister for Health and the Minister of State with responsibility for primary care had not utilised the opportunity in the House prior to Easter or on our return to address this. I have endeavoured to raise this matter every week since the conclusion of the recess and have only now succeeded in having my issue selected.

I appeal to the Minister of State to secure a withdrawal of these measures mindful of the very serious consequences they will have for individuals and families currently dependent on the medical card.

Alex White (Dublin South, Labour)
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I thank Deputy Ó Caoláin for raising this matter. The maintenance of health services is a priority in 2013 for the Government, despite the need for significant and challenging financial savings in the health area. Even with the extra resources made available to the Health Service Executive as part of budget 2013, just over €750 million in savings are needed during 2013. My script states €750 billion and bad and all as matters are, it is not a figure of that magnitude.

Budget 2013 set out the wide range of savings that were required and the general medical service, GMS, scheme was one of a number of areas identified. A number of steps are being taken to reduce the cost of the GMS, which costs about €2 billion per year. At the end of 2012, there were approximately 1,986,000 qualifying people under the GMS. Medical cards make up the majority of this number, amounting to about 93% of the total. As part of budget 2013, the Government has made provision for an additional 200,000 persons to be covered by the GMS. Nonetheless, it is important that we prioritise the use of scarce financial resources in the current budgetary position.

Among the budget 2013 savings measures announced was a reduction in the income limits for over 70s medical cards referred to by Deputy Ó Caoláin. It should be noted that the overwhelming majority of medical card holders aged over 70 are unaffected by that change. For the wealthiest 5% that are affected, those cardholders under the old income limits will continue to be provided with a free GP service. The Health (Alteration of Criteria for Eligibility) Act 2013 was enacted on 28 March last to give effect to the revised eligibility arrangements and the Deputy actively participated, as he always does, in the debates on the various Stages of that Bill.

Last December, at the time of the budget, it was also announced that the rules on a person's expenses that are taken into account in calculating their net income for medical card purposes would be tightened. The changes recently introduced by the HSE mean that payments on a home improvement loan and a €50 per week allowance for a car are excluded from the standard means test assessment. These changes took effect from April.

Where a decision is made by the HSE not to grant a medical card or a GP visit card, the applicant will be advised that they can request a review of the HSE decision if they believe their financial or other circumstances have not been correctly assessed. In such a circumstance the applicant may also be requested to provide any additional relevant information or details of any change in their circumstances since their original application.

To make the point clear, and Deputy Ó Caoláin clarified this correctly in the course of his contribution, the exclusion from travel to work costs relates to removing the weekly amount of €50 allowed to cover standing charges, such as depreciation or other running costs, used when considering travel to work costs as an outgoing where public transport is not available or suitable and a car is required. This means that the HSE will continue to consider the standard mileage costs or public transport costs when assessing eligibility. The Deputy will be aware that there are a broad range of allowable expenses under the means test assessment for medical cards that have not been affected by these changes.

I assure the Deputy that the changes were identified with a view to mitigating the impact on the assessment process while also yielding savings. In so doing, the new assessment arrangements continue fully to take account of a person's mortgage or rental expenses. In addition, other allowable expenses were protected in budget 2013. The need to reduce the income limits for medical cards was thereby avoided.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Again, I have to ask the Minister to accept that the situation regarding the transport expenses will significantly discriminate against people who live in the vast swathes of rural Ireland where there are no public transport facilities. Workers on comparable incomes carrying out similar tasks on a daily basis located in any of the major urban and city centres that have public transport will not be similarly affected. This is discriminatory against people who live throughout the country and, as I know of cases personally, in my constituency, particularly in Cavan and Monaghan.

Equally, in terms of home improvement loan repayments, while the Minister is continuing to make provision for the mortgage repayment element in the calculation, the home improvement loan, in terms of upgrading to particular enjoyable standards, is often essential. It can be for an expanding family or the particular needs of a disabled member of the household. There are a range of home improvement loans that are essential. They are not for decorative purposes or the sheer enjoyment of it. They are essential to the needs of the particular household and to cut that off with these consequences is unacceptable.

How can the Minister of State square the oft-claimed commitment of this Government, shown in its programme for Government document, to introduce universal access to primary care free at the point of delivery with the ongoing restrictions of medical card eligibility? These measures run contrary to the Minister's stated programme and his stated intent.

Alex White (Dublin South, Labour)
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Deputy Ó Caoláin has raised that issue several times and I have answered it several times. I will now answer it again, particularly in the case of the over 70s debate we had and the legislation we introduced. It was pointed out to the House, and I repeat it today, and the Deputy must accept this because it is a fact, that anybody who had a medical card removed from them as a result of the changes made had a general practitioner, GP, visit card extended to them instead. It is simply not true to say, therefore, that this measure runs contrary to the policy.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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There is no such guarantee in this situation.

Alex White (Dublin South, Labour)
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The Deputy has many criticisms-----

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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That was for the over 70s.

Alex White (Dublin South, Labour)
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Please, Deputy. There are not many people here. We do not have to interrupt each other. The Deputy has many criticisms that he can legitimately make and questions he can legitimately ask but it is not logical to say that it runs contrary to a policy when nobody has lost access to their GP-only card through any of these measures.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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We are not talking about the over 70s now. I ask the Minister of State to please deal with the issue.

Alex White (Dublin South, Labour)
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The Deputy asked how that runs contrary to the Government's policy to extend GP visit cards to the full population. It does not run contrary to it.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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This is not about the over 70s.

Alex White (Dublin South, Labour)
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The Deputy must accept that because it is factual. The Deputy asked me how it was consistent with the policy of free GP care. It is not inconsistent with that.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Home improvement loans. Transport costs to work.

Alex White (Dublin South, Labour)
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This is difficult but the Deputy saw the level of cuts that had to be made. There is no doubt that it is extremely difficult but when we examine the various options, and we had to examine the options, we found every one of them difficult. Does the Deputy believe there is any adverse change or cut with which anybody on this side of the House feels comfortable? The answer is "No". We want to maintain as best we can the integrity of the system we have and the maximum amount of resource we have available to it to ensure that those resources are best used. That is what we are trying to do in the circumstances.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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There is no automatic entitlement to a GP card when losing one's medical card under these measures.