Health and Childcare Support (Miscellaneous Provisions) Bill 2019 [Seanad]: Committee and Remaining Stages

Sections 1 to 3, inclusive, agreed to.

Amendments No. 1 to 4, inclusive, may be discussed together.

I move amendment No. 1:

In page 5, between lines 13 and 14, to insert the following:

"Issuance of European Health Insurance Card to eligible persons

4. (1) An eligible person shall be entitled to a European Health Insurance Card to be issued by the Executive.

(2) An application for a European Health Insurance Card by an eligible person under subsection (1) shall be made in the prescribed form and manner at HSE Local Health Offices or through the HSE managed website.

(3) On receipt of an application under subsection (1), the Executive shall issue a European Health Insurance Card to the eligible person, or the person acting on their behalf, in the prescribed form and manner, where it is satisfied that—

(a) the person in respect of whom the application is made is an eligible person, and

(b) he or she, or a person acting on his or her behalf, has complied with this section and any regulations made under section 5.".

I have already outlined the reasons I have proposed these amendments. Nobody is disagreeing with the rationale for this. This is my attempt to save the State a few shillings from what would be a very expensive reimbursement scheme. I want to hear from the Minister for Health with regard to the legal advice and the reasons it was done. I am not accusing anyone of acting in bad faith and I do not believe anyone has done so, but a very firm and clear commitment was given to people in the North. It was very much welcomed by them but they are adults. They just want to hear the reasons that may not be possible or the pathway that may exist to eventually get there.

Regarding the exact mechanism by which this will work, citizens in Northern Ireland will not have one of these cards.

The explanatory memorandum was not great at explaining exactly how the cash is going to flow. I can ask my question now or I can do so during the debate on the relevant section. I do not want to mix up Deputy O'Reilly's amendments.

We can get it dealt with now.

There are British, Irish and EU citizens living in Northern Ireland. Let us say one was to travel to France, get sick, incur healthcare costs of €20,000 and go home. This Bill provides for reimbursement, so that can happen. Will the Minister explain how that payment mechanism will work? Ultimately, will the Irish State pay the €20,000 bill or is there some reciprocal arrangement whereby the Northern Ireland Office or the UK will pay it? Will the Irish taxpayer be picking up the tab for citizens in Northern Ireland incurring healthcare bills in France or Germany?

I will deal with Deputy Donnelly's point before addressing the substance of Deputy O'Reilly's amendments. This is a unilateral decision Ireland is taking, not a bilateral arrangement with the UK Government. We as a State are making this decision to fulfil what we believe are our responsibilities under the Good Friday Agreement. Irish taxpayers will meet the reimbursement costs and there is no role for the Northern Ireland Office, the UK or anyone else in that regard. We all agree this is the right and proper thing to do under the spirit of the Good Friday Agreement.

I refer to the operation of the scheme. We have instructed the HSE to provide for a robust online portal system that will require some verifications from the applicant. It will validate the applicant's eligibility status, through provision of proof of residence, for example. It will also require validation of reimbursement claims, such as copies of receipts, and the completion of a self-declaration form, which confirms that the health benefits being reimbursed meet the terms of the scheme. As I stated on Second Stage, one cannot go to France for an operation in a planned manner. This provision is only for people who get sick while on a temporary visit abroad. That is how EHICs have always worked. The primary legislation will not deal with the operational scheme. Instead, statutory regulations will set out the form and manner in which the HSE will reimburse applicants, as well as the detailed design of the scheme. I expect to sign these regulations in the coming weeks, before 31 October. We will operate the scheme through an online portal in as easy a manner as possible while putting safeguards in place. I am happy to keep the House updated as the regulations progress.

I acknowledge the good faith in which Deputy O'Reilly's amendments were tabled. In an ideal world, not only would I be accepting these amendments, but they would be in the substance of the Bill we brought forward. The effect of the Deputy's amendments is to delete references to the direct reimbursement scheme, which is the core purpose of the legislation before the House, and replace them with an explicit obligation on the Minister for Health to issue EHICs to eligible persons resident in Northern Ireland. That is what we set out to do, and while it seems a simple proposal on the face of it, I assure the Deputy that it is far from straightforward. The Deputy has rightly asked me, on behalf of the people of Northern Ireland, to explain why that is the case.

The legal basis for issuing EHICs is provided by EU Regulation No. 883/2004. It was not debated much during Second Stage but that is the European Parliament regulation on which EHICs hang. We all know how they work, so I do not need to go through that again. Our preferred approach to this objective was to extend cover to the target cohort, that is, people resident in Northern Ireland, under that regulation. This approach, if deemed feasible, would have allowed the HSE to issue EHICs to eligible residents in Northern Ireland almost identically to how it does currently. However, that regulation is very detailed. It supports the free movement of people by protecting the social security entitlements of EEA nationals who exercise their right to free movement within the EEA, ensuring that entitlements are not diminished as people move within that area. Its core purpose is to provide for the co-ordination of pensions and unemployment benefits. As such, it has a much broader scope than the sole benefit of EHICs, and there could be unintended consequences to extending it.

Once the Government decided to proceed with this objective, officials in my Department carried out detailed work over the summer months in consultation with other key Departments, principally the Department of the Taoiseach, the Department of Foreign Affairs and Trade and the Office of the Attorney General. They assessed whether it was possible to extend the EHIC entitlement to the target cohort only by utilising the discrete healthcare provision of EU Regulation No. 883/2004. We also held informal and formal engagements with the European Commission, as it is responsible for oversight of and technical guidance on the implementation of governing legislation. A subsequent meeting took place in July with representatives of the European Commission and all relevant key stakeholder Departments, at which they explored the possibility of using that regulation to extend EHIC benefits in more detail. Following the formal engagement, Ireland was advised by the Commission that using the existing legal basis set out in EU Regulation No. 883/2004 to extend EHIC cover is not feasible. We therefore had to look for an alternative, which is this Bill. This is absolutely not the perfect way to achieve this goal. However, it is the best way to do it by 31 October.

The Deputy referred to the fact that a review clause is built into the legislation. That is to be welcomed. However, what we would all welcome even more is never needing to commence this legislation. We continue to hope for a planned Brexit rather than a no-deal Brexit. This legislation only comes into effect in the event of a no-deal Brexit. If a Brexit deal is reached, there will then be a transition period, during which people in Northern Ireland will continue to be treated as EU citizens. That will allow us two years or so to tease through all these issues.

I seek clarification on two issues. First, the figure I have for the cost of the scheme is €5 million. Will the Minister confirm that is the figure with which he is working, and whether it is provisioned within the budget?

Second, while I appreciate that the mechanism is not contained in the primary legislation, I presume the regulations are well advanced at this stage. Will the Minister walk us through an example of the scheme's operation? Let us take someone from Belfast who is on holiday in France, for instance. What happens if that person breaks his or her leg and goes in for medical treatment? Does he or she need to pay in cash or is there a voucher scheme? How does that payment work?

The Deputy is correct that the €5 million is the pro rata cost. It is an estimate based on a similar pattern of usage for Irish patients. Our most accurate estimate of the cost is €5.3 million and it has been provisioned for as part of our Brexit contingency funding.

A Belfast resident who gets sick in an unplanned manner while on holiday in France and finds himself or herself in hospital will pay the healthcare costs upfront at the point of access. To refer to Deputy O'Reilly's point, if a person does not have an EHIC, he or she must pay upfront. I will try to explain the process in the absence of the regulations to be helpful to the Deputy. That person must then log on to the HSE online portal and fill out the self-declaration form stating that he or she became unexpectedly sick while on holiday in France and went to the emergency department, and what the cost was. He or she must also submit the receipt and proof that he or she is a resident of Northern Ireland. The HSE will then reimburse the cost within weeks. That is how it will work, roughly speaking.

Where stands amendment No. 1?

On the basis of the information the Minister has given, due to the reasons he has outlined, and on the proviso that we will be kept updated on the operation of this scheme, I will withdraw the amendment. The intention of my amendment is clear, but I do not want to create a scenario where we have no provision at all, which is my understanding of what would happen. That cannot happen. While I am not disputing that the scheme as outlined by the Minister is better than nothing and is to be welcomed, it is not what people in the North were promised. Pressure will remain from my party to ensure those people will not have to go through that process, should it come to it. It is difficult. There is a public health system in the North. We have used the example of France. It would be difficult to be treated there as a patient from a third state only to come home and be treated as a European citizen. We are planning for a scenario we hope will not happen.

On the basis of the assurances and explanations given by the Minister, I withdraw the amendment.

Amendment, by leave, withdrawn.
Section 4 agreed to.

I move amendment No. 2:

In page 6, to delete lines 15 to 17 and substitute the following:

“(b) the form and manner in which the Executive shall issue an eligible person, or a person acting on his or her behalf, a European Health Insurance Card;”.

Amendment, by leave, withdrawn.

I move amendment No. 3:

In page 6, to delete lines 27 and 28 and substitute the following:

“(a) the proper and efficient administration of the issuance of a European Health Insurance Card to eligible persons under section 4;”.

Amendment, by leave, withdrawn.

I move amendment No. 4:

In page 6, to delete lines 29 and 30.

Amendment, by leave, withdrawn.
Section 5 agreed to.
Sections 6 to 9, inclusive, agreed to.

Amendments Nos. 5 and 6 are related and will be discussed together.

I move amendment No. 5:

In page 8, line 18, after “ “(iva)” to insert the following:

“an Irish citizen who is ordinarily resident in Northern Ireland, a British citizen who is ordinarily resident in Northern Ireland, and”.

I will withdraw the amendment on the basis of the clarification offered by the Minister for Children and Youth Affairs. It will be appreciated that this is a sensitive matter, especially in light of the judgment in the DeSouza case. It is imperative that we have on the formal record that we are all on the same page and we understand what does and does not constitute an Irish citizen.

Amendment, by leave, withdrawn.
Section 10 agreed to.

I move amendment No. 6:

In page 8, line 22, after “ “(iva)” to insert the following:

“an Irish citizen who is ordinarily resident in Northern Ireland, a British citizen who is ordinarily resident in Northern Ireland, and”.

I will withdraw this amendment on the basis of the clarification received earlier.

Amendment, by leave, withdrawn.
Section 11 agreed to.
Title agreed to.
Bill reported without amendment and received for final consideration.
Question proposed: "That the Bill do now pass."

I thank the Dáil and the Seanad for the speedy consideration of this legislation. I acknowledge the cross-party and cross-grouping support for it.

I also want to acknowledge another group of people who are serving our country well during such a difficult time as we prepare for all Brexit eventualities, namely, our Civil Service. A large amount of work has gone into this legislation, as indeed has a large amount of work gone into the Brexit omnibus Bill. I am not sure our citizens, indeed those of us in this House, will ever fully understand the extent of the pressure under which the Civil Service has been working to prepare for every possible eventuality in a world of great uncertainty. I want to express my gratitude and that of the Government for this work.

The opportunity cost of all this is significant. We have teams of civil servants in all Departments who would much rather be working on issues we would rather they were working on. Obviously, it is right and proper that Brexit preparedness are priorities Nos. 1, 2 and 3.

I want to acknowledge both Paul Flanagan and Tom Monks and their team from my Department, as well as Laura McGarrigle from the Department of Children and Youth Affairs and her team. On a broader basis, on behalf of every Member, I want to acknowledge the absolute dedication of the Civil Service at a difficult time. The country is extraordinarily well served.

Question put and agreed to.

A message will be sent to the Seanad acquainting it accordingly.