Máire Hoctor (Tipperary North, Fianna Fail)

For those who turn 70 in the new year, there will be a much simplified means test compared with that applying for the standard medical card scheme, which has been designed to show that their gross income is below the new limits. The new arrangements proposed in this Bill will deliver on the Government's dual objective of prioritising the provision of medical cards to those most in need, while at the same time achieving a more financially sustainable scheme for persons aged 70 and over.

In particular, these arrangements will enable the ending of the very high capitation fee for GPs that has been paid since 2001 only in respect of over 70 year olds, who received a medical card by virtue of age, rather than means. This payment had the distinction of being discriminatory, inequitable and financially unsustainable. It was paid in respect of approximately 38% of people aged 70 and over. I welcome again the recommendation of Mr. Eddie Sullivan of a single fee capitation level of €290, which we intend to implement from 1 January.

Under existing legislation, the objective of the general medical services, GMS, scheme is to ensure that the medical card benefit is available to those who are unable, without undue hardship, to meet the cost of health services for themselves and their dependants.

People aged 70 years and over are more likely to require regular access to health services and it is appropriate that additional support is put in place to enable their access to medical care. At the same time, it is consistent with the general approach of the GMS for many years and with the need to provide for financially sustainable schemes, that the medical card should be provided to all but the top 5% of income earners among the over 70s. There are, and will continue to be, pressing calls on scarce resources to meet the needs of many people across the whole range of health services.

Fortunately, people in Ireland are living longer and healthier lives. This is due in no small part to better health services and the higher living standards as a result of economic growth. We also have at present the youngest population in Europe, with only approximately 11% of people over 65. This will change in the years ahead as our population ages and lives longer. While we welcome this as a nation, we need to plan for it in every respect, including Exchequer commitments which it will entail.

The number of people over 70 is projected to grow to 363,000 by 2011, 433,000 by 2016 and to 535,000 by 2021. We need to plan for, and provide, many health services for the people now aged about 55 and over who will form the over 70s group at that time and use public resources in the most effective and fairest way to provide those services. In that context, the continuation of the automatic medical card, and the associated high capitation fee paid for it, does not represent prudent or fair financial planning.

I now propose to briefly outline the main provisions of the Bill. Section 3 provides for the replacement of section 45(5A) of the Health Act 1970 which provided, since 2001, for an automatic entitlement to a medical card for all persons aged 70 years and over who are ordinarily resident in the State, irrespective of their means.

The old section 45(5A) is replaced by this new section 45(5A) which provides that those people who are 70 or over before 1 January 2009 and who had full eligibility on age grounds will continue to have full eligibility — the medical card is evidence of full eligibility — so long as their gross income from all sources does not exceed the specified limits.

A person who had automatic entitlement to a medical card and, therefore, full eligibility, by virtue of the old section 45(5A) will continue to have full eligibility until 2 March 2009. Consequently, all persons can continue to use their medical cards as normal up to 2 March next, even if their gross income exceeds the relevant income limits set out in this legislation.

Section 4 provides for the insertion of a new section 45A in the Act of 1970 dealing with the eligibility of persons aged 70 and over, and their dependants, for a medical card from 1 January 2009. It provides that people reaching 70 on or after 1 January must make an application to the HSE and, provided they meet the income and other criteria, that is, age and ordinary residency, they will receive a medical card. They will receive confirmation from the HSE that they have full eligibility and they will continue to have full eligibility so long as their gross income does not exceed the limit.

Although the application process for a medical card under these arrangements is a much simplified one, the Minister, Deputy Harney, is conscious that for some people in this category the process may prove arduous. As a consequence, she accepted a Committee Stage Fine Gael amendment that the HSE shall provide any necessary supports to any person making an application for a medical card under this section, whereby they need it by reason of incapacity.

This section also covers people who have already reached 70 prior to 1 January 2009, but who, for a variety of reasons, may not have applied for a medical card under section 45(5A) of the Health Act 1970, which provided for automatic entitlement to a medical card for all persons aged 70 and over.

The Government has been concerned at all times in these new arrangements to ensure that a person aged 70 or over would not lose his or her medical card as an immediate consequence of the death of his or her spouse. For that reason the Minister brought forward an amendment, to this section, on Committee Stage in Dáil Éireann to ensure that a person aged 70 or over would not lose his or her medical card as an immediate consequence of the death of his or her spouse. The amendment provides that a person aged 70 or over whose spouse dies on or after 1 January 2009 will retain the medical card for a period of three years at the couple limit of €1,400 provided the person remains within that limit. As outlined by the Minister, Deputy Harney, in her speech yesterday, this option offers the best solution in terms of what is possible from a non-discrimination point of view as between widowed persons and single persons. Finally, this section provides that dependants of persons covered in this section and section 45(5A) will also have full eligibility.

The gross income limits which will apply under this Bill from 1 January 2009 are as follows. For single persons, the gross income limits are €700 per week, excluding income from savings or similar investments whose capital value does not exceed €36,000. The gross income limits are €1,400 per week for a couple, that is, people who are married or living together as husband and wife, excluding income from savings or similar investments whose capital value does not exceed €72,000. The couple limit of €1,400 will also apply where the spouse or partner is under 70.

This section requires that the Minister review the consumer price index, CPI, annually on 1 September and provides that the gross income limits may be increased to reflect any increase in the index. The Minister gave assurances in the Dáil yesterday that these income limits will not be reduced in response to less favourable economic circumstances and advised that the Government would endeavour to ensure that the income guidelines continue to match the cost of living standards of the day.

The Bill makes provision for the exclusion of income, and interest earned thereon, arising from certain compensation awards payable by the State, as follows: compensation awards to persons under the Hepatitis C Compensation Tribunal Acts, 1997 to 2006; compensation awards by way of the Residential Institutions Redress Board; prescribed repayments made under section 8 of the Health (Repayment Scheme) Act 2006 made to a living relevant person, to the spouse or former spouse of a living or deceased relevant person, or directly to a living child of a relevant person by virtue of section 9(8) of that Act; and ex gratia awards approved by the Lourdes Hospital Redress Board. It further provides that the Minister may make regulations prescribing further payments made for similar purposes also to be excluded as income for the purposes of this Bill.

This section also gives effect to the Government's commitment not to impute income from property. For the purposes of assessing gross income under this Bill, income will not be imputed from any property, whether it is a family home, a holiday home or any other property, unless it is rented, and only the net rental income, calculated as gross income less any costs necessarily associated with the rental of the property, will be included for this purpose.

Sections 5 and 6 are technical amendments which amend sections 47 and 47A, respectively, of the Act of 1970 to provide for the new section 45A being inserted in the Act by this Bill. The amendment to section 47 provides that the appeals process available to persons under section 45 of the Act will also now apply to persons over 70 qualifying for a medical card under this Bill. The amendment to section 47A provides that guidelines on "Ordinarily resident in the State" issued for the purposes of assisting the determination of an appeal under section 47 shall also apply to persons qualifying for a medical card under this Bill.

Section 7, the amendment of section 49 of the Act of 1970, provides that people who are 70 years of age before 1 January and who hold a medical card on the basis of automatic eligibility under section 45(5A) prior to the enactment of this Bill, shall notify the HSE, no later than 2 March 2009, if they have concluded that their income exceeds the gross income limits.

The Government wants to ensure that the process of self-assessment required under this provision will be much simplified compared to that required under the existing hardship-based scheme. Consequently, the HSE has been asked to ensure that any assistance that a person may need on self-assessment will be made available by it on an administrative basis.

Subsection (b) amends subsection (2) of section 49 of the Act of 1970, such that the provisions applicable to a person who knowingly contravenes the requirement set out in subsection (1) to notify the HSE of any change in the circumstances that entitle him or her to a service provided by the HSE under the Health Acts, shall also apply to persons qualifying for a medical card under this Bill. The purpose of this section is to amend section 4 of the Health Contributions Act 1979 to provide an exemption from the health contribution for any person who is over the age of 70 or reaches that age on or after 1 January 2009. The amendment will exempt everybody over 70 from paying the contribution regardless of whether they fall into the existing categories exempted under section 11 of the 1979 Act.

Sections 9 and 10 are technical amendments to the Social Welfare Consolidation Act 2005 so that the existing statutory provisions on the sharing of information between public bodies, which already apply to section 45 of the 1970 Act, shall now also apply to section 45(A) of that Act as amended by this Bill. Section 11 is a technical amendment to ensure that the existing statutory provision in relation to the sharing of information between the Registrar of Births, Deaths and Marriages and the HSE, which already applies to section 45 of the 1970 Act, shall now also apply to section 45(A) of that Act as amended by this Bill.

This Bill is designed to give effect to the Government's decision to replace the automatic entitlement to a medical card for persons aged 70 and over with a new arrangement based on gross income limits. Under the new arrangement, the limits are set at a sufficiently high rate to ensure that the majority of people aged 70 and over will continue to qualify for a medical card. I commend the Bill to the House and look forward to hearing the views of Senators.