The medical card battle may be won but the war for free GP care for all is still being fought
See below for my analysis from the Irish Independent on 23 June 2014.
Last Tuesday, Health Minister James Reilly, flanked by HSE chief Tony O’Brien at a press briefing in Government Buildings, announced the reinstatement of 15,000 discretionary medical cards to those who have lost them since 2011. Two days later, junior minister with responsibility for primary care, Alex White, finally admitted to the Oireachtas Health Committee that the contentious measure to give free GP care to under six-year-olds would be delayed until the autumn.
Three weeks previously the government finally decided to try and undo some of the damage done by tens of thousands of people losing their discretionary medical cards, many of these are people who are very sick, disabled, old and young.
It took only four days to pass after their hammering in the local and European elections for government to try put the genie back in the bottle.
By announcing the suspension of reviews for all those who currently have discretionary medical cards, they greatly eased the worry of over 50,000 people and families who have discretionary cards.
Through a relatively quick change in health policy, the government managed to do what for months and even years it had been saying was an impossibility.
Speaking at the press briefing on Tuesday, Mr O’Brien stated that “in light of today’s decision by government, the HSE has greater freedom to exercise its powers and to observe its obligations under the 1970 Health Act and is returning these cards on a temporary basis, pending further decisions by Government expected in the autumn”. The autumn decision is reference to the new commitment to provide medical cards on the basis of medical need, a radical shift in policy and law which up to now has only allowed medical cards be allocated on the basis of financial hardship.
While just 65,000 people have been directly affected by the government’s medical card u-turns, the remaining 1,735,000 people with medical cards can be reassured by O’Brien’s pronouncement. Explicitly stating that the HSE now has “greater freedom”, combined with the widespread political panic about not removing many more medical cards may well result in fewer medical cards being withdrawn over the months ahead, than was originally planned. The developments on the medical card front are in direct contrast to the inertia and failure to deliver on free GP care. Free GP care for all by 2016 was a key commitment in the 2011 Programme for Government, viewed by many as a Labour policy and reluctantly agreed to by Fine Gael in exchange for their model of Universal Health Insurance which was very much a Fine Gael agenda.
The Programme for Government committed to free GP care for those on the long-term illness scheme by March 2012, to those on the high tech drug scheme by March 2013, neither of which was delivered.
When Alex White took over as junior minister from Roisin Shortall, he explained it was legislatively impossible to do this and proposed the solution of starting the roll out of free GP with under six year-olds.
This was officially announced in Budget 2014 with the firm pledge that it would be in place by mid-2014. Free GP care for under-sixes was met with fierce opposition from many parties, most vociferously GPs, who felt it was too unfair to be taking medical cards off the very sick and disabled and to be giving them to healthy young children. After months of a stand-off and talks about talks, negotiations have not yet even begun between government and GPs on a new GP contract which Alex White sees as the vehicle for introducing free GP care.
This legislation is going through the Houses of the Oireachtas and it was during the discussion of the Health (General Practitioner Service) Bill 2014 with the health committee last Thursday that Mr White finally fessed up that free GP care for under-sixes would not be delivered until the autumn.
It is no coincidence that the kicking to touch on free GP care is in the same timeframe as when the expert panel is due to report on how best to progress medical cards on the basis of medical need.
It is unlikely, although by no means certain, that either Ministers White or Reilly will be in their current roles in four month’s time.
If this week’s announcements are a good indicator of what’s to come, then whoever are the new health minister, might well progress the Programme for Government commitment of medical care based on medical need, through the extension of medical cards to most or all of the population, while shelving the high profile promises of free GP care and universal health insurance.