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Seanad Éireann díospóireacht -
Wednesday, 15 Dec 2021

Vol. 281 No. 8

Health Insurance (Amendment) Bill 2021: Second Stage

Question proposed: "That the Bill be now read a Second Time."

I welcome the Minister of State to the House. She has five minutes.

I am pleased to have this opportunity to address the House on the Health Insurance (Amendment) Bill 2021

This Bill was published on 1 December and concluded its passage through the Dáil on 8 December. I welcome the support received in that House for the core principle of community rating, which is long-established and well-supported Government policy for the health insurance market. Our community-rated health insurance market means that the cost of health insurance is shared across all members of the market.

This is a short and technical Bill that is comprised of nine sections that all focus on the specific issue of health insurance. This legislation is required each year to revise the parameters of the risk equalisation scheme, which is a financial mechanism that supports our community-rated health insurance market. The risk equalisation scheme requires state aid approval from the European Commission to function as part of the private health insurance market. The current scheme was approved in 2016 with similar schemes approved and in operation in Ireland since 2003. To date, the scheme has been considered a state aid that is compatible with the Internal Market by the European Commission. The current scheme is approved to operate until 31 March 2022. Negotiations are at an advanced stage with the European Commission for the new scheme and are expected to be finalised shortly.

In addition to the general amendments, this year’s Bill provides the legislative basis for enhancements to the scheme. These have been developed with relevant stakeholders in the market, including the Health Insurance Authority and the insurers, and negotiated and finalised with the European Commission.

I will now outline the specific sections of the Bill. Section 1 defines the principal Act as the Health Insurance Act 1994.

Section 2 amends section 6A of the principal Act to include high-cost claim credits, which the insurer is entitled to have paid on behalf of an insured person. Section 3 amends section 7E of the principal Act. It provides that the Minister may require the Health Insurance Authority to furnish a report relating to the high-cost claims credit parameters. Section 4 amends section 7F of the principal Act to provide for an updated reasonable profit figure. Section 4 also provides for the transitional arrangements for how it is to be applied for the three-year periods 2020-22 and 2021-23. The benchmark is increasing from 4.4% to 6%.

Section 5 amends section IIC of the principal Act to provide for a new effective date for revised age-related credits payable from the risk equalisation fund. It also introduces a time limit on all credits that can be claimed from the fund. Section 6 replaces table 2 in Schedule 4 to the principal Act. This table provides for age-related credits which are payable for insured people over the age of 65. These new credits would be payable from 1 April 2022.

Section 7 amends the principal Act by the addition of Schedule 5, which provides the parameters for high-cost claims. Section 8 amends section 125A of the Stamp Duties Consolidation Act 1999. This will specify the stamp duty rates that will apply for 2022. Of note, it provides for a reduction in the stamp duty levy applicable to health insurance contracts from 1 April 2022. Section 9 provides for the Short Title, commencement, collective citation and construction of the Bill.

The provisions in the Bill relating to the introduction of high-cost claims credits and the amendment of the benchmark for reasonable profit are subject to approval with the European Commission under state aid rules. The commencement of these provisions will be by ministerial order.

To summarise, this Bill allows us to maintain the community-rated health insurance market. The provisions of the Bill will increase the effectiveness of the risk equalisation scheme, which is a fundamental support to the market.

I would like to conclude by highlighting this Government’s commitment to improving public health services under the Sláintecare programme. As access to these services improves, the proportion of people who hold health insurance may decrease over time. Importantly, the programme for Government also commits to retaining access to private healthcare services for people in Ireland thus ensuring choice for those accessing healthcare. While such a high proportion of people hold health insurance across Ireland, it makes sense to maintain the community-rated health insurance market.

I commend this Bill to the House.

I thank the Minister of State. As she has outlined, this is a very short technical Bill and we are in here every year renewing it. It is very welcome that the stamp duty on medical insurance is reducing. The measure should put money back into the pockets of the people who have health insurance next year. At a time when inflation is rising substantially the measure is very welcome. This leads on from the announcement yesterday that all householders next year will have their electricity bill reduced. I hope that the medical insurance companies will look at their own processes to see if they can give an even bigger reduction back to people next year in their premiums. I thank the Minister of State and she has our full support.

I welcome the Minister of State to the House. This Bill is a yearly event and I fully support it. The Minister of State will be glad to know that no amendments to this Bill have been tabled in this House, as I am sure she knows already. The fact that there are no amendments says much about the Bill.

Senator Clifford-Lee made a point on the stamp duty levy reduction. It might be handy to have a note on that because while it is a news line, I do not know the exact impact of it. I ask the Minister of State to circulate that note at some stage, not necessarily today. It would be handy to have a brief note on the impacts of stamp duty levies and the figures we are talking about. I know this measure comes into effect on 1 April 2022. It makes sense.

There is always the challenge of equal access to healthcare. As someone who has Vhi Healthcare insurance, and many of my colleagues also have private healthcare, we too are not guaranteed access to health on that basis. That is a problem in itself. There is also the greater issue of Sláintecare and people accessing health services during the Covid pandemic at a time of amazing demands on our hospitals. To be fair to those working in the private hospital sector, they stood up to the plate and made services available at a very difficult time. In turn, many of their members who had private health insurance took a hit. Speaking for myself and many of my colleagues, Vhi Healthcare sent rebates, though moderate and not very large, to people of approximately €100 or €150. That was a gesture that recognised the same comprehensive services were not provided in a very fast or timely manner. We all have to put our shoulders to the wheel and support people who are vulnerable at particular times when there is a demand on our health services.

I again thank the Minister of State for bringing this Bill to the House. I will give it my full support.

The Minister of State is very welcome to the House. I will take this opportunity to wish her all the very best for Christmas. I hope she will get a bit of a break. This Bill is legislation that comes before us annually. There are always little bits and pieces of it that change. I agree with my colleague and friend, Senator Boyhan, in wanting to know a little more about the stamp duty levy reduction. I was not aware of it but if it saves a few pounds for people it has to be good news. It is coming in during quarter 2 next year. It will only be for information purposes but if we got the figures at some stage, we could at least advise people accordingly.

I will raise one other issue that I am not sure the Minister of State was made aware of, but I have been contacted by a couple of people regarding it. It concerns students from abroad who come to Ireland. There was some sort of scheme that covered their medical insurance at a nominal cost, possibly €200 or €300. Apparently, for some reason, and I cannot remember the exact details, those students are not now recognised as part of the risk equalisation scheme. It seems frightfully unfair because in the past, third-level colleges covered their health insurance costs as part of the offer package to attract them to come to this country to study in the first place. We all know that many of our third-level institutions benefit enormously from international students because they pay significantly higher fees than Irish students.

As part of the welcoming initiative certain student allowances were covered, one of which was health insurance. It now seems that we are looking at a situation where that insurance will quadruple in cost. For a young man or woman coming to Ireland to study in Dublin City University or University College Dublin we are talking about €1,000 or €1,200 in health insurance costs. I am sure it is an anomaly and might be something that has not been spotted, but I have been made aware of it by someone who used to work in my office and is now working with a consultancy company. She made me aware of it and I said I would raise it. I am not sure if the Minister of State is aware of it, but she might be able to do something about it because, God knows, we need as many of these third-level students coming to this country as possible.

As a general point, and this is something I fundamentally believe in, we should have a one-tier health service for everybody. Everybody should be able to access health services irrespective of financial background and so on. We are probably a long way from that, but I will always put on the record that it is something we should aspire to. We should aspire to have two things; a world-class health service and access for all to it. If the pandemic has taught us nothing else, it has taught us the importance of our health service, the people who work in it and that when people need to access the health service and a full suite of services they should be able to do so. There should be no difference between a billionaire and somebody who is not a billionaire when it comes to the benefits they get from our health service.

We can never say enough about the phenomenal men and women in our front-line health services. I will give a shout-out to those working in accident and emergency departments, operating theatres, wards, healthcare facilities, nursing homes, the people who provide care in the home, home help and so on. They have been amazing heroes over the past two years. We can never thank them enough and I know the Irish people will always want to thank them. I have no doubt this Bill will fly through the House.

It is nice to see the Minister of State. I thank her for coming to the House. It is good to have this opportunity every year to debate a Bill like this so we can see where we are at with Sláintecare and the commitment all parties in the House gave to phasing out private health insurance and the private health sector, and to working towards a public universal healthcare system where people are treated on the basis of need and not how much money they have in their pockets.

The Minister of State set out what the Bill will do and we will support this, but a fundamental question needs to be asked as to why people take out private health insurance. I think it was Deputy Howlin, many years ago, after his first spell in Government in the 1990s, who made the point that it was only then that he realised that private health insurance exists and depends on a public service that fails. If the public service worked, why would anyone take out private health insurance? Unfortunately, that is more true today than ever. The vast majority of people take out private health insurance because they feel they need it, they cannot depend on our public system and if they or a family member gets sick, the fastest route to help them is through private health insurance, whether it is to get a scan, test, assessment, appointment or treatment. This is true, but the problem is that all those who cannot afford to take out private health insurance are left on public system waiting lists.

According to the most recent figures, 900,000 people in this State are waiting to see a hospital consultant and 200,000 of them have waited more than 18 months. That begs the question of where the delivery of Sláintecare is, which promises that people should not have to wait longer than four months for treatment, when 200,000 people in this State have been waiting more than 18 months, some of whom, in areas such as orthopaedics or scoliosis, are children. It is a scandal. Sláintecare will not happen until we make a commitment to properly resource our public hospitals, recruit the consultants, specialists, nurses and healthcare assistants we need, and to have public beds in public hospitals.

I have to mention the situation in University Hospital Limerick, which continues to get worse, unfortunately, month after month. The typical number of people on trolleys in that hospital is now 85 per day. We know further investment is coming but, having met hospital management, we know there is currently a 200-bed shortage. We know that the next set of promised beds will not arrive for at least another two years. When they do arrive, instead of the 96 beds that were promised, it will actually be half that number because the other half are replacing existing beds. The question I asked last week in the Seanad was about what the people of Limerick are supposed to do in the meantime. It completely undermines confidence in our public health system. This is the type of factor that drives people towards the private health market.

It is a good time to revisit this topic to see what we should be doing to drive the process of Sláintecare forward and to acknowledge that health insurance does not deliver in many respects. For example, it does not cover primary care. One of the new problems we have now is that people are struggling to access GPs, never mind pay the costs to see them. We also know that unless someone has a Rolls-Royce package, private health insurance often does not work in reality. We see queue skipping and the purchasing of private healthcare in public hospitals. These are things we just need to move away from. As a party committed to a national health service, Sinn Féin is very clear that its priority will be to remove private healthcare from our hospitals and to do so far more quickly than it is being done at present.

I will address the issue Senator Conway raised because I have also been approached by organisations representing overseas students. We were expecting an amendment to this Bill.

I know it is not now coming forward, but this is an issue that was raised with me more than a year ago. I want to pay credit to Senator Hoey, and Senator Malcolm Byrne has also been working on this issue. We need to look after these students. It is grossly unfair they are excluded from this scheme at present. I ask the Minister of State for a response on what actions are being planned and what will happen for those people.

The one issue I have with the Bill is in section 4, where we see an increase in the "reasonable cost" from 4.4% to 6%. I want to understand why that is. I would have thought we should not be increasing those costs at this point in time. If the Minister of State had a comment on that, it would be very helpful.

I am always conscious the Minister of State tends to come into this Chamber to wrap up every session, but is appropriate to pay tribute to her work. She is passionate about what she does and the fruits of her labour are now being seen. I will follow on from Senators Gavan and Conway. I have been raising this issue around international student health insurance and had a Commencement matter last week with the Minister of State's colleague, the Minister of State, Deputy Feighan.

Frankly, I am frustrated. I introduced legislation on this issue. I was proposing to look at bringing forward amending legislation to this Bill, but I held off from doing so on the basis I would get certain guarantees that the issue would be addressed. I find the most frightening phrase in the public service is that this matter falls between a number of Departments. This one has been battered between the Department of Justice and the Department of Health, with the Department of Further and Higher Education, Research, Innovation and Science, for obvious reasons, having an interest in it as well.

This issue has now been running for 18 to 20 months. It was one of the earliest issues I brought up in this House, not long after my election. The Irish council for overseas students, the Union of Students in Ireland, the Irish Universities Association and the Technological Higher Education Association have all been raising it as a matter of concern. This has been running for a while.

The legislation I brought forward was one solution. However, I was told an easier solution would be found from the Department of Justice. I was told a number of weeks ago that there was imminent positive news. I was told last week by the Minister of State, Deputy Feighan, that the news was coming very soon. Perhaps the Minister of State might give us some good news, because it is crucial to these international students who, for the most part, tend to be healthy. They do not tend to pose a significant risk of ending up in our hospitals and so on. Unfortunately, a small number of them do.

However, international students enrich the higher education experience here in Ireland and it is important, coming out of the pandemic, for our higher education institutions to be in a position to attract significant numbers. I decided not to proceed with the amendment on the basis a solution would be found on this issue. However, I will be pressing ahead with this in the new year because of the number of promises I have seen, unless the Minister of State has good news here for us today.

The Minister of State is very welcome and I thank her for coming to discuss this all-important issue. While I realise it is pretty much a technical Bill, I welcome the fact people will be able to, as was alluded to, have some extra money in their pockets as a result of it. Senator Gavan raised the problems around Limerick hospital and the fact people are taking up beds, but we now have a Vhi SwiftCare clinic and a Laya healthcare clinic in Limerick. I have to compliment the staff working there. I have not used it personally myself, thank God, but have used it in Dublin and Cork. I have heard great compliments on the efficiencies of the clinics and how they are working, and also that people have been able to have relevant scans or X-rays. It is helping to keep people out of the public hospital on one side, while I know it is a problem on the other side with regard to some issues they cannot deal with. One used to be able to claim tax relief on private health insurance. One could put it against one's tax bill at the end of every year. That was done away with. It is something that needs to be looked at in order that people could get a tax relief-----

It is still there, but it is taken at source.

Taken at source. Okay, because a few people have raised it with me and perhaps they need to go back to their places of employment. I thank Senator Clifford-Lee for clarifying that. I support the Bill and I am sure it will go through quickly.

I thank the Senators for their contributions to today's debate and facilitating the passage of the Bill. I thank them for their support. I will try to deal with a few of the issues that were raised. Senator Clifford-Lee raised the issue of the reduction in stamp duty. Taking into consideration the surplus built up, the stamp duty on advanced health insurance contracts will be €406. This is a decrease of €43 from 2021 rates. On non-advanced health insurance contracts, the stamp duty will be €122. This is a decrease of €35 from the 2021 rates. That is positive.

Senator Gavan asked about the rationale for the increased reasonable profit from 4.4% to 6%. The risk equalisation scheme requires approval under state aid rules by the European Commission and a condition of approval is that the net beneficiary cannot be overcompensated. The reasonable profit figure is used for an over-compensation test which is conducted every three years the scheme operates. It assesses whether a net beneficiary of the risk equalisation scheme has surpassed the reasonable profit and, if so, any excess profit is returned to the risk equalisation fund.

The Bill provides for a small increase from 4.4% to 6% on sales. This figure was recommended by the Health Insurance Authority, having obtained the services of external economic consultants. This 6% figure is at the lower end of the scale recommended by the review. The Minister for Health does not have a role in setting prices for health insurance products or targets for profits and this year's Bill reduces the stamp duty on health insurance contracts, which is hoped will be reflected positively in the insurer pricing.

I will refer to Sláintecare. It is important, because when this Bill was discussed in the Dáil last week, we heard a lot of contributions pointing out that 46% of people in Ireland have private health insurance. However, I was pleased to inform the Dáil that 42% of people in Ireland have a medical card or a doctor-only card. Many people have access to free GP care and 36% of them have a medical card.

I will touch on Sláintecare, because many Deputies and Senators referred to it. The Sláintecare Implementation Strategy and Action Plan 2021-2023 was approved by Government in May this year. The six-month progress report published last month indicated that of the 112 deliverables, 109 were on track or progressing with minor challenges. I expect the progress to continue at pace in 2022, supported by the allocation in budget 2022 of €21 billion, which was the biggest-ever investment in Ireland's health and social care service to deliver Sláintecare.

There is no doubt about the appreciation in both Houses of the importance of Sláintecare and moving it forward. We saw Sláintecare at its best this year, when 8.2 million doses of a vaccine were administered, free at the point of entry, with access to all. That proves what Sláintecare is all about.

Senator Malcolm Byrne raised the issue of health insurance for non-EEA students in a Commencement matter last week and it was raised by other Senators.

The issue concerns non-EEA students studying in Ireland who are required by the Irish Naturalisation and Immigration Service in the Department of Justice to meet certain visa requirements when studying in the country, one of which relates to health insurance. In order to meet immigration requirements, non-EEA students studying in Ireland for more than one year must purchase a health insurance policy from an insurance provider registered with the Health Insurance Authority, which is the independent statutory regulator of the Irish market. This position has been affirmed in the Irish courts. I know this is causing a lot of bother for students from non-EEA countries studying in Ireland. I understand the officials are engaging on this and that there will be a positive update in the new year. This is as much information as I have. There is a lot of work going on in the background on this issue. I thank everyone for raising it. It is only when these issues are raised on the floor of the Seanad or Dáil that they come to people's attention.

Will the Minister of State keep us posted on this issue?

Absolutely, I certainly will.

I thank the Minister of State.

The purpose of the Bill is to specify the revised credits and corresponding stamp duty levies to apply on health insurance policies from April 2022. The credit and levy rates for next year strike a fair balance between the need to support community rating while maintaining sustainability of the market. I reiterate the Government's commitment to improving public health services under the Sláintecare programme. I thank everyone for their co-operation on Second Stage and for supporting this technical Bill.

Question put and agreed to.

When is it proposed to take Committee Stage?

Is that agreed? Agreed.

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