Máire Hoctor (Tipperary North, Fianna Fail)

It is no harm to remind the Senator.

Senator O'Toole asked whether it would be fairer to give the free medical card to people over 80. I would respond by asking whether it is not fairer to allow 95% of people over 70 to retain their medical cards. The Senator suggested the automatic entitlement of persons over 70 to the medical card should be replaced by an automatic entitlement for persons over 80. While the number of persons over 80 is less than that over 70, such a proposal would still mean a particular group, albeit a smaller one, would have medical cards regardless of their income levels. The Government is not prepared to return to allowing a group of people, irrespective of age, to have a medical card without reference to their means.

Senator O'Toole also asked whether people should be entitled to buy back their medical cards at a rate of €640, which was the levy charged to the State by the general practitioners. I assume he is associating this figure with the higher GP capitation fee of €640. He mentioned €650 but the figure was €640 and will be until 31 December 2008. This sum pertained to those who received the medical card on age grounds having reached the age of 70. Other costs need to be taken into consideration in respect of average medical card costs for those over 70, such as drug costs. The average cost of a medical card for a person of 70 and over who obtained the card on age grounds was actually €2,400.

A very important question was asked about those living in nursing homes with an outlay of perhaps €4,000 per month and whose income threshold exceeds the given figure of €700 per week. If such a person does not qualify in respect of the gross threshold of €700 per week, an assessment can be made for the medical card under the normal medical card means-testing arrangement whereby a person's net income is considered. Under this assessment, it is highly likely that a person with a monthly outlay of €4,000 in fees to remain in a nursing home would qualify, especially after medical expenses are taken into account.

Senator Twomey seemed to concentrate particularly on the fact that there was an increase in pay for Deputies and Senators. He referred to this several times. My colleagues and I accepted a 10% reduction in our salaries as Deputies and Ministers of State. Did Senator Twomey hand back 10% of his salary given that he placed so much emphasis on this matter?

Senator Twomey asked whether I, as Minister of State responsible for older people, was consulted on the measure to be adopted on foot of budget 2009. I was not consulted prior to the budget announcement. On the morning of the announcement, I and the other Ministers of State were told about the measure in the office of the Minister, Deputy Harney. This was the first time it was discussed. That does not come as a surprise because we understand that the budget is discussed at Cabinet, where there is strict confidentially. Ministers of State are not privileged to hear of Cabinet discussions.

I do not recall Senator Twomey referring to the fact that he should declare an interest as a general practitioner in respect of this Bill. The flat fee to which he referred is €290, which was the recommended fee. However, the fee of €927 remains the fee for general practitioners who attend to people in long-stay nursing home care. It has not changed and the Senator failed to recognise and mention that.

Senator Twomey suggested it would cost only an additional €5 million to extend the medical card to all people over 70. In calculating the cost of the medical card for persons of 70 and over, a range of costs must be considered, including the GP capitation fee and drugs costs. Therefore, to give the medical card to the 20,000 who will lose the card under the new arrangements would cost in the region of €20 million and not the €5 million being suggested by Senator Twomey.

Senator Norris referred to widows and widowers, on which subject I want to advise the House. The Senator incorrectly referred to Senator Shatter as the person who introduced the amendment. It was not he because it was a Government amendment. In the very early stages of preparing this legislation, I brought to the attention of the Minister, Deputy Harney, the anomaly that would deprive a bereaved person of the medical card on the death of a spouse and I stated this would be quite harsh. The Minister advised this House some weeks ago that she would do all she could to protect the medical cards of the bereaved. This matter was the subject of detailed consultation with the Office of the Attorney General. The advice it gave was that a balance must be struck between protecting the position of widows and widowers, on the one hand, and avoiding discriminating against people who have never been married to each other.

In summary, the advice we obtained was that a provision that allowed a widow or widower to keep the medical card indefinitely based on the married couple's income limit of €1,400 would be unlikely to withstand scrutiny in the courts if it were to be challenged, for example, by a single person who had been refused a medical card because his or her income exceeded the single person's income threshold of €700.

It was considered, however, that if a time limit was specified, it would be less likely to be successfully challenged. The time specified in the amendment agreed in the Dáil yesterday is three years from the date of death of the spouse. This will provide a reasonable period for the widow or widower, while adjusting to her or his new circumstances, to not have to worry about a medical card. At the end of the three year period, the widow or widower will, of course, be entitled to apply for a medical card, either under the new scheme in the Bill, where the gross income is less than €700, or the ordinary medical card scheme where she or he will be assessed on net income. Even if the net income of the widow or widower exceeds the HSE guidelines, it would still be open to the executive to grant a medical card on grounds of medical need and hardship.

I believe that Senator Nicky McFadden mentioned savings achieved as a result of the records of 10,000 deceased persons remaining on the medical card database. The HSE updates the medical card list on an ongoing basis, and of course GPs are obliged to inform the HSE when a patient dies or, indeed, moves to a new address. Information from the Department of Social and Family Affairs as well as from GPs assists in this process. I would be concerned, of course, if that was the case and the Department of Health and Children will discuss the matter with the HSE if the figures turn out to be accurate.