Nicole Ryan (Sinn Fein)

I welcome the Minister of State and am pleased to contribute to the debate on the Bill, the annual legislation that renews and adjusts the risk equalisation scheme which underpins our community-rated private healthcare insurance market.

Sinn Féin will support the Bill, as in previous years, and we do so while restating serious concerns about the direction of our healthcare system and the continuing reliance for so many families on private healthcare. As the Minister of State mentioned, almost half the population now hold private healthcare insurance. They pay a staggering €2.5 billion a year in premiums. This is not because people see private insurance as an optional extra or a luxury; it is because too many people simply cannot rely on the public system as it stands. We have 300,000 people waiting for scans and over 40,000 people have been waiting more than 18 months just for imaging. That is indefensible. When people are waiting months just to get a diagnosis, they understandably feel they have no choice but to pay for health insurance. That is not a sustainable or fair model of healthcare.

The truth is the Irish voluntary insurance model has for decades been facilitating a two-tier system where those who can pay jump the queue and those who cannot are left waiting. This continues to be an indictment of successive Governments’ failure to build a fully functioning universally accessible public health service.

Private healthcare is now being removed from public hospitals. That is an important and welcome step. If done correctly, this should finally increase public capacity and reduce an overdependence on private insurance. However, we need to be honest. The benefit of this change will depend on how the Government manages the transition. Increased public capacity must actually result in more productivity, more theatre time, more diagnostics, more appointments and more beds being used efficiently or else nothing will change.

The Bill adjusts credits and stamp duties in line with the annual requirements but households still face rising premiums, rising levies and rising cost pressures. The original legislation gives the Oireachtas the power to regulate the reasonable rate of profit in the insurance industry. That power exists for a reason – because the State must ensure that affordability and the public interest are not subordinate to corporate gain. The previous Government actually increased the allowable profit margin and that cannot continue unchecked.

That brings me to the amendment I have tabled. It would require the Health Insurance Authority to produce a detailed report on the rising insurance costs, the level of industry profit and the potential impacts of removing private practice from public hospitals on future premiums. The amendment does not block the Bill. It does not interfere with the risk equalisation. It simply ensures the Oireachtas has full, transparent and independent information before it as the structure of the health system changes. The HIA already publishes annual reports but this amendment would ensure that it would specifically examine the consequences for customers and not just the industry. While the removal of private healthcare from public hospitals is very positive, we must ensure that insurers cannot use it as an excuse to hike premiums. If costs go down for insurers, premiums must also go down for customers. If profits rise disproportionately, the Oireachtas must intervene. The amendment gives us the evidence base to do exactly that - to legislate if necessary and offset increased customer costs against industry profit levels and ensure no intended consequence of the system reform is allowed to quietly land on the shoulders of ordinary families. Ultimately, the long-term goal must be a public health service that is strong enough, fast enough and accessible enough for people so they no longer feel forced to buy health insurance just to access timely care. Affordable, efficient, universal public healthcare is not a radical idea - it is a standard across Europe. For too long people have been told to accept waiting lists as inevitable, but they are not. The high rate of private insurance uptake is in itself a mirror held up to Government policy. It is a reminder that the public system is failing to give people confidence and that has to change.

Therefore, while we support the Bill, we do so in the context of a system badly in need of reform and accountability. Risk equalisation, fair pricing and protecting customers are essential but, most of all, building a public health service that actually works – one where people do not have to pay twice for healthcare – must be our guiding objective. Our amendment would strengthen the direction of travel. It would also give the Oireachtas the tools and information needed to hold insurers to account and protect customers at a moment of major structural change. It is sensible, proportionate and responsible, and I urge that it be accepted. The Irish people deserve a health system they can trust without having to reach into their pockets for private insurance out of fear of endless queues.This is the challenge that is before us. It is one we must meet with urgency and ambition.