I understand Deputy Jan O'Sullivan is in possession on amendment No. 5, a ministerial amendment. Amendments Nos. 7 to 10, inclusive, and 30 to 34, inclusive, are related to amendment No. 5. Amendments Nos. 5, 7 to 10, inclusive, and 30 to 34, inclusive, are being discussed together and it is my advice that Deputy Jan O'Sullivan was in possession but had concluded. Is that the case?
Health Insurance (Miscellaneous Provisions) Bill 2008: Report Stage (Resumed) and Final Stage.
Debate resumed on amendment No. 5:
In page 5, between lines 39 and 40, to insert the following:
"‘cumulative net financial impact', in relation to a registered undertaking or former registered undertaking which has furnished one or more information returns to the Authority in respect of a period, means the difference between—
(a) the total amount of the age-related tax credits recorded in accounts for that undertaking in respect of that period as extracted from accounts furnished pursuant to section 7F(1)(a) and (b) to the Authority by the undertaking in respect of that period, and
(b) the total amount of the stamp duty referred to in section 125A of the Stamp Duties Consolidation Act 1999 recorded in accounts for that undertaking in respect of that period as extracted from accounts furnished pursuant to section 7F(1)(a) and (b) to the Authority by the undertaking in respect of that period;”.
—(Minister for Health and Children, Deputy Mary Harney)
We were discussing whether we would take all these amendments together. I do not like the idea——
I was not in the Chair but——
I do not mind if Deputy Reilly wants to——
The Minister moved amendment No. 5.
On a point of information, I had no issue with amendments Nos. 5 and 7 to 10, inclusive, being taken together but I was not happy to take amendments Nos. 30 to 34, inclusive, together with them.
It is a matter for the House how amendments are grouped. Has the Minister a view?
They are all connected. I do not know what the issue is. I am happy to discuss them.
If matters are related the idea is that we encompass them together rather than waste time in a repetitious debate. I suggest Members allow the grouping to stand and if they feel later there is some further point on an amendment I will allow some flexibility to open a point that had not been raised in this debate. I will ask the Chair at the time to do the same.
That is very fair. In the earlier part of the debate I objected strenuously to one of my amendments being ruled out of order by reason of it being against the spirit of the Bill. The Acting Chairman at the time did not want to engage and I understand why — it was not his ruling but the Ceann Comhairle's. I went to the Ceann Comhairle's office but he was not there. The officials were to ring me back but did not do so before I came in here.
To which amendment does the Deputy refer?
I am talking about amendment No. 1.
I ask Members to proceed with this grouping of amendments and when I leave the Chair I will ask the Ceann Comhairle's office to communicate with the Deputy.
I wish to make the point, which I was not allowed to make and which the Leas-Cheann Comhairle might take with him when he leaves. It states at the end of the Long Title "and to provide for related matters". I cannot accept that the amendment is against the spirit of that.
The notion of providing for "related matters" is a standard provision in legislation and is not meant or interpreted to be open-ended to allow the inclusion of everything thereafter.
I accept that, but this is very specific. It relates to our incurring costs at the European court.
An Leas-Cheann Comhairle: I will have that issue raised with the Ceann Comhairle’s office. I call Deputy O’Sullivan to speak to amendment No. 5 and the grouping agreed to.
I seek more clarification on this matter. The Minister has introduced some substantial amendments on Report Stage, which we obviously have not had a chance to discuss before. They are amendments we need to get right because we are already falling foul of EU Commissioner McCreevy. We need to be careful not to fall foul of him further in amending this legislation. I regret that we must deal with such detailed and technical amendments at this point in the debate.
As I understand it, amendment No. 5 relates to how an insurance company might gain more from risk equalisation than the risk justified and what should happen to that money. Schedule 2 deals with that matter in detail, under the heading "Community framework for state aid in the form of public service compensation (2005/C 297/04)". It covers "case-law of the Court of Justice of the European Communities" and so on. It behoves us to take note of that and ensure that the contents of this legislation comply with EU regulations and what the EU Commission considers to be an interpretation of EU regulations. The schedule on page 31 states:
22. Any over-compensation may be used to finance another service of general economic interest operated by the same undertaking,. . . 23. The amount of over-compensation cannot remain available to an undertaking on the ground that it would rank as aid compatible with the Treaty
I am flummoxed as to whether I am competent to accept or reject the Minister's amendments, which is why I am asking these questions. On the one hand, that is already contained in the Bill and, on the other, we have amendments addressing the same issue. They may or may not be contrary to Schedule 2. I ask the Minister to provide more background information on the reasons for introducing these amendments. Do they arise from discussions with the EU Commission? If so, are the amendments, particularly Nos. 41 and 44, inserted on its advice? As the Minister has said they are all related to that issue. In order to be competent legislators, we need more information on the background to these amendments.
As I said before the lunchtime break, the purpose of the legislation is to provide by way of a tax credit by the Exchequer the support of older sicker people by younger people. That has been done by way of a stamp duty on the companies. Clearly, there can be no intention here of overcompensation. That is not only our view, but also very much the view of the EU Directorate General for Competition. This is a competition matter and not one for Commission McCreevy who deals with the Internal Market. We cannot distort competition by taking from one to give to another in circumstances which are not fair. Therefore, the requirement is for this to be a justifiable state aid. There is an assumption that state aid is never allowed. State aids are allowed if they are justifiable in the public interest — in this case in the interest of the older and sicker people in the insured population.
The HIA would be required to return each year to the Minister the details — we will deal later with the periods and so on — on these matters and recommendations on the tax credit so that it can be addressed in the context of budgets. These are technical provisions to address that point. I believe Deputy Reilly asked me what overcompensation would be. Clearly, the HIA would seek to ensure that the return for the companies would be the general return one would expect in the market. The return in the general insurance market is approximately 4% to 5% and one would expect that kind of return.
Why have all these amendments been introduced on Report Stage?
I flagged on Committee Stage that I would be introducing them on Report Stage. Some of them are clarifications from our own perspective and some of them are on foot of our engagement with the EU on the matter of justifiable state aid. I flagged that matter, because otherwise I would not be able to introduce them. We had been in dialogue with the EU for quite some time and I had expected a decision from it that morning. I think the positive determination may have come the next day. Clearly, these provisions are to ensure that there is no question of any overcompensation.
Like Deputy O'Sullivan, I seek further clarity on matters like "age-related tax credits recorded in accounts". I am sure there is nothing major in this and I do not want to make a bigger deal out of it than it deserves. We need reassurance and further explanation as to the technicalities. Most of the amendments are simple enough. However, I have concerns about amendments Nos. 5, 30 and 31, on which I seek clarity.
Before the break I asked what happens to the excess profit if excess profit is adjudged to have accrued. Does it return to the Exchequer or is it redistributed among the other insurance companies?
I seek more detail on the report by the authority setting out the information it has received from the insurers and the provision whereby the Minister may request a further report or information. Is there any particular reason the Minister needed to get further information from the companies as proposed in amendment No. 44? I do not have a major problem with it, but I wonder why it was inserted at such a late date.
I also seek more clarity. These provisions are quite complicated. In particular, amendment No. 41 states:
Where, in respect of a period, the Authority has determined under subsection (5)(b) that the cumulative net financial impact of the relevant financial provisions on a registered undertaking or former registered undertaking was positive, and determined under subsection (6)(a) that the undertaking has made a profit which is in excess of the reasonable profit determined under subsection (4), it shall prepare a report
It continues to provide that the Minister can ask for a report even if it did not need to be prepared under that subsection. If the report is prepared, who looks at it and determines whether it is an appropriate reward? Deputy Reilly asked what then happens to the money. Why are such detailed changes necessary? We are dealing not with one amendment that will clarify that one cannot make excess profit in risk equalisation but with many complicated amendments. I am seeking a little more clarity on the issue.
Many of the amendments have the approval of the EU. Others arise out of issues raised on Committee Stage in respect of the provision of greater clarity. We are seeking to make insurance affordable to older and sicker people through what was previously risk equalisation and is now a tax credit. For example, where a company, in this case the VHI, is over-compensated that money will go to the taxpayer. We are dealing here with taxpayers' money and not the money of any individual other company. It would be ludicrous if such money were to go to a company. Where there is over-compensation in respect of a tax credit, then it is the taxpayer who should benefit. We do not believe we are doing so; we believe we have got it right but only time will tell.
The Health Insurance Authority, HIA, will submit a report to the Minister who will then publish it. The matter will then be considered in the context of the budget in terms of adjustments to the tax credit and so on. Currently members get a tax break at the standard tax rate. What we are doing is taking money that would go, and has for a number of years, to a company. The amount is taken from a person's premium and goes directly to the companies. The tax break is payable at the standard rate of tax and we are reorganising this between younger and older people.
Amendment agreed to.
I move amendment No. 6:
In page 5, between lines 41 and 42, to insert the following:
"‘information return' means an information return referred to in section 7D(1);".
Amendment agreed to.
I move amendment No. 7:
In page 5, to delete lines 42 to 44 and in page 6, to delete lines 1 to 31.
Amendment agreed to.
I move amendment No. 8:
In page 6, line 32, after "the" to insert "cumulative".
Amendment agreed to.
I move amendment No. 9:
In page 6, lines 36 and 37, to delete all words from and including "a" in line 36 down to and including "undertaking" in line 37 and substitute the following:
"a period, means that, for that period and that undertaking".
Amendment agreed to.
I move amendment No. 10:
In page 6, line 38, before "net" to insert "cumulative".
Amendment agreed to.
I move amendment No. 11:
In page 7, to delete lines 24 to 27.
I cannot accept this amendment which would allow an insurance company to offer a product for 24 hours. In other words, an insurance company could offer a product to a particular company, many of whose members are young people, and give them 24 hours to make up their mind about it before anybody else has an opportunity to hear about it. Competitors of the VHI made a complaint to me on this issue. It is completely unreasonable and is not in the interests of consumers or others who would like to avail of those products to have the period deleted. I am proposing that companies cannot withdraw their product after one day and that they must have it on the market for a period of no less than 31 days.
The Minister has misconstrued what I am attempting to do. The amendment does not seek to allow a company to put a product on the market for 24 hours. We want the period reduced to four or five days for the simple reason that under another part of the legislation no other company can offer the product for the 31 day lead-in time availed of by the first company. That is the problem with this section, as I interpret it. The amendment seeks to afford more rather than less competition and does not seek to promote sharp practice such as that suggested by the Minister.
I do not wish to misrepresent the Deputy's motives but the effect of his amendment would be that a company could offer a product for only one day. While I accept it would be offered at community rating those who do not know about it will not be able to avail of it. I mentioned earlier that there is in this city a company that employs 1,200 to 1,400 people. As I understand it, that company has not had a claim for the past 18 months to two years because all those involved are young, healthy people, which is a healthy situation for any insurance company. We want to ensure that products that are available are available for a reasonable period to all persons.
Question, "That the words proposed to be deleted stand", put and declared carried.
Amendment declared lost.
I move amendment No. 12:
In page 11, line 10, to delete "10" and substitute "3".
Subsection 7AB. states:
—(1) Where a registered undertaking proposes, on or after the commencement of section 8 of the Health Insurance (Miscellaneous Provisions) Act 2009, to offer in the State a new type of health insurance contract (and regardless of whether the contract is already offered outside the State by the undertaking or any other person), it shall, not later than 10 working days before first making any such offer, submit a sample of the contract to the Authority.
We want the period shortened to three days.
I have already shortened it from 20 to ten days, which I believe is reasonable. What we are seeking to do is ensure the products offered are fair and provide community rating. I believe ten working days, which is two weeks, for the health insurance authorities to assess those products is not unreasonable. Previously, they had 20 days within which to do so and would prefer if they still have that length of time to carry out the assessments. I have halved the length of time provided. I do not believe three days is a realistic timeframe within which to do the type of job that needs to be done. For this reason, I cannot accept the amendment.
I accept that the Minister has come a long way to meet us and on that basis withdraw the amendment.
Amendment, by leave, withdrawn.
I move amendment No. 13:
In page 11, line 42, to delete "new".
The deletion of the word "new" from the section will facilitate the health insurance authority continued register of all health insurance contracts. The current wording is considered to be unduly restrictive.
That makes sense.
Amendment agreed to.
I move amendment No. 14:
In page 12, line 10, to delete "or renewed".
Amendment agreed to.
I move amendment No. 15:
In page 12, line 46, to delete "person." and substitute the following:
"person,
where that information is held by the health insurance business in respect of insured persons.".
We discussed this issue on Committee Stage. We are seeking to take the onus off the insurance company to obtain PPS numbers. I accept the law has changed and that from now on they will have those numbers. However, there is retrospection involved here. The Bill places an additional onus on insurance companies to chase people for their PPS numbers.
The Revenue Commissioners require the insurance companies to have PPS numbers to make tax credits to individuals. The Bill refers to "all reasonable efforts". In other words, we are asking them to do only what is reasonable. Clearly, the Revenue Commissioners require the PPS number to be able to allocate the tax credit to the individual company. This would be a cop-out. The words "reasonable effort" are included in the Bill.
With due respect, I do not believe it is unreasonable to say "where that information is held by the health insurance business in respect of insured persons". If they have the information, they should hand it over.
We require them to obtain the information and to take all reasonable steps to do so. If they cannot get it, that is a different issue. They are required to make every effort to get the information. In other words, they should ask the people they are insuring for their PPS numbers at the time of renewal or on taking out new contract so that it can be transmitted to Revenue who in turn can allocate tax credit to them. That is all that is required.
Are there any obstacles to insurance companies getting PPS numbers? When HIQA announced that there should be new health numbers, it pointed that in many cases it is not appropriate to use the PPS number for health information. Has that been considered?
The jury is out on the appropriate electronic patient identifier. The general view is that the PPS is not appropriate for it, something else will be needed and the sooner we get it the better, not least for patient safety issues.
We are discussing the matter with the Data Protection Commission and we must satisfy the commissioner. The Revenue Commissioners require the PPS number to give the tax credit and the steps proposed in the legislation are not unreasonable. We are asked for our PPS numbers at present. I was looking at my health insurance renewal recently and there was a reference to the number on that, perhaps in preparation for this legislation.
The Minister could take this on board if she wanted to modify it slightly so the information is held by the insurer.
Question, "That the words proposed to be deleted stand", put and declared carried.
Amendment declared lost.
I move amendment No. 16:
In page 13, to delete lines 34 to 37.
Amendment agreed to.
I move amendment No. 17:
In page 13, to delete line 38 and substitute the following:
"(d) the in-patient indemnity payments, or a”.
Amendment agreed to.
I move amendment No. 18:
In page 13, to delete line 43 and substitute the following:
"(e) information relating to the health”.
Amendment agreed to.
I move amendment No. 19:
In page 13, to delete line 46 and substitute the following:
"(f) such other information relating to the”.
Amendment agreed to.
Amendments Nos. 20 to 25, inclusive, are cognate and may be discussed together by agreement.
I move amendment No. 20:
In page 14, line 31, to delete "period" and substitute "periods".
This is a technical amendment to substitute "periods" for "period" in the analysis and evaluation of the Health Insurance Authority Bill that will be sent forward when it is enacted. The first report sent forward will be for the period January to July 2009 and next year it will be for July to December 2009 and the first part of 2010. The reports will be submitted in advance of the budget deliberations each year.
Amendment agreed to.
I move amendment No. 21:
In page 14, line 36, to delete "period" and substitute "periods".
Amendment agreed to.
I move amendment No. 22:
In page 14, line 40, to delete "period" and substitute "periods".
Amendment agreed to.
I move amendment No. 23:
In page 14, line 43, to delete "period" and substitute "periods".
Amendment agreed to.
I move amendment No. 24:
In page 14, line 50, to delete "period" and substitute "periods".
Amendment agreed to.
I move amendment No. 25:
In page 15, line 5, to delete "period" and substitute "periods".
Amendment agreed to.
Amendments Nos. 26 and 27 are related and may be discussed together by agreement.
I move amendment No. 26:
In page 15, line 25, after "Minister" to insert the following:
"(including information in relation to the profitability of any registered undertaking or former registered undertaking where the operation of the relevant financial provisions is expected to result in a positive cumulative net financial impact on the undertaking)".
These amendments enhance the guidance already provided in this section for the authority for the content of its report to the Minister, reflecting the primacy of the principal objective and also to have regard to the profitability of any net beneficiaries and avoiding any over-compensation in proposing the level of the credits and duty.
Amendment agreed to.
I move amendment No. 27:
In page 15, lines 35 to 41, to delete all words from and including "undertakings)," in line 35 down to and including "and" in line 41 and substitute the following:
"undertakings) having regard to the principal objective specified in section 1A(1) (in so far as that objective relates to health insurance contracts that provide for in-patient indemnity payments) and to achieving the aim of avoiding overcompensation being made to a registered undertaking or former registered undertaking under the operation of the relevant financial provisions, and".
Amendment agreed to.
Amendment No. 28 not moved.
I move amendment No. 29:
In page 16, to delete lines 12 to 16.
This addresses the appointment of further advisers. There is enough advice within the Department, the HIA and the HSE without seeking outside advice. We are trying to reduce costs — there are cutbacks in hospitals and we have debated Crumlin Hospital, medical cards, palliative care and people lying on trolleys — so I see no need for further advisers, and certainly not for them to be enshrined in legislation, which predicts it will happen whether it is necessary or not.
There are a lot of advisers already, the Attorney General and other legal people who worked on the drafting of the Bill. We are trying to save money. There are many people working in the Department, in spite of the fact that most of its functions were given to the HSE. The facility should exist already within the Department to provide the advice necessary.
There are 475 people working in the Department of Health and Children but it is the second largest Department in terms of legislation and the busiest in answering parliamentary questions, with the second biggest budget. That is not to say there is not room for further reductions. Two thirds of the staff in the Department are at the lower grades, with a third in the higher grades.
This provision was introduced by Deputy Howlin when he was Minister and used by his successor as Minister, Deputy Noonan. We do not have actuarial staff in the Department and it would not be cost effective to employ such staff full-time because they are expensive and rarely needed.
We are asked to evaluate submissions by companies who have actuarial expertise. I must evaluate them and advise the Government. It is not realistic to ask me to do so using regular civil servants. If I wanted advice on colorectal cancer, I would go to a colorectal cancer expert. This is a specialist area and the skill is not readily available. We go to tender when we are recruiting expertise in the area. This is not about appointing advisers, it is about appointing experts to advise on technical issues related to health insurance. I cannot accept the amendment because all my predecessors felt it necessary to have these provisions as well.
What is the role of the HIA? Are there no actuaries in the Department of Finance or the HIA who could be called upon? What are they doing in the Health Insurance Agency? It is the agency with the expertise in this area and I find it difficult to accept that we must enshrine in law that outside advisers are needed.
There is no actuarial advice in the Department of Finance. The HIA is a regulator and will be part of the financial regulatory environment. It is financed by the industry and will have a role in the regulation of health insurers and a further role in assessing the effect of the tax credit and reporting to me. I then have to assess if I am to advise the Minister for Finance if tax credits should be altered and the Government must consider that in a budgetary context.
If necessary I must have a lot of advice. We were in court on a number of occasions on risk equalisation and had to bring in expertise from outside the State. We were up against huge expertise from the different interests. The Deputy is being unreasonable, we do not get outside expertise for the sake of it, we have greatly reduced the amount of money spent on consultancies in the Department and the HSE. This, however, is an area where it is necessary.
No one wants to deny the Minister the best advice when it is needed, and I am sure other Departments can call upon advice, but it is odd that it must be legislated for. I would have imagined the Government is always entitled to do that.
There is no point in being repetitive. I have made the case.
Question, "That the words proposed to be deleted stand", put and declared carried.
Amendment declared lost.
I move amendment No. 30:
In page 16, to delete lines 20 to 46 and substitute the following:
"(a) maintain and furnish to the Authority (before 1 April of the next succeeding year), in such form as may be specified by the Authority, a statement of profit and loss in respect of—
(i) its health insurance business in the State which falls within paragraph (b) of section 7D(1), and
(ii) such other health insurance services, provided by the undertaking, as may be prescribed,
(b) maintain and furnish to the Authority (before 1 April of the next succeeding year), in such form as may be specified by the Authority, a balance sheet in respect of—
(i) its health insurance business in the State which falls within paragraph (b) of section 7D(1), and
(ii) such other health insurance services, provided by the undertaking, as may be prescribed,
and
(c) furnish to the Authority (before 1 April of the next succeeding year), such other information relating to the year as may be prescribed and, without limiting the generality of the foregoing, such information may include a statement of profit and loss and a balance sheet in respect of its health insurance business as it relates to those persons receiving age-related tax credits.”.
Amendment agreed to.
I move amendment No. 31:
In page 16, to delete lines 47 to 48 and in page 17, to delete lines 1 to 3 and substitute the following:
"(2) (a) A statement of profit and loss or balance sheet shall, prior to its being furnished to the Authority pursuant to subsection (1), be certified by an independent accountant in such form as may be specified by the Authority.
(b) The Minister may prescribe the bases for the calculation of costs, premia and other relevant financial data that are to be included in a statement of profit and loss or balance sheet to be furnished to the Authority pursuant to subsection (1).”.
Amendment agreed to.
I move amendment No. 32:
In page 17, line 16, to delete "of the year concerned." and substitute the following:
"of the period from 1 January 2009 to the end of the year concerned.".
Amendment agreed to.
I move amendment No. 33:
In page 17, line 23, after "the" to insert "cumulative".
Amendment agreed to.
I move amendment No. 34:
In page 17, line 27, to delete "for the year" and substitute the following:
"for the period from 1 January 2009 to the end of the year".
Amendment agreed to.
I move amendment No. 35:
In page 17, line 29, after "the" to insert "cumulative".
Amendment agreed to.
I move amendment No. 36:
In page 17, line 33, before "net" to insert "cumulative".
Amendment agreed to.
I move amendment No. 37:
In page 17, line 35, to delete "year" and substitute "period".
Amendment agreed to.
I move amendment No. 38:
In page 17, line 38, to delete "year" and substitute "period".
Amendment agreed to.
I move amendment No. 39:
In page 17, line 41, to delete "year" and substitute "period".
Amendment agreed to.
I move amendment No. 40:
In page 17, to delete lines 47 to 53 and in page 18, to delete lines 1 to 5 and substitute the following:
"of a period, it shall make a further determination as to the monetary equivalent amount of the profit which is in excess of the corresponding monetary equivalent amount of such reasonable profit in respect of that period.".
Amendment agreed to.
I move amendment No. 41:
In page 18, to delete lines 6 to 36 and substitute the following:
"(7) Where, in respect of a period, the Authority has determined under subsection (5)(b) that the cumulative net financial impact of the relevant financial provisions on a registered undertaking or former registered undertaking was positive, and determined under subsection (6)(a) that the undertaking has made a profit which is in excess of the reasonable profit determined under subsection (4), it shall prepare a report (in this Part referred to as the ‘draft report’) setting out—
(a) the reasonable profit determined under subsection (4),
(b) the amount determined under subsection (5)(b) to be the positive cumulative net financial impact on the undertaking,
(c) the monetary equivalent amount determined under subsection (6)(b) to be the profit of the undertaking which is in excess of the corresponding monetary equivalent amount of such reasonable profit,
(d) the cumulative amount of overcompensation, being the lower of the amounts referred to in paragraphs (b) and (c),
(e) the amount of overcompensation to be paid to the Exchequer by the undertaking, being the cumulative amount of overcompensation referred to in paragraph (d) reduced by the total amount of overcompensation paid or due to be paid to the Exchequer pursuant to the operation of subsection (10) in respect of all the periods prior to the first-mentioned period, and
(f) the bases on which it made the determinations, and calculated the amounts, referred to in paragraphs (a) to (e).”.
Amendment agreed to.
I move amendment No. 42:
In page 19, line 4, after "days" to insert the following:
"(or, if applicable, the expiration of the longer period permitted pursuant to subparagraph (ii))".
Amendment agreed to.
I move amendment No. 43:
In page 19, line 25, to delete "paragraph (d)” and substitute “paragraph (e)”.
Amendment agreed to.
I move amendment No. 44:
In page 19, between lines 33 and 34, to insert the following:
"(12) Notwithstanding that the Authority may not, in respect of a particular year, or in respect of a particular registered undertaking or former registered undertaking, be required under subsection (8) to furnish a report to the Minister, the Minister may make a request in writing to the Authority to be furnished, within the period specified in the request (being a period reasonable in the circumstances), with such information relating to any determination it has made under subsection (5) or (6) in respect of a particular registered undertaking or former registered undertaking (including information relating to the basis on which such determination was made) as the Minister specifies in the request.
(13) The Authority shall comply with a request made under subsection (12) by the Minister.".
Amendment agreed to.
Amendment No. 45 arises from Committee Stage proceedings.
I move amendment No. 45:
In page 19, line 47, to delete "7F(8)(c).”.” and substitute the following:
"7F(8)(c).
7H.—Where a registered undertaking effects a health insurance contract on or after the commencement of section 9 of the Health Insurance (Miscellaneous Provisions) Act 2009 (including any renewal of such a contract entered into before that commencement), it shall, at the same time as effecting the contract, or as soon as is practicable thereafter, give—
(a) the policy holder, or
(b) the person to whom the registered undertaking issues the request for payment of the premium due under the health insurance contract, where that person is not the policy holder,
a statement in writing setting out—
(i) the premium payable under the contract in respect of each insured person before any deduction referred to in the definition of ‘net premium' in section 2 is made from the premium, and
(ii) the net premium under the contract in respect of each insured person.".".
The aim of this amendment is to ensure that information is given to consumers. Companies will inform them of the gross premium before the deduction of any tax credit.
As the Ceann Comhairle was reading out all those amendments I felt as though we were in a church and my response was "Amen".
I was going to say the Minister would make a good auctioneer.
I assure the Minister any sermon I would make would be far more interesting than that.
I agree with this amendment, which states that the insurer must provide information to the policy holder, with which I have no problem. I am surprised it was not in the Bill originally.
Amendment agreed to.
Amendment No. 47 is consequential on No. 46 and No. 48 is an alternative to No. 47. Nos. 46 to 48, inclusive, will be discussed together.
I move amendment No. 46:
In page 20, line 20, to delete "and".
I gave a commitment on Committee Stage to do this to provide for specific inclusion of information on open enrolment rights where a contract is subject to renewal. I am satisfied the proposed amendment achieves the wishes of the Deputies opposite who raised this.
Amendment agreed to.
I move amendment No. 47:
In page 20, line 24, to delete "contract." and substitute the following:
"contract, and
(d) without prejudice to the generality of paragraph (a), requiring registered undertakings to include a statement in their offers to renew health insurance contracts, or a class of such offers, as to the rights (including open enrolment rights), or a class of such rights, of the policy holders concerned in respect of the contracts.”.
Amendment agreed to.
Amendment No. 48 not moved.
I move amendment No. 49:
In page 20, to delete lines 25 to 49.
This amendment proposes to delete subsections (2) and (3) of section 11, which pertains to penalties, including the lines
(a) specifying the type of contract and the information, and
(b) requiring registered undertakings, the advertising of which relates (whether in whole or in part) to the contract, to ensure that the information accompanies the advertisements in the manner and form specified in the regulations.
(3) The Minister shall not make a regulation under this section unless the Minister is of the opinion that—
(a) the typical policy holder or potential policy holder of the type of health insurance contract concerned would need the information concerned in order to make an informed contract decision . . .
Amendment No. 50 proposes to delete the following two subsections, 11(4) and 11(5), which include the words "Nothing in this section shall be construed to preclude a regulation being made under this section which applies to all types of health insurance contract." I ask the Minister to respond by validating that.
I cannot accept these amendments as they would be contrary to the interests of consumers. Advertising can be misleading. If we deal with the last issue — making it clear that open enrolment is provided for — advertising could distort this in some way and mislead people. I cannot agree to the Deputy's amendments as they are not in the interest of good consumer law.
Is the Minister arguing that these sections confer additional protections for consumers?
Yes. We want to make sure consumers are not misled as to the nature of products being advertised.
All right. I have no problem with that — or with the first half, anyway.
Amendment, by leave, withdrawn.
Amendment No. 50 not moved.
Amendment No. 51 arises from Committee Stage proceedings.
I move amendment No. 51:
In page 24, line 31, to delete "7C, 7D" and substitute "7AC, 7D, 7E, 7F, 7G".
This is a technical amendment reflecting the additional functions conferred on the Health Insurance Authority following Committee and Report Stages.
Amendment agreed to.
Amendments Nos. 53 and 54 are technical alternatives to No. 54 and, therefore, Nos. 52 to 54, inclusive, may be discussed together.
I move amendment No. 52:
In page 33, to delete lines 16 to 42.
I seek the deletion of section 19 of the Bill, which amends section 112A of the Taxes Consolidation Act 1997. Amendments Nos. 53 and 54 are in conflict with this.
They are in the Minister's name.
Deputy Reilly's amendment has the effect of deleting one of the purposes of the Bill, so I clearly cannot accept it. Amendment No. 53 makes a necessary syntactical change to facilitate the insertion of new definitions into subsection (1) of section 112A of the Taxes Consolidation Act 1997, and inserts new definitions for "employee" and "employer" into subsection (1) of section 112A of the same Act.
Amendment No. 54 deletes the proposed amendments to subsections (2) and (3) of section 112A of the Taxes Consolidation Act 1997, as provided for in the Bill as initiated, and inserts a new subsection 2A into that section which ensures that where an employer pays a health insurance premium on behalf of an employee the employee is charged to income tax on the full value of the perquisite — i.e., the gross premium paid by the employer to the authorised insurer plus the age-related tax credit due in respect of the premium and the amount payable by the employer to the Revenue Commissioners in accordance with section 112A(3); that is, the standard-rated tax relief due on the premium.
The amendment also deletes the proposed amendment to subsection (3) of section 112A of the Act as provided for in the Bill as initiated. This refers to a charge to tax on employers that pay health insurance premiums on behalf of their employees, equal to the amount of the age-related tax credit due in respect of premiums paid, and is to deal with benefit-in-kind issues raised by the companies.
I am trying to understand what is happening here. The Bill amends the Taxes Consolidation Act 1997. As I understand it, we are talking about cases in which the employer is paying the health premium. It happens in many cases that a person's health insurance is paid for by his or her employer. We are talking about the tax associated with the levy to achieve risk equalisation.
Yes.
Will the Minister clarify who is paying the tax? Is it the employee or the employer?
Nothing changes here. At the moment, if one's employer pays one's health insurance, that is considered a benefit-in-kind and a tax is applied by the Revenue Commissioners. I have forgotten the amount, but one must pay a sum of money in lieu of that. It is the same if one has a company car or any other such benefits. What we are seeking to do in this legislation, as a result of representations from companies, is not to impose any further burdens on companies as a result of the tax credit or in terms of their corporation tax. It is to be factored out before they pay their corporation tax. In other words, they will not pay more taxes by virtue of the way in which we are shifting money from younger to older people. That is what these amendments seek to do. This also applies to companies' capital requirements. What we are doing in the legislation does not affect any of those things.
Will the Minister clarify that it will not impose an additional tax on employees?
That is correct, unless the Minister for Finance proposes to do so in a given year.
Under section 19, the proposed new subsection 1(a) of section 112A states:
In this section—
(a) as respects so much of a payment that qualifies for relief under section 470, ‘appropriate percentage’, ‘authorised insurer’, ‘relevant contract’ and ‘relievable amount’ have the same meanings, respectively, as in section 470,
The Minister has reassured Deputy O'Sullivan that nothing herein incurs an additional cost either to the employee or the employer. How can that be? Surely one or the other will face an additional charge. Is the Minister saying this will negate any additional payments from either the insured or the employer who is insuring him or her?
This purpose of the legislation is to transfer the sum that is given by way of a tax credit to the benefit of older people from younger people within the group of insured persons. How the insurance companies deal with this requirement is entirely a matter for themselves. In other words, it is a decision for individual companies as to whether health insurance premia will increase on foot of this. That is not what we are seeking to do in the legislation. It stipulates that the sum of money allowed by the Revenue Commissioners for health insurance will be redistributed as between older and younger people. Fundamentally, these measures are a case of transferring money. We had sought to attain our objective by way of risk equalisation but instead it is being done through a tax credit.
Question, "That the words proposed to be deleted stand", put and declared carried.
Amendment declared lost.
I move amendment No. 53:
In page 33, lines 27 and 28, to delete all words from and including "and" in line 27 down to and including "long-term" in line 28 and substitute the following:
"(c) ‘employee’ and ‘employer’ have the same meanings, respectively, as in section 983, and
(d) ‘qualifying insurer’ and ‘qualifying long-term”.
Amendment agreed to.
I move amendment No. 54:
In page 33, to delete lines 31 to 42 and substitute the following:
"(b) by inserting the following subsection after subsection (2):
"(2A) Where, for any relevant year of assessment, an employer makes a payment of emoluments to an employee consisting of a perquisite in the form of a payment to an authorised insurer under a relevant contract, and such payment qualifies for relief under section 470B for that relevant year of assessment, section 112 shall apply as if the perquisite were increased by the amount of the age-related tax credit or age-related tax credits, as the case may be, that the employee is entitled to under section 470B in respect of the payment.", and
(c) in subsection (3), by deleting “(within the meaning of section 983)”.”.
Amendment agreed to.
Amendments Nos. 55 to 57, inclusive, are related while amendments Nos. 58 to 67, inclusive, are technical alternatives to amendment No. 57. Therefore, amendments Nos. 55 to 67, inclusive, may be discussed together.
I move amendment No. 55:
In page 34, to delete lines 1 to 3.
This amendment proposes to delete section 20 which states:
Section 458 of the Act of 1997 is amended, in the Table to that section, in Part 2, by inserting "section 470B" before "section 472".
Amendment No. 56 proposes to delete section 21 which states:
Section 470 of the Act of 1997 is amended, in subsection (1), in the definition of "relievable amount"—
(a) in paragraph (a), by inserting “reduced by the amount of credit due (if any) under section 470B(4)” after “amount of the payment”, and
(b) in paragraph (b), by inserting “reduced by the amount of credit due (if any) under section 470B(4)” after “referable to such reimbursement or discharge”.
My party opposes the insurance levy because we are of the view that it has increased and will continue to increase the cost of insurance. It is pushing younger people out of the market, the very customers the Minister seeks to retain in order to pay for the insurance needs of the older generation. I will not get political about the current recession but there is no doubt that fewer people are now in a position to afford health insurance. This measure is the nail in the coffin for many families who have tried desperately to continue paying their premia. People are desperate to retain their insurance because they have lost faith in the public health service to deliver timely and efficient care. That lack of confidence arises from the manner in which the service has been managed, which is primarily a matter for the Minister.
I do not particularly support Deputy Reilly in objecting to the specifics of the legislation. However, the Bill essentially proposes an awkward measure to deal with risk equalisation. It is not what any of us would consider ideal, and we will have to wait some years before we have appropriate legislation.
The fundamental problem is that people are obliged to take out private health insurance because they do not trust the public health system. Many do so while disagreeing with the concept of the separation of private and public patients and the dual system which incorporates that concept. They feel obliged to seek private cover because they are fearful of the consequences of not doing so. That is not an acceptable system. This conglomerate arrangement is different from what pertains in every other civilised country. The Labour Party accepts this legislation because we consider it essential that there be a rebalancing between younger and older clients of health insurers in order to ensure that insurers receive some form of compensation to allow them to continue to provide a service to older people.
However, this does not mean we are in favour of the current system. This legislation is necessary in the circumstances in which we find ourselves, but we do not support the mixed arrangement whereby more than 50% of the population take out private health insurance because, as Deputy Reilly observed, they have no confidence in the public system. That is not the case in any other jurisdiction. I am sure the Minister agrees to some extent that the public health service is currently subsidising the private system. That is unacceptable. We must find an alternative system. I acknowledge that the Minister is setting up a group to examine this, but it will not report until some time next year. Both of the main Opposition parties have already put forward proposals for an alternative one-tier system that would involve people paying into a universal system of health insurance. As I said, my party supports this legislation because it is necessary, but we do not support the mixed health system in operation in the State.
We are about to have a philosophical debate. When the Progressive Democrats Party was formed many years ago, we advocated universal health insurance. However, we changed our minds after being presented with the prospective consequences by a group established to examine the issue. What Deputy O'Sullivan is proposing is compulsory universal insurance whereby some would pay the full commercial cost of health services while others would be entirely subsidised and still more would be somewhere in the middle.
I read an article in The Economist today which set out various models of health provision, including the Dutch model under which there have been rising prices and consolidation of insurers. The reality is that there is no perfect model. I do not mean to be critical of the Opposition proposals, although I would like to see them costed. When Professor Charles Normand, who is a member of the expert group we have established, put forward the universal proposal for the Adelaide Society, he estimated it would cost a minimum of €300 million per year for hospital cover alone. There will always be better-off people in society who will be willing to purchase more. There is no doubt about that. Even under a universal model such as that proposed by the Deputy, there will be people who wish to avail of extras in addition to the basic cover.
The State health insurer was established by the then Minister, Mr. Tom O'Higgins, because the better-off did not have universal access to hospitals. It was envisaged that 10% to 20% of the population would take out insurance and thus cover their own costs for hospital care. When universal cover was introduced in the early 1990s, we began to see the consequences of having this mishmash in hospitals where doctors receive a public salary as well as a top-up for insured patients. In any normal situation, economics play a part in all our lives. Those types of incentives inevitably cause unnecessary problems such as the case of the late Susie Long who was told in a hospital funded by the State, in which all the staff and services are paid for by taxpayers, that she could have a colonoscopy the following week if she had health insurance, otherwise she must wait. In her case, unfortunately, the consequences were fatal.
Under the new consultant contract, some 25% of consultants now work full-time in the public system. While I wish the figure was 100% and everyone would be seen on the basis of medical need, at least we have made a start. As I indicated, someone from a different party was critical that one cannot secure preferential access to a named consultant in County Louth because he no longer does private work. The consultant is obliged to see everybody because everyone has cover.
Deputy Reilly is trying to fillet the Bill. The purpose of the legislation is to make sure health insurance continues to be affordable. Regardless of what arguments one makes, companies have a way of defining products to attract members of a particular age group. For example, sports injury and maternity benefits are only attractive to younger people. Even active 80 year olds do not generally suffer from sports injuries and will certainly not find themselves in maternity hospitals. In the autumn, after the Bill has been passed, I hope to address the issue of minimum benefits. I am concerned that services such as rehabilitation, stroke care and so forth are being limited by the insurance companies. I do not want such circumstances to prevail.
Other people introduced risk equalisation, which is a principle I support. I tried to implement such a system but the legislation was struck down by the Supreme Court. The Bill marks a time-limited effort, over three years, to transfer from the young to the old and from the healthier to the sick by way of a tax credit skewed in favour of older people so as to make insurance more affordable for them and make older people more attractive to insurance companies.
A great deal of ingenuity and effort has been invested in this legislation by public servants, actuarial advisers and many others. Having discussed at length and with numerous people means of achieving our objective in the short term following the Supreme Court decision, I have concluded that this legislation is the only way to do so.
The purpose of Deputy Reilly's amendments is to fillet the Bill. If they were accepted, we would never be in a position to secure authorisation. We must implement our objective in this calendar year. This can only be done through the tax credit model and stamp duty on insurance companies. For this reason, I cannot accept the amendments.
The Minister referred to a philosophical discussion and I am certain we could have one. She also indicated the Bill was time-limited to three years. I note amendment No. 60 refers to "the year of assessment 2009, 2010 or 2011" and states "where a payment made to an authorised insurer is a monthly or other instalment towards the payment of the total annual premium due under a relevant contract, and the payment of such an instalment becomes due and is made in the year of assessment 2012".
That is an accounting issue. The provision is in respect of 2011. The legislation will not be applicable in 2012.
The House has been informed the legislation will only apply for three years. Deputies were also informed that the VHI would be authorised by 1 January and, thereafter, 1 March. The most recent date we have been given is 1 September. We have little faith in the ability of the Government to adhere to the initial timeframes it expresses, often with a view to bringing this side of the House with it.
The Fine Gael Party staunchly supports the VHI, a company that has served many people very well and has been an integral part of the health service since its establishment more than 50 years ago. We also fully support the concept of community rating. Let there be no confusion on that issue. The problems my party have are with the manner in which risk equalisation is being introduced, the extent of the levies and manner in which they have come about as well as the decision to take a soft option rather than addressing the substantive issue, namely, the requirement to establish proper support for community rating to allow the system to work as opposed to putting the issue on the long finger.
Other countries have managed to introduce community rating. The Minister referred to TheEconomist. She is also correct that no system is 100% perfect. A perfect system will not emerge anywhere but we can strive for a major improvement by examining the models in place in other countries where levels of equality are much greater.
The Minister referred to the late Susie Long. We still do not have equality, which is not a matter of precluding those who have done well in life from using their money to add comfort to their medical care but one of ensuring that everyone has access to basic standards of medical care with which everyone can be satisfied in terms of securing timely access to life-saving and life-altering treatments which make the difference between longevity and not achieving one's full potential. My amendments address the core of my disagreement with the Bill and I will stand over them.
None of us, including the Minister, regards the Bill as perfect. It is a stop-gap measure. Will it be possible to introduce the proper legislation sooner than the three years suggested? Perhaps we will have moved to a universal system into which everyone must pay within three years, although no one knows what lies ahead. No one likes the idea of transferring moneys from one company to another, in this case through a complicated system of levies and so forth. Having a central fund into which everyone pays a certain amount, depending on age mix and so forth, and from which companies with a larger proportion of older policyholders are paid, appears to be a preferable system.
That is correct. The model the Deputy describes is risk equalisation which proved to be a bone of contention. All companies or practices would find contentious a requirement to transfer money to a competitor. Under the model proposed in the Bill, moneys will be transferred by the State through the tax system. From that point of view, the proposed system is preferable to direct transfers.
One cannot have community rating while filleting the Bill to the extent Deputy Reilly seeks. While I do not doubt the Fine Gael Party supports the VHI, the Deputy must not understand what we are doing in this legislation — I do not mean to sound arrogant — as he would not otherwise have proposed the amendments before us. If accepted, his amendments would fillet the Bill and we would be unable to continue with a system of community rating.
The Bill will apply for three years. If, however, a person takes out a premium in mid-2011, it will run into 2012. The year 2012 is referred to for accounting purposes. The legislation will apply in 2009, 2010 and 2011, but 2012 is included because premiums taken out in 2011 will run into 2012 as they are normally taken out for one year and paid in monthly instalments. The inclusion of the year 2012 in the text of the amendment is to address issues that arise as a result.
I do not believe for one moment that risk equalisation will be in place in three years, even if the Government were to change in the morning. Even Deputy Reilly acknowledges it would not be in place until year five. At least the Labour Party, when it last proposed its model, put a price of €4 billion on it. I invite Deputy Reilly to have his proposal costed by the Department of Finance. It is comic politics to suggest everyone will secure access to free primary care and 2 million more people will gain access to insurance without incurring additional costs. I would do this in the morning if that were the case.
The health budget was only £5 billion when we made our proposal. It has increased significantly since that time.
Yes, it has increased to €16 billion, which amounts to 40% of all the tax we will raise this year. To explain some of the reasons health is so expensive in Ireland, TheEconomist article to which I referred notes that doctors are paid 3.7 times the average wage in the United States, 4.2 times the average wage in Britain but seven times the average wage in Ireland. We are all paid much more than our counterparts elsewhere which is the reason money does not go as far here as it does elsewhere.
That applies to the Minister too.
Yes, but I am not paid seven times more.
I wonder if the figure the Minister cited refers to general practitioners or consultants. In any event, it is a red herring. The main point is that the Minister maintains we cannot have a system of risk equalisation. Of course we can and it is available in other countries. The Minister is merely fiddling with the margins instead of addressing the real issue. We will take a Mickey Mouse approach for three years even though she does not believe it will be possible within that timeframe.
I referred to the possibility of introducing universal health insurance.
She used the words "risk equalisation".
I was responding to Deputy Jan O'Sullivan, who thought we might have universal health insurance.
If the Minister meant to say "universal health insurance", this can be achieved within a five year period and without additional costs. We are spending €5,000 annually on health for each man, woman and child in this country compared to €4,000 in Holland, which ranks first in terms of quality and second in terms of value for money. If it can be done in that country, it can be done here.
The Minister might not formerly have wished to do it and perhaps she has since changed her mind but she has had a long time to introduce change. The people made their judgment in the last local elections and they shiver when they look at our health services. They do not have confidence in her or the HSE to deliver. I do not have confidence in this Bill because, while I would like to accept its bona fides, I do not believe it is the correct way to achieve its stated objectives. Addressing the substantive issues will require a different type of legislation. What is the Department, the HSE and HIQA doing if they cannot address these issues once and for all instead of introducing interim measures which hurt people, increase the cost of insurance to young families and push people out of the market? I intend to press my amendment to a vote because it lies at the core of my disagreement with the Minister.
In regard to comparisons with the Dutch health care model, a visit to a general practitioner in the Netherlands costs €24.80 whereas it would cost €50 or more in this city. We should compare like with like. Hospitals and insurers have closed or consolidated with the result that prices have risen very rapidly. This is not a perfect world.
Yesterday I discussed health reform in the United States with a doctor and US Congressman who was here as part of a visiting delegation. These reforms aim to move away from procedure based medicine because of the rising costs involved. I have not met any health Minister in the developed world who is not concerned about costs. Equally, we have one of the best health care systems in the world, regardless of how often the Deputy rubbishes it. Significant advances have been made in cancer and cardiac care, infant mortality and life expectancy. We are not perfect but we are improving at a fast rate. That is nowhere more evident than in the area of cancer.
The scheme of risk equalisation was introduced by the former Ministers for Health, Deputies Howlin and Noonan. It was a good idea but, unfortunately, it has been litigated out of existence and was eventually struck down by the Supreme Court. It will take some time to go back to the drawing board and I do not doubt that we will again face litigation. In the meantime, older people will not be able to afford insurance.
That is a supposition.
Since I triggered risk equalisation in 2005, there has been nothing but litigation. That is a fact. I do not know how many times we have been in the courts but we have not been able to transfer payments. We are now addressing the matter by way of the tax system, which I believe is fair. This is a short term measure which has been approved by the EU as a justifiable state aid because it serves the needs of older and sicker people. I appeal to the Deputy not to press an amendment which effectively fillets the legislation.
Question put: "That the words proposed to be deleted stand."
The Dáil divided: Tá, 76; Níl, 46.
Tá
- Ahern, Michael.
- Ahern, Noel.
- Andrews, Chris.
- Ardagh, Seán.
- Aylward, Bobby.
- Behan, Joe.
- Blaney, Niall.
- Brady, Áine.
- Brady, Cyprian.
- Brady, Johnny.
- Browne, John.
- Byrne, Thomas.
- Calleary, Dara.
- Carey, Pat.
- Collins, Niall.
- Conlon, Margaret.
- Connick, Seán.
- Coughlan, Mary.
- Cregan, John.
- Cuffe, Ciarán.
- Cullen, Martin.
- Curran, John.
- Devins, Jimmy.
- Dooley, Timmy.
- Finneran, Michael.
- Fitzpatrick, Michael.
- Fleming, Seán.
- Flynn, Beverley.
- Gogarty, Paul.
- Grealish, Noel.
- Hanafin, Mary.
- Harney, Mary.
- Haughey, Seán.
- Healy-Rae, Jackie.
- Hoctor, Máire.
- Kelleher, Billy.
- Kelly, Peter.
- Kenneally, Brendan.
- Kennedy, Michael.
- Killeen, Tony.
- Kirk, Seamus.
- Kitt, Michael P.
- Kitt, Tom.
- Lenihan, Brian.
- Lenihan, Conor.
- Lowry, Michael.
- McEllistrim, Thomas.
- McGrath, Finian.
- McGrath, Mattie.
- McGrath, Michael.
- McGuinness, John.
- Moloney, John.
- Moynihan, Michael.
- Mulcahy, Michael.
- Nolan, M. J.
- Ó Cuív, Éamon.
- Ó Fearghaíl, Seán.
- O’Brien, Darragh.
- O’Connor, Charlie.
- O’Dea, Willie.
- O’Flynn, Noel.
- O’Hanlon, Rory.
- O’Keeffe, Batt.
- O’Keeffe, Edward.
- O’Rourke, Mary.
- O’Sullivan, Christy.
- Power, Peter.
- Power, Seán.
- Roche, Dick.
- Ryan, Eamon.
- Sargent, Trevor.
- Scanlon, Eamon.
- Treacy, Noel.
- Wallace, Mary.
- White, Mary Alexandra.
- Woods, Michael.
Níl
- Allen, Bernard.
- Bannon, James.
- Barrett, Seán.
- Breen, Pat.
- Bruton, Richard.
- Burke, Ulick.
- Byrne, Catherine.
- Carey, Joe.
- Clune, Deirdre.
- Connaughton, Paul.
- Coonan, Noel J.
- Coveney, Simon.
- Crawford, Seymour.
- Deasy, John.
- Deenihan, Jimmy.
- Doyle, Andrew.
- Durkan, Bernard J.
- English, Damien.
- Enright, Olwyn.
- Feighan, Frank.
- Flanagan, Charles.
- Flanagan, Terence.
- Hayes, Tom.
- Hogan, Phil.
- Kehoe, Paul.
- Lee, George.
- McCormack, Pádraic.
- McEntee, Shane.
- McGinley, Dinny.
- McHugh, Joe.
- Mitchell, Olivia.
- Naughten, Denis.
- Neville, Dan.
- Noonan, Michael.
- O’Donnell, Kieran.
- O’Dowd, Fergus.
- O’Keeffe, Jim.
- O’Mahony, John.
- Perry, John.
- Reilly, James.
- Ring, Michael.
- Shatter, Alan.
- Sheahan, Tom.
- Sheehan, P. J.
- Stanton, David.
- Timmins, Billy.
Tellers: Tá, Deputies Pat Carey and John Cregan; Níl, Deputies Paul Kehoe and David Stanton.
Question declared carried.
Amendment declared lost.
I am now required to put the following question in accordance with an Order of the Dáil of this day: "That the amendments set down by the Minister for Health and Children and not disposed of are hereby made to the Bill; Fourth Stage is hereby completed; and the Bill is hereby passed."
Question put.
The Dáil divided: Tá, 89; Níl, 47.
Tá
- Ahern, Dermot.
- Ahern, Michael.
- Ahern, Noel.
- Andrews, Chris.
- Ardagh, Seán.
- Aylward, Bobby.
- Behan, Joe.
- Blaney, Niall.
- Brady, Cyprian.
- Brady, Johnny.
- Browne, John.
- Burton, Joan.
- Byrne, Thomas.
- Calleary, Dara.
- Carey, Pat.
- Collins, Niall.
- Conlon, Margaret.
- Connick, Seán.
- Coughlan, Mary.
- Cregan, John.
- Cuffe, Ciarán.
- Cullen, Martin.
- Curran, John.
- Devins, Jimmy.
- Dooley, Timmy.
- Ferris, Martin.
- Finneran, Michael.
- Fitzpatrick, Michael.
- Fleming, Seán.
- Flynn, Beverley.
- Gogarty, Paul.
- Grealish, Noel.
- Hanafin, Mary.
- Harney, Mary.
- Haughey, Seán.
- Healy-Rae, Jackie.
- Hoctor, Máire.
- Howlin, Brendan.
- Kelleher, Billy.
- Kelly, Peter.
- Kenneally, Brendan.
- Kennedy, Michael.
- Killeen, Tony.
- Kirk, Seamus.
- Kitt, Michael P.
- Kitt, Tom.
- Lenihan, Brian.
- Lenihan, Conor.
- Lowry, Michael.
- Lynch, Ciarán.
- McEllistrim, Thomas.
- McGrath, Finian.
- McGrath, Mattie.
- McGrath, Michael.
- McGuinness, John.
- Mansergh, Martin.
- Moloney, John.
- Morgan, Arthur.
- Moynihan, Michael.
- Mulcahy, Michael.
- Nolan, M. J.
- Ó Caoláin, Caoimhghín.
- Ó Cuív, Éamon.
- Ó Fearghaíl, Seán.
- O’Brien, Darragh.
- O’Connor, Charlie.
- O’Dea, Willie.
- O’Flynn, Noel.
- O’Hanlon, Rory.
- O’Keeffe, Batt.
- O’Keeffe, Edward.
- O’Rourke, Mary.
- O’Sullivan, Christy.
- O’Sullivan, Jan.
- Penrose, Willie.
- Power, Peter.
- Power, Seán.
- Roche, Dick.
- Ryan, Eamon.
- Sargent, Trevor.
- Scanlon, Eamon.
- Stagg, Emmet.
- Treacy, Noel.
- Tuffy, Joanna.
- Upton, Mary.
- Wall, Jack.
- Wallace, Mary.
- White, Mary Alexandra.
- Woods, Michael.
Níl
- Allen, Bernard.
- Bannon, James.
- Barrett, Seán.
- Breen, Pat.
- Bruton, Richard.
- Burke, Ulick.
- Byrne, Catherine.
- Carey, Joe.
- Clune, Deirdre.
- Connaughton, Paul.
- Coonan, Noel J.
- Coveney, Simon.
- Crawford, Seymour.
- Creed, Michael.
- Deasy, John.
- Deenihan, Jimmy.
- Doyle, Andrew.
- Durkan, Bernard J.
- English, Damien.
- Enright, Olwyn.
- Feighan, Frank.
- Flanagan, Charles.
- Flanagan, Terence.
- Hayes, Tom.
- Hogan, Phil.
- Kehoe, Paul.
- Lee, George.
- McCormack, Pádraic.
- McEntee, Shane.
- McGinley, Dinny.
- McHugh, Joe.
- Mitchell, Olivia.
- Naughten, Denis.
- Neville, Dan.
- Noonan, Michael.
- O’Donnell, Kieran.
- O’Dowd, Fergus.
- O’Keeffe, Jim.
- O’Mahony, John.
- Perry, John.
- Reilly, James.
- Ring, Michael.
- Shatter, Alan.
- Sheahan, Tom.
- Sheehan, P. J.
- Stanton, David.
- Timmins, Billy.
Tellers: Tá, Deputies Pat Carey and John Cregan; Níl, Deputies Paul Kehoe and David Stanton.
Question declared carried.