Pre-election government guff won’t ease medical card issue
See below analysis from Irish Independent, published on 22 May 2014.
So just days before the Government take a very hard wallop in the local and European elections, some of their most senior figures, including the Taoiseach, are trying to dampen the medical card controversy by indicating another potential about-turn on the issue.
The finance minister made a point of saying that the change won’t be announced until after tomorrow’s election so that it’s not viewed as a pre-election “stunt”, but assures the public, it will be announced “shortly”.
Health Minister James Reilly is busy reassuring people that the Government “is making sure the most vulnerable and most in need will be looked after”.
All of the politicians are admitting that the manner in which children and adults are losing their medical cards is “insensitive”. And they say they are very upset by hard-hitting stories portrayed in the media. Who wouldn’t be?
Yet, despite all this guff, there is absolutely not one ounce of clarity on what this alleged change might be.
If previous form is a good indicator of their future response, this is this just another pre-election salvaging exercise.
For two-and-a-half years in government, there was complete denial from the highest political level that people were losing medical cards. And for the first two-and-a-half years, they were right – the overall number of people with medical cards reached its peak in September 2013, when over 1,864,500 people had medical cards.
But what opposition parties and groups working with people with certain medical conditions were highlighting during this time was that people with discretionary medical cards were losing them.
And they were. There were 25,000 fewer people with discretionary medical cards in September 2013 than when this Government came into office in March 2011.
This drop in discretionary cards was largely caused by centralising the processing of medical cards, including discretionary cards. In effect, once people’s income went over a certain level, no discretion was left, no matter how sick nor how much they needed services to which a medical card facilitates access, without cost.
Early in the Government’s term when this centralising was taking place, there were problems with people losing their cards without being notified. The then minister with responsibility for primary care, Roisin Shortall, took the issue in hand and changes were made so that GPs as well as individuals were notified of card withdrawal. Extra time and leeway was given so that most of those who were meant to keep their cards, did.
Some of the 25,000 who lost their discretionary cards got medical cards on the basis of their low income. But many did not and this is what was agitating TDs and interest groups. Eventually, last October, there was acknowledgement that something was amiss and a HSE public information campaign was launched. The HSE made its website more user-friendly and promised to communicate better. But communication exercises, no matter how good or bad, cannot override the law (the 1970 Health Act) or remedy an ever-dwindling budget.
Between October and December, there was much political heat about the HSE overspend and the 2014 Budget.
Taoiseach Enda Kenny and the departments of the Taoiseach and Public Expenditure and Reform were to take a more hands-on approach to managing the health budget.
Even with this closer oversight from on high, there was continued denial that anything had changed. It was only the week before Christmas, when the 2014 HSE Service Plan was published, that there was explicit acknowledgment that there would be, for the first time since the HSE was established, a decline in the number of people covered by medical cards in the year ahead.
The hard cases rumbled on and it was really only as government TDs were out canvassing in their constituencies did it really hit the political radar. Backbench TDs were appeased with a nonsense promise of a third tier to access medical cards, which has come to nothing.
Now, days before the people vote, the Government is saying that after tomorrow, medical cards reviews will be done differently.
The bottom line is that people are losing their discretionary medical cards because it has centralised and streamlined the discretionary process. And after six years of austerity cuts to the health budget, one of the only things left to cut are medical cards.
Nothing will change after tomorrow, people will continue to lose medical cards unless the Government changes the rules for medical card eligibility or it gives more money to the HSE to cover the medical card scheme.