Health (Alteration of Criteria for Eligibility) (No. 2) Bill 2013: Fifth Stage

Question proposed: "That the Bill do now pass."

The reason we are opposing this Bill is quite simple. In effect, the Government is legislating for a U-turn of massive proportions. This Bill is simply about reducing the income eligibility criteria that apply to over 70s. It is about taking medical cards from another 35,000 people. A key question must be asked in this context. If it was bad a number of years ago for a couple over the age of 70 to be ineligible if they had an income of €1,400, why are we now being told that it is good to set the threshold that applies to a couple at €900?

The Deputy's party tried to take it off the whole lot of them.

The Deputy voted against €1,400 a few years ago.

It is simply incredible that Government Deputies can come in here and vote this Bill through. The words that should ring in their ears are "shame on you".

Does the Deputy remember what happened the former Minister of State, John Moloney, in the church?

I wish to remind Deputies of the reaction of the current Minister, Deputy Reilly, when he was an Opposition spokesperson, to Fianna Fáil's proposal to apply a threshold to the previously universal entitlement of the over 70s to a medical card.

I remind the Deputy that it was Fianna Fáil which had initially provided for such an entitlement.

Deputy Reilly, in his capacity as Fine Gael's spokesperson on health, rightly described what Fianna Fáil was doing as a "vicious attack". He suggested in the strongest terms that the proposal to introduce thresholds represented a "savage assault on the elderly". Since they took office, the Minister for Health and his Ministers of State have legislated for two reductions in the qualification threshold for a full over 70s medical card. Both of those reductions have been introduced this year. The Bill before the House is the Health (Alteration of Criteria for Eligibility) (No. 2) Bill 2013. This is the second time this has been done to over 70s in this calendar year. Single people over the age of 70 who live alone will have their qualification threshold for a full medical card reduced to €500. The threshold that applies to couples and people living together in various relationships will be reduced by €300 from €1,200 to €900. The consequences of this decision of the Minister and of the Government, made as part of budget 2014, will be very serious indeed. Members of all opinion on all sides of the House cannot be unaware of the impact of this measure on people in their communities and constituencies. It will have serious consequences. It is causing untold upset and worry. Even at this 11th hour, this Bill should be withdrawn.

I assume the Deputy will inform the Chamber that they will have free GP care.

Not if they are sick.

There should be no mistake about what free GP care will entail for them. They will have to meet the cost of their medications, up to the limit of €144 per month. What about all the other services that the full medical card covers? I remind the Minister that not everyone over the age of 70 is in comfortable retirement.

We are talking about €900.

As a result of various advances, many people are working to a later age. I am sure many people in this Chamber aspire to continue to work beyond the age of 70. Many people who have depended on medical cards will take a significant hit as a result of this measure, which will have a serious impact on their daily life conditions. It is fundamentally wrong. I agree with what the Minister, Deputy Reilly, has already said on the floor of this House. That is why it is all the more reprehensible that, having already targeted the most vulnerable among our senior citizens, he is now doing so for a second time in this calendar year. It is fundamentally wrong. This House should not approve this Bill. I absolutely oppose its passage.

Like many others, I have tried to raise this issue with the Taoiseach on Leaders' Questions and in other forums in recent months. The Minister, Deputy Reilly, and his colleagues know that what is happening is a complete shambles. I contacted the office twice today. I am holding a copy of the HSE's medical card criteria. I spoke to two senior officials today. A man from County Limerick whom I happen to know contacted my office. He is over the age of 70 and has significant medical problems. His application for an over 70s medical card has been refused because his income exceeds the threshold by €25. He has been informed that if he wants his medical circumstances to be taken into account, he must submit an under 70s application form. How can he do that when he is over the age of 70? This is a fact. He has been told to submit a fraudulent application, but he will not do so. He cannot change his date of birth. This is where it has gone.

If he wants to qualify for the over-70 scheme, it is assessed under the income of €298 per couple. He has to supply misinformation. This is farcical. I heard that poor gentleman speak on the radio about his terminally ill wife. Do we have any humanity left in us? Do the Members opposite have any humanity left in them? They were well able to shout with the over-70s; we remember the lorry outside here some years ago. They had to take away the ladder because so many of them were trying to get up on it. They pulled the ladder from under them. Government Members when they got into power pulled up the ladder from the people and are trying to stand on them.

It is disgraceful and despicable. They know it is wrong. The Minister, who is sitting here tonight smiling, and the Minister of State just cannot explain this away. Those working in my office are on to people on a regular basis trying to get some sense of the system but we cannot get it. The system is that clearly they were told to withdraw 40,000 or more by hook or by crook. It is not appropriate to tell a man who is over 70 to apply through the under-70 scheme. I know it is possible to bend and twist, but if the Government is going to change people's date of birth what will it do next? It was to hell or to Connacht with Cromwell; it is to hell or anywhere else with the Government. It is outrageous and that is why I am opposed to the Bill.

This legislation underlines the complete incoherence of the Government's health policy. In theory the Government is supposed to be extending access to primary care. However, in reality it is reducing access. This measure and the other budget measures are taking €149 million from the medical card scheme. That represents tens of thousands of medical cards that will be withdrawn from people who need them in the coming year, which is a scandal.

This legislation means that those over 70, who everybody in government deemed were entitled to medical cards, are now losing that entitlement. The new income limit that applies to the over-70s is a gross income limit. It is not net and there are no disregards. It does not matter what are a person's medical expenses. It does not matter what are their other living expenses; only the gross figure is taken into consideration. In some cases that amounts to lower income than for people under 70, where disregards are allowed. The point is that it is based on a gross figure. Taking that into consideration plenty of people who absolutely need a medical card will now lose it.

The medical card for the over-70s is essential not just because it gives them access to the GP care and medication they need, more importantly the medical card gives them access to all those other community-based primary-care services that are so critical to people in their older years when they depend on things such as physiotherapy, speech and language therapy if they are recovering from a stroke, home-help services and public health nursing services. The 35,000 people over 70 who will lose their medical cards will be denied access to those services. That means there will be no access even if they could afford to pay for it because those kinds of essential primary-care services are available only through the public system.

This is a disgrace and all those on the other side of the House who are party to this and support this legislation should hang their heads in shame.

Deputy Kelleher talks about consistency but he applies it only to this side of the House and never to his own side. He, of course, is a member of a party that abandoned any commitment to primary care ten years ago.

We are not talking about primary care.

It published a reasonably good strategy document and then washed its hands of it and handed over the matter to its erstwhile friends in the Progressive Democrats and allowed them to manage its health policy all the time until it suddenly woke up to it when it ended up in opposition and had to actually address some of these issues. We all know that when the Fianna Fáil-led Government made an attack, which is the word that is so often used, on the over-70s, it was going to remove all cover for all over-70s-----

-----without any replacement of any kind of access to GP care without fees.

At least we had the capacity to see the error of our ways; the Government has not.

We know the answer to that question and the Deputy knows it himself. It is no use for Deputy Kelleher and Deputy Dooley to seek to apply standards to this side of the House which they are not prepared to apply to their own side of the House.

The Government has none. That is why Deputy Shortall left. At least she had some standards.

Deputy, please.

A sense of some proportion might help.

Was the Minister of State on the truck outside?

Some 85%-----

He was driving it.

Deputy Mattie McGrath does not seem to understand the over-70s and I will come to him in a minute.

(Interruptions).

Some 85% of all persons over 70 will retain full medical cards if this measure is passed by this House. Some 93% of all persons over 70 will have free access to their GP.

If they are healthy.

No, it is without any condition. Some sense of proportion on this measure is called for. The 10% of people involved here, some 35,000 persons, who lose access to the full medical card, will have it replaced by a GP-visit card.

I do not believe anybody on this side of the House or in this Chamber relishes making any adjustments to eligibility. I have made that clear as has the Minister for Health in his address to the House on this legislation. Deputy Kelleher and his colleagues around him know more than anyone in this House why these adjustments in eligibility need to be made. He knows better than anybody the economic situation the country has faced as a consequence of the reckless mismanagement of the economy by him and his party colleagues.

The Government is asking the over-70s to subsidise the under-fives.

There is no point in coming into this House and telling us we should be consistent when, of course-----

The old and the sick will be subsidising the under-fives.

-----the circumstances the Government faces mean that regrettably we need to make some adjustments in eligibility.

The Minister of State knew that in 2011.

We have maintained cover for 93% of the over-70s. We have ensured, obviously, that people still have access to the drugs payment scheme.

It is just the oldest and sickest who will be hurt the most.

We have ensured that it is only the better off - I accept that is a relative phrase - persons over 70 will be affected by this. We have done it in the fairest possible way. That is what we have done in all the measures we have introduced in this House.

Deputy Mattie McGrath seemed to make a joke that someone who was over 70 was invited to apply for the under-70 scheme.

He was told to. It is no joke. The Minister of State is the joke.

He should not try to mislead the House or to mislead his constituent or anybody else. A person over 70 is still free to apply in the normal scheme - the net scheme. There is no exclusion on a person over 70 from applying through the net approach that is available to persons there. He should not try to suggest that somebody who was over 70 was being told to apply for an under-70 scheme. There is no age limit on the net scheme for which people can apply.

The Minister of State is trying to keep them confused if he can.

The Deputy probably knows that but it was just part of his rhetoric. None of the changes we have sought to introduce is particularly relished on this side of the House. We have done it in the fairest possible way. We have done it in a way that minimises the impact on the most vulnerable in our society and in particular on older persons. For that reason the interventions of the Members opposite at this late stage cannot be taken particularly seriously.

Question put: "That the Bill do now pass."
The Dáil divided: Tá, 63; Níl, 31.

  • 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.
  • Fitzgerald, Frances.
  • Fitzpatrick, Peter.
  • Hannigan, Dominic.
  • Harrington, Noel.
  • Harris, Simon.
  • Hayes, Tom.
  • Heydon, Martin.
  • Keating, Derek.
  • Kenny, Seán.
  • Kyne, Seán.
  • Lynch, Ciarán.
  • Lynch, Kathleen.
  • Lyons, John.
  • McCarthy, Michael.
  • McEntee, Helen.
  • McGinley, Dinny.
  • McHugh, Joe.
  • McLoughlin, Tony.
  • McNamara, Michael.
  • Mitchell, Olivia.
  • Murphy, Dara.
  • Murphy, Eoghan.
  • Nash, Gerald.
  • Neville, Dan.
  • Nolan, Derek.
  • Ó Ríordáin, Aodhán.
  • O'Donnell, Kieran.
  • O'Dowd, Fergus.
  • O'Mahony, John.
  • O'Reilly, Joe.
  • Phelan, Ann.
  • Rabbitte, Pat.
  • Reilly, James.
  • Ryan, Brendan.
  • Spring, Arthur.
  • 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.
  • Flanagan, Luke 'Ming'.
  • Fleming, Sean.
  • Halligan, John.
  • Healy, Seamus.
  • Higgins, Joe.
  • Kelleher, Billy.
  • Kirk, Seamus.
  • McConalogue, Charlie.
  • McDonald, Mary Lou.
  • McGrath, Mattie.
  • McGrath, Michael.
  • McGuinness, John.
  • Mathews, Peter.
  • Murphy, Catherine.
  • Nulty, Patrick.
  • Ó Caoláin, Caoimhghín.
  • Ó Fearghaíl, Seán.
  • Ó Snodaigh, Aengus.
  • O'Brien, Jonathan.
  • Shortall, Róisín.
  • Smith, Brendan.
Tellers: Tá, Deputies Joe Carey and John Lyons; Níl, Deputies Aengus Ó Snodaigh and Seán Ó Fearghaíl.
Question declared carried.