Emer Higgins (Dublin Mid West, Fine Gael)

I thank the Senators for their contributions and their proposed amendment. Unfortunately, I must reject the proposed amendment and I will outline why.

The Health Insurance (Amendment) Bill 2025 updates risk equalisation credits and stamp duty levies for health insurance policies in Ireland. Its main goal is to adjust risk equalisation scheme to reflect yearly changes in the market. The Bill is mostly technical and is focused on keeping the scheme running smoothly. As the Senator alluded to, it comes to us every year.

The amendment before us deals with two matters and neither matter relates to the risk equalisation scheme. The first, as the Senator detailed, asks for an examination of the profits of private companies in a competitive voluntary health insurance to potentially offset rising costs against these companies' profits. This second is an examination of the potential impact of the removal of private practice from public hospitals on the cost of health insurance. I will address each individually.

First, the amendment provides that I bring forward a proposal to use the profits of commercial companies to help reduce rising insurance costs for consumers. This proposal does not relate to the maintenance of the risk equalisation scheme, so it is not relevant to the Bill. I understand the Senators have concerns following recent media reports relating to the profits of health insurance companies. While the Health Insurance Authority’s role includes monitoring the operation of the health insurance Acts and advising me on matters relating to my functions or on health insurance generally, it is not possible to interfere in a competitive market.

The Department of Health engages with the European Commission’s competition body on Ireland’s application to keep the risk equalisation scheme operating in accordance with the approval granted under state aid rules. The risk equalisation scheme sets a standard for reasonable profit for net beneficiaries of the scheme, that is, insurers who receive more from the scheme than they pay in. This is currently set at 6% and meets the European Commission’s decision on the scheme under state aid rules, which allows the scheme to operate in Ireland’s health insurance market. I also advise the Senators that the current reasonable profit rate of 6% is in the process of being reviewed as part of preparations for Ireland’s application to the European Commission for state aid approval in relation to the scheme for next year and 2027. While I understand the Senators’ concerns, beyond the European Commission approval process and administering the risk equalisation scheme, neither the Health Insurance Authority nor the Minister for Health have a role in the private health insurers’ prices or profits.

The second part of the amendment relates to the potential impact of the removal of private practice from public hospitals. This provides for a report on the potential impact of the removal of private practice from public hospitals on the cost of health insurance and for the Minister to bring forward measures to mitigate rising health insurance costs for consumers caused by the profits and the movement of private practice. I thank Senators for the proposed amendment. The issue of reducing private income in public hospitals is particularly pertinent given that this is the year the public-only consultant contract really kicks in. We have reached a critical mass of consultants on the public-only consultant contract and this is the year we expect to see it in our figures. I do not expect this to be a recurring issue. It is really important we understand that, that we keep that on track and keep in place the measure to remove private activity from public hospitals insofar as possible. In continuing to remove private activity from public hospitals, we must make sure that public funding is used for public provision, something the Senator alluded o in her contribution. We must also understand better how, with real delineation between public and private, we can better use private services in tandem with State services.

For these reasons, I cannot accept the amendment on this occasion, but the broader issue the Senators have raised is extremely important and it is something that Senator Costello touched on. As stated by the Minister for Health on the Committee and Report Stages of this Bill in the Dáil last week, the issue of the continued removal of private practice from public hospitals will be the subject of debate at the health committee. In interim, patients have to option to elect to not avail of their entitlement for free care and to use their private health insurance. That option is available to them. The practice of asking patients for their private health insurance details is now being reviewed in the context of what we just outlined in terms of the new regime.

I thank Senator Maria Byrne for her contribution. We all agree with her that our health is our wealth. That is why it is so fantastic that we have such dedicated teams working in hospitals and healthcare facilities up and down the country.