Amendment No. 1 in the names of Deputies Ó Caoláin and Kelleher proposes to delete section 1. Section 1 sets out the principle embodied in the Bill, that is, the introduction of a lower income threshold for medical cards for persons aged 70 years and over. The amendment is, therefore, in conflict with the principle of the Bill, as read a Second Time, and is ruled out of order in accordance with Standing Order 131.
Health (Alteration of Criteria for Eligibility) (No. 2) Bill 2013: Report Stage
Is it possible to comment at all?
I am not presented with the opportunity to receive comments and therefore I am afraid I must rule "No".
That is regrettable.
It is with regret that I must state that decision.
Amendment No. 1 not moved.
I move amendment No. 2:
In page 4, to delete lines 6 to 37, and in page 5, to delete line 1 and substitute the following:
“(b) by the substitution of the following for subsection (3):
“(3) The gross income limits for the purposes of this section and section 45(5A) are the following:
(a) in respect of the period commencing on 1 January 2009 and ending on 4 April 2013—
(i) if a person—
(I) is not married,
(II) is not living together with another person as husband and wife, and
(III) does not have a civil partner,
his or her gross income limit is €700 per week, not including the income from the portion of the person’s savings or similar investments whose capital value does not exceed €36,000, and
(ii) if persons—
(I) are married,
(II) live together as husband and wife, or
(III) are civil partners as respects each other,
their combined gross income limit is €1,400 per week, not including the income from the portion of their savings or similar investments whose capital value does not exceed €72,000,
(b) in respect of the period commencing on 5 April 2013 and ending on 31 December 2013—
(i) if a person—
(I) is not married,
(II) is not living together with another person as husband and wife, and
(III) does not have a civil partner,
his or her gross income limit is €600 per week, not including the income from the portion of the person’s savings or similar investments whose capital value does not exceed €36,000, and
(ii) if persons—
(I) are married,
(II) live together as husband and wife, or
(III) are civil partners as respects each other,
their combined gross income limit is €1,200 per week, not including the income from the portion of their savings or similar investments whose capital value does not exceed €72,000, and
(c) with effect from 1 January 2014—
(i) if a person—
(I) is not married,
(II) is not living together with another person as husband and wife, and
(III) does not have a civil partner,
his or her gross income limit is €500 per week, not including the income from the portion of the person’s savings or similar investments whose capital value does not exceed €36,000, and
(ii) if persons—
(I) are married,
(II) live together as husband and wife, or
(III) are civil partners as respects each other,
their combined gross income limit is €900 per week, not including the income from the portion of their savings or similar investments whose capital value does not exceed €72,000.”.”.
I wish to raise a point of order in respect of the sections of the Bill. Are the sections taken in the course of Report Stage, section by section?
We will go through the amendments as presented here in the Order Paper and that is what I am doing.
Is it the case that Members do not individually take each of the sections, as they do on Committee Stage? In other words, do they decide whether the section is agreed?
As this is new territory for the Chair, I seek guidance from the officials present. I am advised officially that Members only take and decide on the amendments and that is what I will do.
I apologise to the Minister of State.
No, we all learned something. The Minister of State may proceed.
No apologies arise.
I propose this technical amendment No. 2 to improve the construction of the existing text to address a possible ambiguity in the description of a single person as it appears in the Bill and under section 45A(3). In order to make the technical amendment to correct a conjunction in section 45A(3) in a clear and understandable manner, it is proposed to substitute the entirety of subsection 3(a) to (c) in the Bill. Under over-70s medical card legislation, a single person is a person who, first, is not married, second, is not living with another person as man and wife and, third, does not have a civil partner. Under the existing section 45A(3), as amended, and in the current Bill, a single person is identified to qualify for the single person's relevant income limit as a person who:
(I) is not married, and is not living together with another person as husband and wife, or
(II) does not have a civil partner
A possible ambiguity was identified in the description of a single person with regard to the use of the word "or" between subclauses (I) and (II) of the single person subparagraph, where it appears. To address any possible lack of clarity, the Attorney General has recommended that the "or" should be changed to an "and". This is purely a technical amendment. To avoid the conjunction "and" being repeated twice in subparagraph (i), the subparagraph is being divided into three separate clauses in order that the conjunction "and" is used only once. Consequently, the revised text will now read:
(i) if a person—
(I) is not married,
(II) is not living together with another person as husband and wife, and
(III) does not have a civil partner
To help in understanding the new text, it is useful to read it as meaning that a single person is a person who is neither married nor living with someone as man and wife nor having a civil partner. Therefore, subparagraphs (a)(i), (b)(i) and (c)(i) of section 45A(3) of the Health Act 1970 are so amended. As a similar formulation of words is used to describe a couple a number of times in subsection 45A(3), it is necessary to mirror the same changes to "a couple" in subparagraphs (a)(ii), (b)(ii) and (c)(ii) of section 45A(3). The Attorney General has confirmed that the proposed amendment is purely technical in nature and since these are purely drafting amendments, I recommend their acceptance to the House.
I thank the Minister of State for his eloquent explanation as to the reason this is only a technical amendment. However, it is amending the substance of the Bill itself, which is to change the income guidelines and the eligibility criteria. While the amendment itself is technical, the section under discussion is the one which effectively legislates for a U-turn of huge proportions. It is a U-turn in the context of elderly people who will lose their entitlement to a medical card. I have made this point publicly and in the committee rooms on Committee Stage. My party has raised this point here in the Chamber numerous times and the Minister of State still has not given me a satisfactory answer. If it was bad for people's health a number of years ago to have income guidelines placed on them of €1,400 per week, why is it not bad for them now at €900 per week? I really must understand this. Previously, the parties in government had stated that in the case of any people over 70 who lost their medical cards, it could have a detrimental impact on their ability to access health care. However, the Minister of State now tells me it is not as bad as the Government parties then thought and, in fact, €900 per week for a couple is quite adequate and sufficient and this will only affect a small cohort. However, this measure will affect one in ten of those concerned, that is, 35,000 people. Consequently, from the time of the enactment of this Bill, 35,000 people will find they no longer will be eligible for medical cards because of the reduction in the eligibility criteria.
Moreover, not having a medical card will have a profound impact on their ability to access medical care and I will tell the Minister of State the reason this is the case. He may tell me this measure is not that bad, because such people will have a GP-visit card and while this is the case, when they are obliged to go to hospital and do not have private health insurance - because they cannot afford that any longer as a result of the Government's policies - they will be obliged to pay for hospital care. This is because the Government has increased hospital charges to €80 up to a maximum of ten days, which comes to €800 in a year. On top of that, the Government also has decided to increase prescription charges. The reason I highlight all these matters is that consistency is a word that is much maligned in this Chamber. However, there is no consistency in respect of what the Government has proposed, even in the context of the programme for Government.
Brian Lenihan senior's great phrase was "the futility of consistency". I beg the Deputy's pardon.
No, it is fine and the Minister, Deputy Rabbitte, is always welcome to contribute to a debate. While he contributes to many debates, on the health area being debated this evening, it really is about the consistency of Government policy. This amendment drives a coach and four through that because even in the programme for Government, the signatories did not state it was their intended policy to remove or to reduce the eligibility criteria for the over-70s. For this reason, I believe this amendment is simply unacceptable given what is stated in Government policy and what actually is happening on the floor of Dáil Éireann.
This is coupled with another issue that happened only one month ago, when the Minister for Finance told the House he was capping tax relief on private health insurance to €1,000 per adult and €500 per child. He stated that such insurance policies were gold-plated but by any credible stretch of the imagination, any preliminary perusal of the figures the Minister set out, involving €127 million in a full year, would belie that assertion. It simply will have an impact on the average two-plus-two private health insurance policy. It will cause an increase; the VHI has stated that most of their policies will increase in price because of it, as have most of the other health insurers.
That is a different Bill.
It is, but the people who will be affected by this Bill will encounter another difficulty because, having lost their medical cards, they then will incur further costs to cover their health care and by so doing, will lose their private health insurance. That demographic is the one that has the highest proportion of private health insurance extant and for this reason, I believe this legislation is flawed in many ways.
The primary point I make, however, is the point made at the time by the Labour Party and Fine Gael, as did many others, which is that changing eligibility criteria - or introducing them at all - would have a profound, negative impact on people's health and lives. When my party in government introduced a limit of €1,400, we were told that people would die. The limit now is being reduced to €900 for a couple and by any stretch of imagination, this constitutes a massive reduction within a few years. Consequently, there is no point in pretending this is anything other than what it is, namely, a transfer of medical card cover from those who are over 70 to those who are aged five and under. This is because the Government's budget for primary care has not increased. Had the Minister of State come into the Chamber and stated that, while this measure was being brought in, the Government also had increased the overall primary care budget to make available funding for those aged five and under, one then could logically argue there had been no impact from one to the other. However, as matters stand and there is no other way of dressing it up, this is a direct transfer between those who will lose cards on foot of this measure because of the change in income eligibility to those who are five and under.
The Minister of State keeps asking me what is Fianna Fáil's view on this issue. It always has been that one does not take from the most vulnerable and the most sick and then transfer those funds elsewhere. The Government should at least be honest and open in that regard, which is that it has made a policy decision regarding cover for the under-fives but that it is being funded by the retrenchment of entitlement to those who are 70 and over and more broadly, in respect of discretionary medical cards.
If the Minister of State can convince me otherwise, perhaps we can have a more informed debate some other day on that issue. We will oppose this amendment not because it is a technical amendment, but because it is an amendment to the section of the Bill which reduces the eligibility criteria for a couple from the previous ceiling down to €900. If it was bad at a cap of €72,000, then surely it is worse at what will now be a cap of €36,000 for an individual or €54,000 for a couple. For those reasons we will oppose the amendment. The amendment may be a technical one in the mind of the Minister of State, but it is fundamental in my mind.
I did not have the opportunity to either address the first amendment in my name and that of Deputy Kelleher, or indeed, the specific section to which that amendment referred. The Minister of State's amendment is an opportunity for us to make it crystal clear to him and to his colleagues in the Department of Health that the so-called Health (Alteration of Criteria for Eligibility) (No. 2) Bill 2013 is an absolutely scandalous piece of legislation that will have very serious consequences for many people aged 70 years and older. There is a mistaken notion that people at 70 and over are no longer in working life but many of them are. Fortunately, due to advances in lifestyles, medication and health care supports, people are living longer and they are leading active and employed lives into later years.
People aged over 70 are being doubly discriminated against, and not only by virtue of the ever-decreasing thresholds for qualification that the Government has introduced since taking office in 2011. It very particularly targeted couples in this instance by changing the equilibrium of qualification between the single person and a couple, but it is also penalising them because the calculation is based on the gross rather than the net income. This does not take into account the fact that there will be those aged 70 and over who still have mortgage repayments, who still incur costs for travelling to work. Once they have crossed the threshold from 69 to 70, they lose the entitlement to have those matters taken into account in determining their net income. It is a very serious matter.
I wonder what level of pre-calculation was employed in determining the numbers who would, as a consequence of this legislation, lose the full medical card. The figure of 35,000 is cited. I wonder what exercise has been carried out in determining the impact of those who are marginally over the €500 and because this is gross income, the real figure in comparable terms with those under 70 means the threshold for them is even less in real terms in comparison to those of younger years.
The €500 gross threshold for qualification for those aged 70 and over is punitive and it will lead to significant difficulties for people at that point in their lives. In the case of couples, the Minister of State has not even seen his way to maintain the equilibrium between a single person and two people together, that is, double the single qualification figure. Instead, it has been reduced by €300 for a couple in the budget 2014 statement of intent.
The legislation will hurt many people. It is no compensation to them that they will have a GP-only card. There is no compensation for them under the drugs refund scheme. They will be penalised up to €144 per month in terms of their medication needs, if indeed that is the level of expenditure in the provision of their medication needs. There is much more besides. All of the other areas such as hospital access and various other services come with the possession of a full medical card.
Technical though the Minister of State may argue this amendment is, this is at the core of the legislation and he is providing us with another opportunity to make it crystal clear that this is an outrageous proposition and one that will have untold consequences for many citizens who are incredulous that he has targeted older people not only in regard to the medical card, but he has also penalised them across a range of other areas, including the telephone allowance, and other examples in the package of measures introduced in budget 2014. I am never surprised at some of the measures that Fine Gael would bring forward but I am doubly incredulous that the Labour Party is an integral part of bringing forward and defending what is the indefensible.
As I said on Committee Stage, I was happy to record welcoming the introduction of the GP-only card for all children aged five years and under, as part of the programme of the roll-out of free GP care for all citizens, universal access to GP care. It is not free but it is free at the point of delivery. However, all the good intent this should have signalled has been completely erased by the targeting of €149 million so-called savings from the medical card fund and yet only €37 million is set aside for the roll-out of free GP care for children. It is a case of giving with one hand in such a small way and with no certainty as to the intent over the next 12 months and beyond to continue that roll-out and yet taking such a wallop back. It is inexcusable. As Deputy Kelleher has indicated his intent, I most certainly will be opposing not only this amendment, but the passage of this piece of very objectionable legislation.
Whereas I could understand - although for reasons that will be clear - I would not agree with the Deputies in their opposition to the Bill and to the sections of it. I am at a complete loss to understand why they would oppose this amendment because it is manifestly a technical amendment which simply makes clearer the definition of a single person. It has no material effect - I invite the Deputies to read it. This amendment was not moved on Committee Stage although it arose from Committee Stage proceedings. It is simply a technical amendment. I am not suggesting that section 2 of the Bill is merely technical. I never stood up to suggest, and nor would I, that what is in the Bill - the change in eligibility - is simply technical. With respect to my colleagues opposite, I cannot for the life of me see how I could be contradicted that this amendment simply sets out in clearer terms a definition of a single person.
The Deputies have not asked me to deal with that matter further so I will not do so but I will comment briefly on the issues that have been raised by them.
Deputy Kelleher called for consistency but he only calls for consistency on this side of the House. He never calls for or observes consistency on his side of the House because if he was doing that there would be a long list of problems he would have to contend with and a long list of decisions the Government of which he was a member made which would render a nonsense his criticism of this Government. For example, we know what the intention of the Fianna Fáil-led Government was in terms of medical cards for those over 70. We know its proposals did not even propose replacement with access to general practitioners without fees for those over 70. It was a blanket move from which it had to pull back and even when it set the eligibility rates, those who were excluded in that decision of the previous Government were not awarded GP cards. I repeat that no one who loses access to the full medical card in these measures, or in last year's measures, will be left without free access to their GP. They will all have an automatic replacement of the full medical card with a GP card.
I agree with colleagues. I have not tried to make light of these proposals. I have never taken a cavalier attitude to the extent that these are minimal changes, that they are meaningless or that they do not affect people. They do affect people, and it is regrettable that these adjustments have to be made but they only affect 10% of the holders of over 70s medical cards. There is a replacement with a GP card, as I mentioned. On Second Stage a Deputy on the opposite side of the House who is not present said that the sole income of approximately 80% of those over 70 was the old age pension. If that is the case, it should be pointed out that the new limit of €500 is over double the State pension. I do not make light of the fact that some people will lose access to the full medical card, which will be replaced by the GP card, but 93% of all over 70s in the State will still be covered for free access to their GP, and something of the order of 85% will maintain and continue to have a full medical card. Following the implementation of this budget measure only 7% of over 70s, those with the highest incomes - the better off over 70s, and I know "better off" is a relative term - will not qualify for either a medical card or a GP card.
Deputy Ó Caoláin raised on Committee Stage the issue of gross income versus net income but as I pointed out on the previous occasion, a person over 70 can still opt to be assessed under the net income system. A person over 70 is not confined to applying under the gross income system but may opt to be assessed under the net income system. They still have that available to them. However, it has been the experience, and it is clear, that huge numbers of over 70s qualify and the gross income assessment seems to suit the circumstances of the vast majority of people who are over 70.
We dealt with the issue of double the cost and the €500 and €900 on Committee Stage where I said that it is the case that living costs for two people living together are not always double the cost of one person living alone, and I gave examples on Committee Stage of other areas of public policy that do the same.
I respectfully disagree with Deputy Ó Caoláin when he says that in respect of the 10% of persons who will lose their full medical card, it is no compensation for them to have a GP-visit card. I cannot accept that. It will come as a considerable relief to many of those people, even if they would prefer to maintain the full cover, and they have access to the drugs payment scheme, which gives considerable comfort also.
The Minister believes this is just a technical amendment. We stated at the outset that we accept it is a technical amendment but it is a technical amendment to the fundamental part of the Bill. That is the reason we are opposing it, and we have no other way of opposing it. I have said already that this is legislating for a U-turn of massive proportions and I need to find a mechanism with which to oppose the section that reduces eligibility for people over 70. Technical or not, it is a fundamental part of this Bill.
I cannot accept the Minister's explanation that it affects only one in ten people over 70. One in ten is a substantial number of people. UB40 had a song in the 1980s, "One in Ten", which was an iconic song for many young people who were unemployed at that time. One in ten persons over 70 are back to a situation where they will now lose their medical card and as I said previously, to be consistent on that side of the House-----
It is not ten and ten as it was in the Deputy's proposal.
-----what the Minister said prior to 2011 and in the programme for Government in 2011 is at complete variance with this Bill. That is why I have to oppose the technical amendment the Minister has placed before me because it is amending the fundamental Part of this Bill, which is to deny another 35,000 people medical cards.
I remind the Minister that the Title of this Bill is the Health (Alteration of Criteria for Eligibility) (No. 2) Bill 2013. This is not the first time the Minister has done this in this year of 2013. Does he have any idea as to how older citizens feel about this measure? This is the second time in this 12 month period the Minister has targeted the medical card entitlement of over 70s members of our communities. They were rocked by what the Minister did earlier this year and they are incredulous that he has repeated the dose, and even made it worse in terms of those who are a couple, by whatever definition in today's terms.
I know from people I have spoken with that there is huge concern about this measure. People at that particular point in their lives feel absolutely helpless. They are being continuously targeted and as I said to the Minister on Committee Stage, I would not take any comfort from the mobilisation we witnessed when Fianna Fáil first sought to introduce thresholds to what was previously a universal entitlement for over 70s, and the massive response from the older population and many others who understood and supported them. The fact that that has not been replicated in anything like the same numbers should be no comfort to this Government because that anger is palpable, real and undoubtedly will manifest itself as they decide best.
It is unacceptable that the Minister would think we are only opposing a technicality regarding the definition of single people in the Bill. The Minister should think for a moment how he would react to what is being presented to us if he sat on this side of the Chamber. The Minister's amendment is a reaffirmation of all that is wrong with this Bill at its core.
To repeat, I completely understand the Deputies' problems with this Bill but I cannot understand their problems with my amendment, which is entirely technical because it has to do with how a single person is defined.
It makes no mention of the €500 and the €900.
Amendment put:
The Dáil divided: Tá, 67; Níl, 30.
Tá
- Bruton, Richard.
- Burton, Joan.
- Butler, Ray.
- Buttimer, Jerry.
- Byrne, Catherine.
- Byrne, Eric.
- Cannon, Ciarán.
- Carey, Joe.
- Coffey, Paudie.
- Conlan, Seán.
- Connaughton, Paul J.
- Coveney, Simon.
- Creed, Michael.
- Daly, Jim.
- Deasy, John.
- Deering, Pat.
- Doherty, Regina.
- Donohoe, Paschal.
- Doyle, Andrew.
- English, Damien.
- Farrell, Alan.
- Ferris, Anne.
- Fitzpatrick, Peter.
- Hannigan, Dominic.
- Harrington, Noel.
- Harris, Simon.
- Hayes, Tom.
- Heydon, Martin.
- Keating, Derek.
- Kehoe, Paul.
- Kenny, Seán.
- Kyne, Seán.
- Lynch, Ciarán.
- Lynch, Kathleen.
- Lyons, John.
- McCarthy, Michael.
- McEntee, Helen.
- McGinley, Dinny.
- McHugh, Joe.
- McLoughlin, Tony.
- McNamara, Michael.
- Mitchell, Olivia.
- Mitchell O'Connor, Mary.
- Murphy, Dara.
- Murphy, Eoghan.
- Nash, Gerald.
- Neville, Dan.
- Nolan, Derek.
- Ó Ríordáin, Aodhán.
- O'Donnell, Kieran.
- O'Donovan, Patrick.
- O'Dowd, Fergus.
- O'Mahony, John.
- O'Reilly, Joe.
- Phelan, Ann.
- Phelan, John Paul.
- Rabbitte, Pat.
- Reilly, James.
- Ryan, Brendan.
- Spring, Arthur.
- Stagg, Emmet.
- Stanton, David.
- Tuffy, Joanna.
- Varadkar, Leo.
- Wall, Jack.
- Walsh, Brian.
- White, Alex.
Níl
- Boyd Barrett, Richard.
- Broughan, Thomas P.
- Browne, John.
- Collins, Joan.
- Cowen, Barry.
- Doherty, Pearse.
- Donnelly, Stephen S.
- Dooley, Timmy.
- Ellis, Dessie.
- Ferris, Martin.
- Fleming, Sean.
- Healy, Seamus.
- Higgins, Joe.
- Kelleher, Billy.
- Kirk, Seamus.
- McConalogue, Charlie.
- McDonald, Mary Lou.
- McGrath, Mattie.
- McGrath, Michael.
- McGuinness, John.
- Mathews, Peter.
- Murphy, Catherine.
- Naughten, Denis.
- Nulty, Patrick.
- Ó Caoláin, Caoimhghín.
- Ó Fearghaíl, Seán.
- Ó Snodaigh, Aengus.
- O'Brien, Jonathan.
- Shortall, Róisín.
- Smith, Brendan.
Tellers: Tá, Deputies Emmet Stagg and Paul Kehoe; Níl, Deputies Aengus Ó Snodaigh and Seán Ó Fearghaíl.
Amendment declared carried.
Amendments Nos. 3 and 4 have been ruled out of order.
Amendments Nos. 3 and 4 not moved.
When is it proposed to take Fifth Stage?
Now.
Is that agreed?
It is not agreed. Can we comment on it?
No. I will just put the question.
Would you like to hear our reasons?
There is really no need.
We are opposing the Bill simply because-----
Deputies are not being asked whether they oppose the Bill. They are being asked if they agree to move on to Fifth Stage.
We are opposing Fifth Stage.
The Deputy should wait until the House is asked to consider the question, "That the Bill do now pass".
Deputy Kelleher has overshot the runway.
We are opposing Fifth Stage because we want to-----
If the Deputy agrees to move on to Fifth Stage, he will then be able to speak on the Bill and express his opposition to it. Is that okay? I am only trying to be helpful.
As always.
Bill, as amended, received for final consideration.