I have to move for permission to introduce a Bill called the National Health Insurance Bill. It is rendered necessary by reason of the fact that the administration of Health Insurance was transferred from the British Government on the 1st April, 1922. It was not possible at the time of transfer or since to effect a complete severance of the Free State system from that of the rest of the late United Kingdom. In the past, although there were separate Insurance Commissions for the different countries composing the United Kingdom, the insurance system in each country was not a self-contained entity, but was involved in some respects in the working of the system in one or more of the other countries. An Approved Society had headquarters in one country and a membership probably in England or Scotland or Wales or Ireland. In the case of one particular company, which is an insurance company, there was a very large membership in the area of the Saorstát.
It now becomes necessary to effect a full severance between the Free State and the rest of the late United Kingdom, and the Approved Societies recognised for Free State purposes must be entirely within the jurisdiction of the Free State, so that all accounts and transactions may be accessible to the Free State Government, which is responsible for financing the insurance system. The present Bill is largely concerned with making provision for constituting into Free State Approved Societies those insured persons who heretofore have been members of British Approved Societies or branches of them. The Bill is divided into five parts. The first part deals with various interpretations of terms used in the Bill. The second part of the Bill deals with transitional provisions, and is merely concerned with prescribing the machinery necessary for that purpose. The fact that the insured persons affected will cease to belong to the British Societies, which have up to this had the benefit of their contributions, necessitates that the British Societies concerned should transfer along with the members such accumulated funds as are properly applicable for providing the insurance benefits of such members. Conversely, where a Free State Society has had members in England, those members must now be cut off and the funds applicable to them handed over by the Free State Society to the British Society to which the members are transferred. Steps such as those provided for in Part 2 of the Bill are obviously required also on the British side, as the arrangements must be of a reciprocal character. In fact, the British Government has already taken power to deal with this matter by an Order in Council, and the details of Part 2 of this Bill coincide for the most part with those of the British Order in Council.
The Bill enables the Insurance Commissioners to join with the British Joint Committee in establishing a Board for making the apportionments of Society funds required in connection with these arrangements. These apportionments are, in general, of a kind to be determined by actuarial investigation and controversial questions are not likely to arise. The Bill enables the Board to carry out the additional function of apportioning the Irish National Health Insurance Fund. The latter task was partially carried out by the Joint Exchequer Board, which, of course, cannot now function for the purpose of effecting a final apportionment. Part 2 of the Bill contains a special provision for the case of those ex-members of British forces who are now resident in the Free State, and who hitherto belonged to the British Navy and Army Insurance Fund. It is proposed that such persons should cease to belong to the British fund, and that the latter should be apportioned, and that the Free State section thereof should be constituted into a special fund, to be called "The Military Forces (International Arrangements) Insurance Fund." It is necessary, in this connection, that the Free State Government should take over from the British Government the liability to guarantee the solvency of the fund. It is understood that the assets to be transferred with the Free State members will be such that the guarantee is likely to be only nominal. Besides the possible liability in respect of the guarantee, the transferring question will involve the actual payment out of the Free State Exchequer of the ordinary State contribution—about £1,500 per annum—in respect of the insured persons concerned. We could, however, scarcely refuse in any case to accept this liability, as it would fall upon us in the normal course even if the persons concerned did not belong to the British Army and Navy Fund, but belonged instead to an ordinary Approved Society in the Saorstát. This fund would also be used as a sort of clearing house for dealing with cases of residents in the Free State who now belong to or may hereafter join the British forces, and residents in Great Britain who now belong to or may hereafter join Free State forces.
Part 3 of the Bill deals with certain necessary adaptations which do not require any special comment. It further enables mutual arrangement to be made between the Free State and Great Britain, including Northern Ireland, for dealing with cases of insured persons who come and go between one country and the other, including cases where, for example, a person is resident in the Saorstát but is employed across the border in Northern Ireland. This part of the Bill also includes a provision enabling the Insurance Commissioners to prescribe how insurance contributions in respect of Lascars are to be applied.
Part IV. of the Bill deals with the important question of the Health Insurance of persons serving in the armed forces of the Free State. The proposal is that every soldier who, on joining the Army, was a member of an Approved Society, is to be maintained in insurance as a member of such Society, the appropriate contributions being paid out of voted moneys by the Minister for Defence. The contributions will be paid as from 1st April, 1922, or from date of enlistment if such date was later. In addition, insurance contributions will be paid by the Minister for Defence in respect of soldiers who were not members of Approved Societies on enlistment, but subsequently elected to become members of Approved Societies. The election must be made within three months after the passing of the Act or, if enlistment is subsequent to the passing of the Act, within three months from enlistment. In these cases the proposal is that the contributions should be payable also from date of enlistment, but not from any date earlier than 1st July, 1922.
The financial effect of this scheme is difficult to determine, as reliable information is not available respecting the number of men in the Army who belonged to Approved Societies at the date of enlistment, and as, in addition, it is impossible to forecast to what extent soldiers who do not belong to Approved Societies may exercise the option of joining them. The Insurance Commissioners seem to anticipate, in the light of the experience of the British Army during the European War, that the option will not be very extensively exercised, as men who have not been in, and do not expect on discharge to take up, insurable employment will not be disposed to trouble about the matter. On the other hand, joining an Approved Society will cost the soldier nothing, and as he may feel that some benefit may eventually accrue to him from joining, it may be that the option would be very freely exercised. For keeping 20,000 soldiers in insurance the cost for a year would be about £30,000. It will, of course, be necessary under the scheme to pay this year contributions in respect of both last year and this year. The scheme does not contemplate the payment of any contribution by the soldier himself.
The financial burden of this proposal is a serious matter at the present time, in view of the unsatisfactory state of the public finances. The total provision for insurance—both Health and Unemployment—in the Army Vote for this year is £37,000. As there is a danger that this may prove inadequate for its purpose, it is very desirable that any excess necessary under this head should be met out of savings to be effected on other subheads of the Army Vote.
Part V. of the Bill contains miscellaneous provisions. It abolishes the arrangements heretofore in force whereby there was maintained a special fund called the "Women's Equalisation Fund." Experience has shown that this fund has not been required to any serious extent for the purpose for which it was established. It was abolished in England as from the 1st January, 1922, and the provision in the Bill is intended to have the same effect here. In 1921 an Act called the National Health Insurance (Prolongation of Insurance) Act was passed for the purpose of securing that insured persons who had fallen into arrears with their contributions would receive a special concession, in view of the fact that their state of arrear was due to the prevalent unemployment. It was provided that, on certain conditions, such persons would be credited with extra contributions, so as to bring them up to a total of 26 contributions in the contribution year. This arrangement applied originally for the benefit year 1921, and was afterwards extended to 1922. The Bill proposes to confirm the arrangement for the current benefit year 1923, and to continue it for 1924. The moneys necessary to provide the extra contributions under this scheme will be drawn, not from the Exchequer, but from a special account, and the necessary arrangements in this connection are made by Clause 26 of the Bill.