Micheál Martin (Cork South Central, Fianna Fail)
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In his Budget Statement last week the Minister for Finance announced that he was cutting tax relief on what he termed "gold-plated" insurance policies, while not affecting the majority of individuals who avail of more standard levels of medical cover. Later that evening the Minister for Jobs, Enterprise and Innovation, Deputy Bruton, contradicted the Minister for Finance when he confirmed that the policy change would affect approximately 500,000 insurance holders. In the hours after that the real and full story emerged, that the removal of the tax credits will impact on people with a basic level of health insurance. Contrary to what Minister for Finance said, approximately 1.2 million people will be affected by this decision. The VHI has confirmed that only 10 of its 93 policies will not be affected. Insurance Ireland has said that the minimal additional cost will be €100 to basic policyholders and up to €360 per family.

This will result in more families with children, and particularly older people, bearing a heavy burden for private health insurance. It will lead to more people leaving private health insurance. It is instructive that approximately 134,000 people under the age of 60 left private health insurance between 2011 and 2012, while approximately 23,000 over 60 have joined. We need balance in the market and this is not sustainable. "The centre cannot hold" in health insurance. It is becoming unaffordable for many families and for many senior citizens.

Will the Taoiseach accept that the Budget Statement by the Minister for Finance was misleading and false because this measure will affect the majority of those who have health insurance? Will he accept that it will be a particular burden on older people and on families with children, given the cost involved? Will the Taoiseach indicate to the House that he will use the forthcoming Finance Bill to change this measure to ensure that the burden that is about to fall on people will not fall?

Enda Kenny (Mayo, Fine Gael)
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I do not accept that. The position as outlined is that the design and focus of this budget is to get this country out of the bailout programme which it has been in for some time. It is also designed to get our country back working through a range of measures. The objective of the Minister for Health, as I have outlined on many occasions, is to reform the current health system, to bring about a single tier health service in which access to health care is based on need and not on ability to pay. The Government is committed to the ongoing sustainability of the health insurance market as part of the transition to the market-based universal health insurance scheme.

Deputy Martin mentioned balance and he took the words "the centre cannot hold" from W.B. Yeats. He did not mention the word "fairness". It is important to understand that while the health insurance companies will comment on the decision of the Government as announced in the budget by the Minister for Finance, it is the Revenue Commissioners, who make individual payments, PRSI number by PRSI number, who have the accurate figures. They say that approximately 50% of people would be affected by these measures.

There are now 259 health plans, which is a recipe for mass confusion about who has what. The tax relief given at source is the second most costly tax expenditure for the Exchequer and is estimated to reach €500 million in 2013. That cost has increased very significantly from 2011, when it cost €404 million, to €448 million last year. That is an increase of 24% in costs over the past two years.

Billy Kelleher (Cork North Central, Fianna Fail)
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That is because premiums are going up.

Enda Kenny (Mayo, Fine Gael)
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Despite that increasing cost the number of insured has fallen by approximately 170,000 over the same period. In the Government's view, taking into account the headline principle of exiting the bailout and moving towards universal health insurance, fairness is the issue. The Government has decided that a subsidy of €200 per adult will be available for all adults across the board who take out private health insurance, and €100 in respect of their children, to a maximum of €600. Every person who takes out private health insurance is entitled to that subsidy from the Government and will get it. That allows people to choose, if they wish, to have more expensive health plans. The relief given applies to everybody across the board. The figures produced for the Department of Finance and for the Minister to bring to Government come from the Revenue Commissioners who pay out the tax relief on a case-by-case basis, and their figures are accurate.

Micheál Martin (Cork South Central, Fianna Fail)
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The Taoiseach's response is incredible. He said that he does "not accept that". What does he not accept? Is he holding to the line that this is only for "gold-plated" insurance policies? That is what the Minister for Finance said on budget day, while not affecting the majority of individuals who avail of more standard levels of medical cover. Even by his own admission and by that of the Minister for Jobs, Enterprise and Innovation, the Taoiseach's figures say that 50% plus will be affected. Does the Taoiseach accept that the Budget Statement was clearly and deliberately misleading, to give the false impression that only the "gold-plated" insurance policies would be affected? Insurance policies for families can cover up to six children per family. This will impose a real burden on families.

The Government is ripping the community rating system apart. There is no way that this can hold. If over 100,000 young people leave, and if that continues, there is no way that the Government can sustain the older population who have health insurance and who depend on the packages that health insurance brings to them. There will be more price hikes. The decision, for example, to charge the full amount for private patients using public beds, even though the majority are PAYE workers, will add further price hikes in January, on top of the annual insurance company price hikes. It is unaffordable now and it is becoming unaffordable month after month for thousands of families. That is the point. There is an incoherence at the heart of Government health policy. On the one hand, the Government says it wants universal health insurance, while on the other it drives people out of insurance. This budget measure is regressive and is unfair.

Enda Kenny (Mayo, Fine Gael)
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There is no incoherence here. The Government has been very clear about the budget focus on exiting the bailout and on dealing with the right of people not to have any income tax increases as a result.

Micheál Martin (Cork South Central, Fianna Fail)
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But this is.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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This is a reply to a supplementary question.

Enda Kenny (Mayo, Fine Gael)
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It is unlike what Fianna Fáil proposed in its own budget for an increase of €500 million. Fairness is involved here.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Would Deputies remain quiet? I ask Deputy Kelleher to remain quiet.

Enda Kenny (Mayo, Fine Gael)
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What the Government has decided to do is-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I will not ask Deputies a second time. Would Deputies please remain quiet? Will the Taoiseach proceed? We are over time. If Deputies want an answer, they should let the Taoiseach answer. If not, I will call a halt to proceedings.

Enda Kenny (Mayo, Fine Gael)
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What the Government has decided to do here is deal with the essence of fairness for every person who takes out private health insurance in order that the Government provides a subsidy in respect of each adult and child up to €600 for every person who takes out private health insurance. Of the 259 plans, many are not available. It also means that every person who wishes to take out private health insurance has the choice. They can have a cheaper or more expensive private health insurance scheme if they wish. Fianna Fáil seems to be saying that we should continue subsidising to a higher level those who make the choice to take out more expensive health insurance schemes. What we have done here is very fair in that every person who takes out private health insurance is subsidised to the limit by the Government. If they wish to take out more expensive private health insurance after that, that is their choice.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I want to make it quite clear that when I call a Deputy, like a Leader, I expect silence and I expect silence for the reply. No shouting from the back benches.

Gerry Adams (Louth, Sinn Fein)
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Más cuimhin leis an Taoiseach, chuir mé ceist air inné ag iarraidh air éirí as a phost agus bhí mé dáiríre faoi sin. An raibh seans ag an Taoiseach smaoineamh ar sin? An cuimhin leis freisin an méid a dúirt sé faoin ábhar tábhachtach seo?

Who said this: "to take away your rights to have a medical card beyond the age of 70, I reject it, the cheek of it, shame on them"? That was the Taoiseach talking about Fianna Fáil's attack on senior citizens and it is perhaps a perfect example of the view of the Minister for Communications, Energy and Natural Resources regarding election promises. Not only has the Government taken away the medical card from elderly people and others in dire need, it has cut income supports for young unemployed people, the bereavement grant, the telephone allowance, maternity benefit and the invalidity pension. It has attacked citizens from the cradle to the grave.

Not only does it insult the intelligence of these citizens, it shows no respect whatsoever for this Dáil. This Social Welfare and Pensions Bill, like a thief in the night, arrived into our pigeon holes overnight. It is to be rammed through in nine hours by the Government. We will have nine hours to debate a welfare Bill with huge implications and yet the Government says it is about political reform. Only last week, the Taoiseach promised a pre-legislative stage and less use of the guillotine. Obviously, he did not believe a word he said.

I again make the point that the Government has no mandate to do any of this. Fine Gael and the Labour Party sought a totally different mandate. People voted them in to do things differently from their predecessors, which is why yesterday I called on the Taoiseach and his Government to resign. I was not joking. I was serious. If the Government believes in what it is doing, it should go to the people and let them have their say. Will the Taoiseach resign and will the Labour Party and Fine Gael go to the people and seek a mandate for what they are doing?

Enda Kenny (Mayo, Fine Gael)
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Gabhaim buíochas leis an Teachta as an cheist a chuir sé. Chuir sé ceist orm ar mhiste liom éirí as cinnireacht na tíre agus oifig an Taoisigh. Dúirt mé leis an Teachta inné nach bhfuil sé ar intinn agam é sin a dhéanamh ar chor ar bith. D'fhiafraigh an Teachta díom an raibh seans agam smaoineamh a dhéanamh faoi sin. Smaoinigh mé faoi aréir agus ar maidin agus is é an freagra céanna atá agam don Teachta. Séard atá i gceist ag an Rialtas seo, idir Pháirtí Fhine Gael agus Pháirtí an Lucht Oibre ná cruth ceart a chur ar eacnamaíocht na tíre agus postanna a chur ar fáil do mhuintir na hÉireann. Sin atá i gceist agam. Is é sin an dualgas atá ag Rialtas na tíre agus tá sin á chomhlíonadh againn, cé go bhfuil sin deacair agus nach bhfuil sé éasca. Beidh seans ag muintir na hÉireann déileáil leis an Rialtas agus le h-iarrthóir ar bith a bheidh ag seasamh san olltoghchán atá ag teacht i 2016. Beidh freagra le fáil ag an Teachta agus agamsa ag an am sin.

Gerry Adams (Louth, Sinn Fein)
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Níl an Taoiseach macánta liom. Táim sásta go ndúirt sé go raibh sé ag smaoineamh faoin cheist a chuir mé air, ach ní chreidim an méid a dúirt sé liom. In Irish or English, the mark of this Government is one of breathtaking arrogance. It is clear from the Taoiseach's reply that he is indifferent. It is not that he does not know what is happening. He is indifferent to what is happening. It is not a matter of giving us pat answers in this forum. He is guided by a very narrow economic and ideological view that is to the right of the Tea Party in the United States. What he is doing is disgraceful and shameful. The axing of the telephone allowance to senior citizens is not even in the Social Welfare and Pensions Bill 2013. The Government will not even give Members of this House, who have been elected and have a mandate, the right to vote on this issue.

The Taoiseach ignored my question about time allocated for the Social Welfare and Pensions Bill 2013. He lambasted Fianna Fáil because it gave two days to the Social Welfare and Pensions Bill in 2009 and accused it of bulldozing the Bill through the Dáil in two days. He is going to do it in nine hours - a pathetic nine hours to deal with measures that will cut deeply into the very fibre of society. Whatever the Taoiseach thinks about the Labour Party, and it is obvious he treats it with indifference, does he not believe that citizens have the right at least to have these issues properly debated in this Chamber?

Enda Kenny (Mayo, Fine Gael)
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Deputy Adams has come a long way in 20 years.

Gerry Adams (Louth, Sinn Fein)
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What does that mean?

Enda Kenny (Mayo, Fine Gael)
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I am sure he remembers 20 years ago today. I want him to understand I have a mandate from the people to sort out the economic catastrophe left by the previous Government.

Gerry Adams (Louth, Sinn Fein)
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Not to do this.

Enda Kenny (Mayo, Fine Gael)
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As I said to Deputy Adams yesterday, we are not going to run away from either reality or our responsibility. That is our duty. In due course, the people will have the opportunity to give their verdict on this Government, as they will in respect of the future of every other Government in due course. What we have tried to do in very difficult circumstances is draft a budget that is focused on getting this country and our people out of the bailout programme. It is also focused on providing opportunity and incentive for people to be able to get employment, go back to work and contribute to their local economy and their country. Deputy Adams does not want that to happen because it is evident in the budget produced by Sinn Féin, which has black holes all over the place, that it would run every entrepreneur and taxpayer earning high salaries out of the country. That is probably what Sinn Féin would like to see.

I have news for Sinn Féin. We will not shirk our responsibility and will continue to make decisions in the best interests of the people in as fair a way as we can. While these decisions are not easy in any circumstances, as I said in answer to a question yesterday, it must have been great fun in the Cabinet room to be able to draft budgets with money it was thought did not have to be paid back. That could be done when billions were sloshing around, so to speak, in the economy and billions were going to waste. Unfortunately, from a political perspective, it is our privilege and duty to deal with the catastrophic consequences of that.

We are almost at the point of exiting the bailout programme. There are brighter days ahead for this country and it is the people who will be responsible for the pragmatic way they have approached this. I do not accept Deputy Adams's argument. It is my duty and privilege to be elected to this chair and office to lead our country and people out of this bailout, get our country back working, restore Ireland's name as a proud country around the world and give our people not just aspirational hope and confidence but also evidence of it in their daily lives. That Sinn Féin has not come up with a constructive suggestion in the past six months speaks for itself.

Séamus Healy (Tipperary South, Workers and Unemployed Action Group)
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Dishonesty is destroying the reputation of politicians and the political system in this country. I ask the Taoiseach who said the following:

The Government has lost touch with the people and misled its own backbenchers. It thought it could carry out this attack on the elderly under the guise of patriotism, when it was more like an act of terrorism.

The principle is simple; universal health care for everyone over the age of 70... Those are the people who made this country what it is today... They raised us, nursed us when we were sick, protected us from violence, grew our food and ran a proud Civil Service. Are we to repay them by taking away something which was freely given...

Billy Kelleher (Cork North Central, Fianna Fail)
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It was a fine speech.

Séamus Healy (Tipperary South, Workers and Unemployed Action Group)
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I ask the Taoiseach who said the following: "Elderly people do not want to be pressurised about means tests and application forms or have to worry about their property, their savings, what they have in the bank, whether a man from Government will call to their home or if they will lose their right to the medical card." It was the Taoiseach in 2008.

Finian McGrath (Dublin North Central, Independent)
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On the back of a lorry

Séamus Healy (Tipperary South, Workers and Unemployed Action Group)
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He was speaking on the same Private Members' motion on medical cards for the over 70s. What did the Taoiseach say on the same issue at an Age Action demonstration in 2008? He said:

To take away your rights to have a medical card beyond the age of 70 years - I reject it! The cheek of them. Shame on them.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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The Deputy is over time. I ask him to put a question.

Séamus Healy (Tipperary South, Workers and Unemployed Action Group)
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I will conclude shortly.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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You should conclude now. You are over time.

Séamus Healy (Tipperary South, Workers and Unemployed Action Group)
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The leader of the Labour Party, Deputy Eamon Gilmore, asked how the then Fianna Fáil Government could disrespect our elderly, “who worked hard all their lives, often paid high taxes and only want the peace of mind of having the medical card if feeling unwell”.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I ask the Deputy to put his question. This is not quotation time; it is Question Time.

Séamus Healy (Tipperary South, Workers and Unemployed Action Group)
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The Taoiseach and his colleagues in Government are now doing the exact opposite. There is deep cynicism among the population regarding politics and politicians.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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What is your question?

Séamus Healy (Tipperary South, Workers and Unemployed Action Group)
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My question is as follows. I have previously appealed to the Taoiseach to reverse the cuts on compassionate grounds.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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You are way over time. Put your question.

Séamus Healy (Tipperary South, Workers and Unemployed Action Group)
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If that appeal falls on deaf ears, I ask him to reverse the cuts at least to protect the integrity of the democratic system by making good the commitments he made in 2008. Will he now withdraw the elderly cuts from the Social Welfare Bill, the health Bill and the Finance Bill?

Enda Kenny (Mayo, Fine Gael)
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The Deputy's quotations are accurate and his question is valid. I have already said that the budget as determined and adopted by the Government will stand. I want to make it clear that the question, the misinformation and, in some cases, the accuracy surrounding the debate about medical cards have been the focus of attention for the last number of weeks. Every person in this country who deserves a medical card will have a medical card.

Robert Troy (Longford-Westmeath, Fianna Fail)
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Tell Joe Duffy.

Mattie McGrath (Tipperary South, Independent)
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That is a joke.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Deputies, hold on.

Enda Kenny (Mayo, Fine Gael)
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The decisions that have been highlighted by various Deputies, and validly so, are cases in point of where we as the Oireachtas, working with the HSE, have to focus on the discretionary elements where these apply. The policy situation in so far as cards are concerned is that discretion applies where there is financial difficulty arising from a person having to cope with a medical challenge or whatever. Various degrees of assistance are given. The service plan produced last year indicated the change in guidelines in respect of the over 70s and obviously that has been carried through.

I want Deputy Healy to understand that the scaremongering that every person in the country is likely to lose a medical card is absolutely nonsensical.

Micheál Martin (Cork South Central, Fianna Fail)
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Nobody is scaremongering.

Enda Kenny (Mayo, Fine Gael)
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Any person who needs a medical card will have one and, in so far as is possible in respect of those persons or children and family members who need aids and appliances or are clearly in a situation where they need assistance, that will happen. For the Deputy's information, we met with the principals from the Health Service Executive about communicating this to people in a way that is very understandable and that displays the compassion and sympathy that we know all Irish people have. A number of cases that have been brought to my attention are clearly difficult and I have referred them to the HSE for consideration in that context. I hope these matters can be dealt with in an understanding and sympathetic fashion. I do not want to see that courageous mother who was on the television the other night -----

Niall Collins (Limerick, Fianna Fail)
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Dead right, you do not.

Enda Kenny (Mayo, Fine Gael)
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Her child, of course, deserves support from the State and that is now being provided.

Séamus Healy (Tipperary South, Workers and Unemployed Action Group)
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As usual, the Taoiseach has not answered the questions I asked him. I wonder whether the Ceann Comhairle has a role in ensuring that questions are answered. Unfortunately, any assurance the Taoiseach gives in this House that individual cases will be dealt with is of no value because of his record of speaking out of both sides of his mouth. That is a fact. I have quoted his comments and, sadly, I have to say so. He has no mandate for these cuts to elderly services. We have heard what he said in 2008. Both Fine Gael and the Labour Party went to the electorate in 2011 with even more extensive commitments in the area of health.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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The Deputy should ask a supplementary question.

Séamus Healy (Tipperary South, Workers and Unemployed Action Group)
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If he is not going to reverse these cuts on health or compassionate grounds, I appeal to him to reverse them on the grounds of preserving the integrity of the democratic system. These cuts are corroding and undermining the democratic system, politics and politicians.

Enda Kenny (Mayo, Fine Gael)
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Deputy Healy will be aware that when the comments to which he referred were made, this country was not in the bailout situation it has been in for the past several years.

Billy Kelleher (Cork North Central, Fianna Fail)
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If the Taoiseach did not know in 2008 that there were problems, we are in trouble.

Mattie McGrath (Tipperary South, Independent)
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He had the books.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Why do we always have the usual suspects shouting from the back? It is always the same people.

James Reilly (Dublin North, Fine Gael)
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Do not forget about Tweedledum and Tweedledee.

Enda Kenny (Mayo, Fine Gael)
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I told Deputy Healy that his quotations were accurate but I should also remind him that persons over the age of 70 who have lost their full medical cards can access the GP card, which gives them free visits to their doctors. They also have recourse to the drugs repayment scheme, which is important. He did not mention the fact that 240,000 children under the age of five will have free access to doctors.

Michael Healy-Rae (Kerry South, Independent)
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Rob the grandparents to give them to the children.

Enda Kenny (Mayo, Fine Gael)
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I am sure he has met many parents in his constituency who appreciate the fact that if they consider their children have ailments or problems they will be able to bring them to their doctors without having to make difficult decisions. I do not accept his assertions. This budget is designed to get the people of our country, young and old, out of the bailout programme and to move to a point where the economy is prospering, jobs are created and people can go to work. As I said to Deputy Martin earlier, every person has the opportunity to chose an amenable private health insurance plan. From a fairness perspective, the Government provides a subsidy for every adult and child of up to €600. It is for the people themselves to choose between a lower cost private health insurance plan and a higher cost plan.

That is a matter of judgment for themselves.

Billy Kelleher (Cork North Central, Fianna Fail)
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It is a matter of Government policy.

Enda Kenny (Mayo, Fine Gael)
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The State, from a fairness perspective, provides a subsidy for every person. As I said earlier, there is a clear decision of Government not to increase income taxes so that people can make these judgments themselves.

Willie O'Dea (Limerick City, Fianna Fail)
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What of PRSI?