David Cullinane (Sinn Fein) | Oireachtas source

Under this Bill, more people over 70 will lose their medical cards and fewer will qualify when they reach the age of 70. Prior to 2008, people over 70 received a medical card without a means test. When the Fianna Fáil-led Government decided to end that entitlement, the current Minister for Health, Deputy Reilly, then Fine Gael health spokesperson, described it as a "vicious attack" and a "savage assault on the elderly". We then had the Fianna-Fáil led Government's climbdown in the face of mass protest. The 2008 legislation set the income limit for over-70s medical card qualification at €700 per week for a single person and €1,400 for a couple. In response to that proposal then Deputy Reilly said it was a "desperate climbdown"and that "their tinkering with income limits is nowhere near good enough". Since then, Deputy Reilly has become Minister for Health. Has the hardship for older citizens lessened since that day in 2011 when he received his ministerial seal of office? It most definitely has not. Is the removal of medical cards any less an attack on them now than it was in 2008? It most definitely is not. The only difference is that Deputy Reilly is now the Minister for Health and different standards must apply according to him and the Government.

Under budget 2013, the income limit for over-70s medical card qualification was decreased from €700 per week to €600 for a single person and from €1,400 per week to €1,200 for a couple. It seems that tinkering with income limits is good enough when it is this Government that is doing the tinkering. This Bill proposes a further reduction in the income limits to €500 per week for a single person and €900 per week for a couple. The fear expressed by elderly people that once a means test was introduced and the income limits had been set very high, it would be a slippery slope to more elderly people losing their cards was real. It is expected that some 35,000 older citizens will lose their medical cards as a result of this change. As stated by Age Action Ireland:

It is contradictory to be removing means-tested cards from a section of society which has high medical needs, in a budget which is rolling out free GP care for children and heralding it as the roll out of its universal primary care plans.

Prescription charges for all medical card holders have been increased to five times the original charge per item introduced by former Minister for Health and Children, Mary Harney, a measure Fine Gael and the Labour Party vehemently opposed in the Houses of the Oireachtas. This increase hits older people badly. The changes introduced in this Bill, taken together with the abolition of the telephone allowance and the prescription charges increase, make budget 2014 a particularly nasty one for older people. I remind the Government that the Minister, Deputy Reilly, championed Fine Gael's fair care health policy with its promise of universal primary care. Fine Gael and the Labour Party received record mandates in the general election of 2011, with manifestos that promised greatly extended and then universal entitlement to free primary care. The programme for Government states that universal primary care will do away with fees for GP care and will be introduced within this Government's term of office. The Minister, Deputy Reilly, promised that the first phase of this, namely, extension of free primary care to claimants of free drugs under the long-term illness scheme would be in place in summer 2012 but it was not. There were supposed to be drafting difficulties because of the change from entitlement based on income to entitlement based on forms of illness. In the autumn of last year we were told by the Minister that it was still on track and a Bill in this regard would be introduced.

When the Health (Alteration of Criteria for Eligibility) (No. 1) Bill, came before us last March, there was no Bill to extend free primary care in any way. Instead, the Minister, Deputy Reilly, had come full circle, from IMO opponent of over-70s universality to IMO beneficiary of it, to vociferous Dáil opponent of change to it and to now imposing a further restriction to the scheme, leading to thousands of older people losing their medical cards.

The Bill further restricts access and cuts 35,000 medical cards. When they were in opposition, both Fine Gael and the Labour Party pointed out that restricting access to primary care was penny wise and pound foolish because older people would suffer poorer health outcomes and require more hospital visits, inpatient care and residential nursing home care. Now, they are further restricting medical card access as a so-called savings measure that will adversely affect the health of older citizens. It is another smooth transition from Fianna Fáil to Fine Gael and the Labour Party. There is not a hair's breadth between them. One simply cannot see the difference. We are told the difference is that the Government has provided for free universal GP care for children aged five years and under. I welcome that measure, as far as it goes, but if it is not part of a clear programme of extension of free GP care to all, with a limited timetable, it might actually undermine the principle of universality. If the Government was genuinely pursuing a policy of universality and a single tier health service with access based on medical need alone, it would have Sinn Féin's support. However, that is not the case. There might be members of the Labour Party who delude themselves into believing they are pursuing such a path, but it is far from the position of Fine Gael in the Government.

A total of €37 million is to be spent on GP cards for children aged five years and under, but €149 million is to be taken from the medical card budget. It is robbing Peter to pay Paul. We are giving some people a medical card, but we are taking it away from older people and have seen what is happening with discretionary medical cards. That is the reality and no amount of spin on the part of the Government will counter it. The reason more people qualify for medical cards is there are more people unemployed and in low income jobs than has been the case for a number of years. That is the reality and why more people need and should have medical cards.