Garret Ahearn (Fine Gael)
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I thank the Minister of State for taking this Commencement matter. The Minister of State is in a neighbouring constituency quite similar to mine. She was with us recently and I thank her for that positive visit to Cashel. I have raised this because of the frustration in my office, and I am sure in hers and others across the country, of people who are not getting medical cards, even though when we deal with them we know they deserve them. I will speak to a couple of examples, and then about how it particularly falls back on the self-employed and farmers. They have an asset that obviously costs a lot, but they will never sell it. They are losing out regardless of how low their income is from that asset or of the outgoings they have. People are missing out on medical cards who genuinely deserve them.

I have a couple or examples I want to put on record. I have been dealing with these for the past number of months. There are two ladies in Tipperary who have both had a leg amputated. These women are both married to farmers. I and Councillor Mark Fitzgerald have been working for months to get these medical cards over the line, but to no avail. The single farm payment appears to be putting them at a distinct disadvantage in attaining the medical card. One of these ladies needs a new prosthesis, but she cannot afford it so needs to get a medical card. However, she cannot get one because her husband is a farmer. I have had this issue a number of times with self-employed people, but particularly with farmers. I suggest, that particularly for these ladies who will live the remainder of their lives with a severe disability, a medical card be automatically granted on medical grounds without the need for financial assessment. I know there are cases where medical cards are granted for severe medical conditions, where they meet certain criteria, but I believe these criteria need to be examined and expanded to include amputees and those living with life-altering illnesses. There have been dramatic changes in the Department of Health in terms of opening up GP care, free GP care and visit cards. I welcome that. The availability of these services is under strain but these people really deserve medical cards.

There is another person in Tipperary who has been living with diabetes for decades. He has a good job and a good wage, but three out of his four children are now in college. The family is struggling significantly. His wife recently returned to work to supplement their income. He is under significant pressure as he is on a strict diet to control his sugar levels. His application has been refused numerous times. I know that man is making financial decisions to make sure he can pay for his children to go to college instead of paying for medicine and looking after himself. That is not the situation we should be in. These are genuine cases where people need to be assessed on the basis of common sense. If somebody is an amputee it is common sense that they should have a medical card based on medical need, and nothing to do with their financial circumstances. I have spoken to others and everyone has these frustrations. I assume the Minister of State has had the same experience. These are genuine people who need support. If we cannot support them, well what are we doing?

Anne Rabbitte (Galway East, Fianna Fail)
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I thank the Senator for raising this Commencement matter, which I am taking on behalf of the Minister, Deputy Donnelly, whose script I will read. If I have time I will also give my own opinion, which I would like to on this one.

Person-centred care is an existing core value of the health service, where everyone living in Ireland and considered by the HSE to be ordinarily resident here is entitled to either full or limited eligibility for health services. Persons with full eligibility, those who hold medical cards, can generally access a wide range of health services without charge.As of January this year, there are over 1.5 million medical card holders and over 530,000 GP visit card holders. Eligibility for medical cards is provided on a statutory basis under the Health Act 1970 and based primarily on means. The Act obliges the HSE to assess whether a person is able, without undue hardship, to arrange GP services, having regard to his or her overall financial position and reasonable expenditure. The HSE assesses each medical card application on a qualifying financial threshold. This is the amount of money that an individual can earn a week and still qualify for a card. It is specific to the individual's own financial circumstances.

The Minister for Health's focus continues to be on ensuring the continued operation of an appropriate and effective medical card system which aims to provide support and access to health services when needed. If an applicant's income is over the limit for a medical card or GP visit card, he or she may still qualify for a discretionary card. The HSE may, and I use the word advisedly, exercise discretion and grant a medical card, even though an applicant exceeds the income threshold where he or she faces difficult financial circumstances, such as costs arising from the illness. Social and medical issues are also considered when determining whether undue hardship exists for an individual accessing general practitioner or other medical services.

I can advise the Senator that since 1 December 2018, the medical card earnings disregard for persons in receipt of a disability allowance has increased from €120 to €427 per week and applies to the assessment processes for both single persons and families. This measure gave effect to one of the key recommendations of the Make Work Pay for persons with disabilities report and enables persons in receipt of the disability allowance to have a higher level of earnings and still retain their medical card. I can assure the Senator that the Minister for Health endeavours to ensure the medical card system is responsive and sensitive to people's needs. The Department of Health keeps medical card issues, including the current medical card income thresholds, under review and any proposals are considered in the context of any potential broader implications for Government policy, the annual budgetary estimates process and legislative requirements.

Last Friday morning I met a farmer of 72 years of age and his wife who is not yet 70. This is his third time applying for a medical card. He is over the threshold by X number of euro but at the same time his wife suffers from a serious underlying health condition. In cases like this there is need for flexibility, particularly with the self employed and in the farming sector. The Senator referred to prosthetics. The price of a prosthetic can be up to €20,000. Many people cannot afford that. Even if one has private health insurance, it is not covered. There are certain needs, such as the example I have just given where people do need a medical card. People of that age have a life-altering experience. They were probably hale and hearty and all of a sudden things have changed dramatically. After having an amputation it can be up to a year later that a person needs to be fitted for a prosthetic. That is not taken into consideration. That is why those people need flexibility. We need to look at a budgetary piece where VAT is removed on the income that people are paying who find themselves in this situation.

Garret Ahearn (Fine Gael)
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Out of the many of the responses I have heard in this Chamber, the last minute was one of the most frank and honest responses I have had on a Commencement matter. I thank the Minister of State for that. If we could keep her in the Department of Health for a couple of years she could sort out all of the problems there. On a serious note and as the Minister of State herself said, people in this situation have enough to be worrying about and they have experienced tragedy. To then feel as though the State is not supporting them is difficult. They come to us genuinely thinking that we can support and help them. It seems such an obvious thing where the State would look to support a person financially to get a prosthesis. However, we cannot and it is incredibly frustrating. When people are using the limited amount of money on other things and not on their own medical well-being, we really have a problem. In her response, the Minister of State mentioned that the HSE may use discretion. I have never seen the HSE move from what the rules are to having any sort of discretion or common sense. It is infuriating from our perspective. One gets to talk to someone in the HSE and they agree that the point is valid but still, nothing changes.

Lynn Boylan (Sinn Fein)
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I thank the Minister of State for her honest response.

Anne Rabbitte (Galway East, Fianna Fail)
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I did emphasise the word "may" and the reason I did so is that I have yet to see the word come into operation myself. The HSE also uses the word "discretion". I have yet to see the word in operation. When it comes to medical cards, they are two words that are held in the dictionary but not in operational circumstances. There should be a review for the self-employed within the medical card section. This will enable us to see how we can put into effect the idea of discretion within the medical card section for people who find themselves in life-altering conditions or where their circumstances change. For example, they might have an income but they have family going to college. In the crisis we are going through at the moment we need to be open to all suggestions that are brought forward.