asked the Minister for Health if, in view of the payment of the second phase of the national understanding of 1 March 1980, and the 16 per cent rise in the cost of living envisaged during 1980, he will revise the income guidelines used in determining eligibility for medical cards before June 1980 and if he will make a statement on the matter.
Ceisteanna—Questions. Oral Answers. - Medical Cards
26.
The income guidelines for the purposes of eligibility for medical cards are normally reviewed on an annual basis by the chief executive officers of the health boards. The guidelines at present in use came into effect on 1 January 1980 and, in determining them, full account was taken of changes in the cost of living during the previous 12 months as measured by the consumer price index at mid-November 1979. The increase in incomes under the second phase of the national understanding also took account of the increases in the consumer price index to mid-November 1979.
Medical card guidelines are an aid to health boards in ensuring that the statutory provisions in determining who has full eligibility for health services are complied with. The method of reviewing the guidelines, which has been in operation for some years, has proved to be effective in keeping them up-to-date.
It would be impractical to revise the guidelines at more frequent intervals to coincide with every change in cost of living or in wages or to anticipate possible future changes.
Is the Minister aware that the guidelines are now irrelevant? He apparently is not aware that at one stage during the term of the Coalition Government the guidelines were reviewed on a six monthly basis. Is he aware that people who would have qualified up to November for medical cards will not now qualify even though they are in a worse financial state owing to the huge increases in the price of food and other commodities?
The guidelines have been revised as recently as January. Developments which take place during the year will be kept under consideration.
The guidelines were taken in November. Is the Minister aware that there have been huge increases in the price of food and people on the borderline are in a worse position now than they were in November?
The two questions are separate. As regards the cost of living for social welfare recipients, benefits have been increased in the budget independently to cope with and cater for increases in the cost of living. As far as the guidelines are concerned, they are separate and independent and relate to wage and salary increases. They have been recently revised.
Since the guidelines are based on an estimate made in mid-November, the price of milk, butter, bread, gas, petrol have gone up and there have been increases in CIE and ESB charges. These could not possibly have been taken into consideration by the health boards when they were reviewing the guidelines which came into effect in January. In those circumstances would the Minister not agree that considerable hardship is caused, due to the direct action of the Government in sanctioning such price increases plus the increases that took place subsequent to the budget?
This is Question Time and there should not be a debate on the subject.
The guidelines are related to wage levels and the recent changes have reflected the changes in incomes which will bring people who have fallen out at the end of the year back in at this stage.
Is the Minister not aware that the majority of people in receipt of medical cards would not be wage earners?
It is related to income levels.
The Minister said wages.
Surely the Deputy realises that it is related to income levels. It is on the basis of income level that one qualifies or does not qualify. In fact, one's income will have changed in relation either to the social welfare benefits received, on the one hand, or the changes under the national understanding—changes in one's level of wages, salary or income. These have been taken into consideration in the preparation of the new guidelines.
Surely the Minister will appreciate that the only relevance income has is in what it will buy. I have listed a number of items which have been increased since then.
The Deputy is missing the point. There is no direct relationship between the guidelines for the medical card which are related to one's income and the cost of commodities. Whether one does or does not get a medical card depends on the level of one's income and not on the cost of other items. To account for the increases in wages which have been awarded during the year, the guidelines have been increased to allow for that. In effect, this will bring into the medical card group people who might have fallen out of it towards the end of the year and this is important.
Could I ask the Minister one question in two sections? Is the Minister aware that there is a glaring anomaly in his area of responsibility, both in the social welfare and in the health fields in that, on the one hand, the Minister's Department for Social Welfare will declare eligible a person for unemployment assistance and because of that declaration of eligibility he will not qualify for a medical card. There is a terrible anomaly here.
This is a separate question.
Could I ask, secondly, if because of the massive increases which have taken place since the publication of the mid-November CPI, the Minister will give a guarantee that it will be reviewed very shortly and not wait until 1 April 1981?
That is a separate question.
That is a repeat of the question that I have answered already.
The Minister will not give a guarantee of a review?
Is the Minister aware that people who may be on a fixed income have now fallen back as a result of food price increases and are now not eligible, even under the new guidelines? These people should be eligible because of the increases in food prices.
People on fixed incomes who were eligible previously must be eligible at this stage if they are on the same income, because the guidelines have increased with income limits so, even if their income increased in line with the national understanding, they will still be eligible.
I am talking about a man and wife on £48 a week.
The guidelines are related to the levels of income.
This is in relation to a man and his wife who are living on £48 a week.
Surely the Minister must be aware of all the price increases that have taken place? There is a large number of people entitled to medical cards and they should get them.
The question is about guidelines and I have demonstrated how the guidelines have been increased and have answered the question in relation to that. The Deputies are trying to bring in the general question of price increases. I have no information on price increases.