Déirdre de Búrca (Green Party)

I welcome the Minister of State. I am thankful for the opportunity to engage in this debate on the Bill. We are all aware that public access to health services is becoming increasingly important. Some Senators referred to circumstances in the United States where 47 million people find themselves without health insurance. Health services and access thereto are becoming increasingly expensive. Ireland is also struggling in this area. We are challenged to produce a response that will ensure all citizens have access to timely and affordable health care.

Ireland has focused considerably on the issue of waiting lists and timely access to health services. Increasingly, however, because of the ruling of the Supreme Court in July 2008 that the risk equalisation scheme was ultra vires, we must really consider the regulation of the health insurance market so health products and services will not become increasingly inaccessible to ordinary members of the public due to their cost. I refer in particular to vulnerable sectors of the population, such as the elderly, who have more health care needs than others. The cost of meeting these needs is likely to grow significantly and, therefore, we must protect the vulnerable and examine ways of incentivising younger people to enter the market. We must ensure the principle of intergenerational solidarity, which has informed the market to date, is upheld, protected and enshrined in the health insurance legislation.

The Minister of State has made it clear this Bill is interim legislation and it is really responding to the Supreme Court judgment. I welcome many aspects of it and its objectives are set out very clearly. The main objective is to ensure access to health insurance cover will be available to all consumers without differentiation on the basis of age and health status. The purpose of the regulations set out in the legislation is to ensure health service providers do not operate within the legislation in contravention of its main objective.

Section 3 sets out that the principal objective of the Minister and the Health Insurance Authority in performing their functions under the Act is to ensure that, in the interest of the common good, access to health insurance cover will be available to all, with no differentiation made on the basis of age or health status. The section also provides that the insurer shall not engage in a practice or agreement against the principal objective. This is very important. Clear definitions of complex terms are also provided, such as "community rated health insurance contract", "community rating" and "net premium".

Section 6 is aimed at ensuring community rated health insurance contracts are made available to all persons without differentiation based on age or health status. Insurers are required to offer any particular contract for a period of not less than 31 days and are to charge all persons the same net premium. The issue of entry loadings is dealt with also. Based on the way the new system of regulations is designed, it is obviously in the interest of citizens to take out health insurance as early as possible so they can contribute over time to the risk pool and the principle of intergenerational solidarity through their insurance contributions so that when they are likely to make greater demands on the health services at a later stage, they will have made early contributions. The late entry loadings are for people who enter late into the market and who do not take out health insurance cover until later in life when their claim costs would be at a higher level. Obviously, they would not have made any contribution to intergenerational solidarity. The main change in this area of the legislation is to ensure that the age at which late entry loadings can be applied will change from 35 to 30. The legislation also clarifies that these loadings can apply on renewal of a contract to which the loading would previously have applied.

The Health Insurance Authority is given a central role in the legislation. Under section 8, insurers are now required to submit new contracts to the Health Insurance Authority 20 working days in advance of offering them to potential customers. Therefore, the authority has a role in screening and supervising the kinds of contracts being offered to potential consumers. The authority is also required to establish a register of health insurance contracts and this register must be available for inspection by the public free of charge at the office of the authority. There will, therefore, be much greater transparency and oversight in the system.

Section 9 obliges insurers to make information returns to the authority, which is a welcome development. The legislation prescribes that these would be six-monthly returns so that the authority, and in due course the Minister, will be enabled to perform functions under the Act. This is an improvement because previously, insurers were obliged to make data returns under the risk equalisation scheme. This provision ensures that more detailed and regular information is required of the insurance providers. The authority must also submit a report to the Minister at the end of every year. This will empower and assist the Minister because it will provide advice on matters that should be brought to the attention of the Minister as a result of evaluation and analysis undertaken. As mentioned already, this is an interim scheme that is being put in place and there will, obviously, be room for improvement. The role of the authority will be to advise the Minister in that regard. This section also provides the Minister with the power to make recommendations to the Minister for Finance on any of the reports submitted.

Section 11 deals with the issue of information and advertising as it relates to consumers. It enhances the position of the consumer with regard to information and advertisements where this is considered to be in the consumer's interest. Section 12 deals with the registration of insurers and section 13 deals with the enforcement of provisions contained in the Act.

The Minister has indicated this is considered an interim scheme to stabilise the market in light of the ruling of the Supreme Court. Therefore, we need to look at the issue of a longer term scheme. The Minister of State, Deputy Moloney, mentioned that until recently some 51% of the public had private health insurance, but that percentage may have decreased slightly. We need to consider the shape the longer term health insurance scheme should take. The Green Party would hope we would consider a universal health insurance scheme.

We can learn from the experiences of other countries, for example Canada, where there is one major health insurer that deals with all the various private health providers. This might be a good model for Ireland to follow. Whatever choice we make, we must ensure we have a proper longer term scheme. Currently our health insurance market is a bit of a hybrid. We have a strong public health system, but we also have increasing pressure as a result of competition law to allow for private providers to enter the market. We need to ensure that whatever health insurance we put in place, we hold true to the object of intergenerational solidarity set out in the Bill and ensure that no member of the public is discriminated against in terms of access to health services or the provision of health insurance on either the basis of age or health status. I welcome the legislation to the House and the Green Party is happy to support it.