Brian Stanley (Laois, Independent)
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76. To ask the Minister for Health if she will examine the threshold for full medical card entitlement for those over 66 years; and if she will make a statement on the matter. [8791/25]

Brian Stanley (Laois, Independent)
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I welcome the opportunity to put this question. I congratulate the Minister and the Minister of State beside her, Deputy Murnane O'Connor, on their appointments. It is the first time I have had an opportunity to raise an issue with the Minister in the Dáil, so I wish her the best of luck in her position. She has a big job ahead of her.

I want to raise with her the income threshold for medical card entitlements. We have not moved on this for years. It is causing problems. There are a great many people caught there without it who are in desperate need of it. We have the aim of getting to a universal health system but we are caught in this situation now and we need movement on it.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I thank the Deputy, and I look forward to working with him as we worked together on the public accounts committee.

Eligibility for a medical card is primarily based on a financial assessment, as the Deputy is aware, which is conducted by the HSE in accordance with the Health Act 1970. The HSE assesses each medical card application on a qualifying financial threshold. That is the amount of money that an individual can earn per week and still qualify for a card. It is specific to one's individual financial circumstances.

People under 70 are assessed under the general means-tested medical card thresholds which are based on an applicant's household income after deduction of tax, PRSI and universal social charge. Certain expenses are also taken into account. People aged 70 or older are assessed under medical card income thresholds which are based on gross income. However, those aged over 70 can also be assessed under the general means-tested scheme where there are particularly high costs.

I assure the Deputy that my Department keeps medical card issues under review in order to ensure the medical card system is responsive and sensitive to people's needs. Over the course of 2025, we will review the existing eligibility framework to clearly assess what is working well and to inform future policy proposals regarding the eligibility framework based on robust evidence. That is an important step towards delivering universal healthcare in Ireland.

Brian Stanley (Laois, Independent)
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I thank the Minister for her reply. I have another question about people of working age, or people under 66, as they are referred to in the question. This question refers to people over 66 years of age. I have deliberately phrased the questions that way because for people who are under 66, the income thresholds are €184 for a person who is single and €201.50 if you are over 66. The basic rate of social welfare is €50 ahead of that at the moment. For a couple, the figure is €266.50, and for a couple over 66, it is €298. I ask the Minister to picture this. For a couple with two children, €342 is the limit, the income threshold. I checked yesterday. I checked the HSE website and I double-checked on the Citizens Information website to make sure I had not got this wrong. It is a real problem for workers and families. The Minister indicated that she might review it. I ask her to go for it in the next budget.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Of course, every extension of eligibility means that we cannot do something else, and we have to try to get the balance right. In 2023, GP visit card eligibility was extended enormously. While that does not meet everything, if you have a GP visit card plus the drugs payment scheme plus, potentially, the long-term illness scheme, there are a lot of measures that the State is taking towards reducing your costs in different ways, and the combined effect is very significant. What I really struggle with is that while 430,000 people were estimated to be eligible under that expansion, as of 13 January this year only 38,517 GP visit cards have been awarded under that median income expansion. It is not as though we do not want people to take them up. As a result of that initially slow update, a media campaign was rolled out to encourage uptake in 2024, including radio ads, out-of-home ads and in-office screens. The other 400,000 people who are eligible for a free GP card might look at the income limits and see if they are eligible.

Brian Stanley (Laois, Independent)
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I thank the Minister for the reply. That is helpful because the GP visit card is welcome. We acknowledge that it is there. The figures she gave mean that, I think, about one in 12 people who are entitled to it have applied for it and got it, or one in 11 or something like that. Obviously, there is a big piece of work there for the Government and all of us to try to get the word out there on that. It is important that we get people into primary care and that we are able to treat them in primary care because many people neglect their own health due to health costs and they finish up with a more chronic condition in some accident and emergency unit. Obviously, that is not the place we want them to be. It is bad not only for their health and for outcomes but also for financial management within the HSE. We are supposed to be moving towards a universal health system under Sláintecare. As I understand it, we have less than two years left to do that. This is one thing we can do, but I wholeheartedly welcome the GP visit card. We need to go the whole way and we need to start moving up the income limits. I think the Minister will agree that a €184 income threshold in 2025 is just off the Richter scale. She mentioned the balance. The seesaw is tipped too much against those on lower incomes.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Again, yes, it is about getting a balance, and we want to extend eligibility and reduce costs as much as possible. The very last thing that I or anybody else in this House wants is somebody not getting medical care because of a question of cost. The Government has taken a range of different ways to spread the benefit it is giving to people in the broadest possible way in addition to medical cards. The GP visit card is one. I would love to see 430,000 people taking it up and using it when they need to use it, supplemented by the drugs payment scheme, supplemented by the long-term illness scheme, which I think needs review as well, supplemented by removing the public inpatient charges for children and adults, and supplemented by our extension of contraception. We are trying to reach different groups in the broadest possible way and reduce the cost of medicine and access to medicine. In addition, all children under the age of eight years and all people aged 70 and over are now automatically eligible for a GP visit card. On the basis that most of our primary care is attempted to be delivered through the GP and primary care network closest to home and getting the original access, it is a really important step. I encourage every Deputy to encourage their constituents to check if they are eligible.