John Kelly (Labour)
Link to this: Individually | In context | Oireachtas source

I am disappointed that the Minister for Health or one of the Ministers of State for Health is not taking this important issue but I appreciate they are in the Dáil on business and are unavailable. This issue relates to the changes in the eligibility criteria for medical cards which took place behind the scenes and of which I was not made aware. When I telephoned the PCRS I was told the changes were implemented under the legislation which dealt with the medical card guideline changes for the over 70s. I read that legislation and they are not in it, although if they are, they are definitely well buried.

In any case, heretofore, people were allowed to write off car loans for the purposes of qualifying for a medical card. It is a noose around one's neck to have to get a car loan to get a car to go to work and not a luxury. All of a sudden the PCRS has scrapped allowing people to write off car loans. Recently, it seems to have scrapped allowing people to write off home improvement loans. During the good times, these loans were thrown at people willy-nilly by the banks. People were sucked into a false sense of security but they still have to repay these loans. I also noticed the €50 car allowance granted to people with a car for the purpose of going to work is gone. That was there to allow for depreciation.

People are losing medical cards left, right and centre because of changes to the criteria. They are being deprived of medical cards from health and financial perspectives. I do not know who is making the decisions. Is it the Minister or the HSE? Does the Government realise the damage it is doing to these people? If somebody is on social welfare, he or she will qualify for a medical card even though the social welfare rate is in excess of the medical card guidelines. However, when one factors in all of the payments middle income earners have - cars for going to work, car loans, home improvement loans, mortgages and creche fees which the PCRS has played around with in that it does not accept certain types of childminders - they are taking home less than those on social welfare. They are really being hit by decisions such as this.

I have no doubt the Minister of State's reply has been written by the HSE and it will probably state that 43% of the people have medical cards but I can tell him that in 1980, some 40% of the people had medical cards. The figure was always been around 40%. It is not much of a change.

We heard today that cancer patients who had discretionary medical cards will now be deprived of them. This is an issue on which I have campaigned for years. I recall writing to the former Minister for Health, Ms Mary Harney, on the issue because I felt she might show some compassion to people with cancer.

Whether the reply I get from the Minister of State is one I like - I assume it will be the usual type that I do not like - I urge him to bring these concerns to the Ministers in question and to ask them to respond to me but not through the HSE. I want to know who is making the decisions because people are really hurting.

As I said, the HSE proposes to give medical cards only to those dying of cancer. It wants to hand a person with cancer a death certificate in that if one gets a medical card, one will know one has six months to live.

Ciarán Cannon (Galway East, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I am taking this matter on behalf of my colleague, the Minister of State at the Department of Health with responsibility for primary care, Deputy Alex White and I thank the Senator for raising it. As the Senator pointed out, changes were made earlier this year to the medical card means test and to the income thresholds for over 70s medical cards. Those changes were made on foot of budget 2013 which identified a wide range of savings that were required across the health services. The General Medical Services, GMS, scheme was one of a number of areas identified in which savings were required.

A number of measures are being taken to reduce the cost of the GMS, which costs approximately €2 billion per year. At the end of 2012, there were approximately 1,986,000 qualifying people under the GMS. Medical cards make up the majority of this number, amounting to approximately 93% of the total. As part of budget 2013, the Government has made provision for an additional 200,000 persons to be covered by the GMS. Nonetheless, it is important that we prioritise the use of scarce financial resources in the current budgetary position.

Among the budget 2013 savings measures announced was a reduction in the income limits for over-70s medical cards. It should be noted that the overwhelming majority of medical cardholders aged over 70 years are unaffected by that change. For the wealthiest 5% who are affected, those cardholders under the old income limits will continue to be provided with a free GP service. The Health (Alteration of Criteria for Eligibility) Act 2013 was enacted on 28 March 2013 to give effect to the revised eligibility arrangements. Last December, at time of the budget, it was also announced that the rules on a person's expenses that are taken into account in calculating their net income for medical card purposes would be tightened. The Senator referred to this in his contribution.

The changes recently introduced by the Health Service Executive mean that payments on a home improvement loan and a €50 per week allowance for a car are excluded from the standard means test assessment. These changes took effect from April onwards.

For clarity, the exclusion from travel to work costs relates to removing the weekly amount of €50 allowed to cover standing charges, such as depreciation or other running costs, used when considering travel to work costs as an outgoing where public transport is not available or suitable and a car is required. This means that the HSE will continue to consider the standard mileage costs or public transport costs when assessing eligibility.

The Senator may be aware that there are a broad range of allowable expenses under the means test assessment for medical cards that have not been affected by these changes. I would like to assure him that the changes were identified with a view to mitigating the impact on the assessment process, while also yielding savings. In so doing, the new assessment arrangements continue to fully take account of a person's mortgage or rental expenses. In addition, other allowable expenses were protected budget 2013. The need to reduce the income limits for medical cards was avoided in budget 2013.

John Kelly (Labour)
Link to this: Individually | In context | Oireachtas source

I thank the Minister of State for the response, which contained everything I expected to be in it. I objected to all categories of people aged over 70 getting medical cards. The Minister of State might have been in government at the time. Previously, the guideline for a medical card for a person aged over 70 was equivalent to two old age pensions so, in effect, the Government was giving medical cards to wealthy people. I was one who spoke out against that at the time.

The Minister of State answered the question on who has changed the eligibility criteria. They were changed by the HSE. That means the Minister has accepted that it can tamper with the way things have been done in the past and affect people who have a rightful entitlement to a medical card, while at the same time he is talking out of the other side of his mouth, saying we will give universal GP cards to everyone in the country, and we will also give medical cards to everyone in the country with a long-term illness. None of that has happened. I am very disappointed that the people making the decisions are not taking those factors into consideration. They have no idea how they are affecting and hurting people.

Ciarán Cannon (Galway East, Fine Gael)
Link to this: Individually | In context | Oireachtas source

For the purpose of clarity, while the changes were introduced by the HSE, they were introduced on foot of a decision taken by the Government last December, at the time of the budget, to amend the mechanisms for calculating net income for medical card purposes.

On the reference made by the Senator to the commitment made by the Government in the programme for Government to introduce free GP care for all, that commitment remains in place. We are mid-way through what I hope will be our five year term in office. I have every confidence in the Minister and his colleagues to deliver on the commitment.