Brian Stanley: Medical Card Thresholds Stuck in 1980s
Brian Stanley challenges the Taoiseach on the growing absence of adequate health cover for middle and low income households and warns that income thresholds for full medical cards have not risen in decades. He urges the government to raise thresholds, guarantee full medical card cover for cancer patients and expand GP capacity ahead of Budget 2027.
Key statistics: Brian Stanley highlights that 45% of people hold limited private insurance, 42% have some form of medical or GP cover, and 13-14% have no health cover at all. He cites current income thresholds for full medical cards and GP-only cards as unchanged for decades and argues this causes medical neglect for many workers and families.
Policy demands: Stanley calls for a stepped-up implementation of Sláinte Care, an increase in income thresholds for medical card eligibility, full medical card cover for cancer patients, a review of discretionary medical cards and further expansion of GP training and HSE-employed GPs to fill access gaps.
Government response: The Taoiseach acknowledged progress in life expectancy, reductions in mortality and expansion of GP access cards and diagnostic hubs. He defended recent investments including reduced drug payment thresholds, new diagnostic and women’s health services and increased college places for health courses.
Implications ahead of Budget 2027: Stanley frames Budget 2027, due in 12 weeks, as the next opportunity to address thresholds and move toward universal care. He stresses the political urgency of delivering tangible steps toward Sláinte Care for families currently without adequate GP access.
Key statistics: Brian Stanley highlights that 45% of people hold limited private insurance, 42% have some form of medical or GP cover, and 13-14% have no health cover at all. He cites current income thresholds for full medical cards and GP-only cards as unchanged for decades and argues this causes medical neglect for many workers and families.
Policy demands: Stanley calls for a stepped-up implementation of Sláinte Care, an increase in income thresholds for medical card eligibility, full medical card cover for cancer patients, a review of discretionary medical cards and further expansion of GP training and HSE-employed GPs to fill access gaps.
Government response: The Taoiseach acknowledged progress in life expectancy, reductions in mortality and expansion of GP access cards and diagnostic hubs. He defended recent investments including reduced drug payment thresholds, new diagnostic and women’s health services and increased college places for health courses.
Implications ahead of Budget 2027: Stanley frames Budget 2027, due in 12 weeks, as the next opportunity to address thresholds and move toward universal care. He stresses the political urgency of delivering tangible steps toward Sláinte Care for families currently without adequate GP access.
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Transcript
Taoiseach, I'm raising with you the situation regarding the absence of health cover for a large section of the population. Many middle and low income households have either very limited health cover or none at all. 45% of the population have some kind of private health insurance, which in most cases is very limited, it's partial and very, very restricted cover. 42% have either a full medical card that gives full GP care or just GP, sorry, full medical cover care or just GP care. This breaks down to roughly 30% for full cover and 12% for GP care, GP attendance. What these figures show is that 57% of the population have very limited cover. And worst of all, 13% to 14% have absolutely no health cover whatsoever. These workers and families are typically on low to middle incomes, but they're living in one of the richest countries in the world. And it's a scandal. The facts are that income thresholds for full medical card entitlements hasn't increased in over two decades. And you were Minister for Health back at that time. The thresholds are of the 1980s variety. A single person has to be on an income of less than €184, with the latest figures this year, to qualify. A couple has the threshold for a couple to qualify for full medical card is €266.50. And for two children, it's €345 per week. GP only cards is €373 for a single adult and €607, which is €30,000 a year, roughly, for a couple. This means they have no access to even basic health care or a GP for a lot of households that can't afford it. And in turn, this causes medical neglect. Now, Sláinte Care, which we fully support, and we're making some progress, but not quick enough towards, but it is 10 years that was given to implement Sláinte Care, universal health care. And that runs out in 17 months' time. The progress and full implementation has to be stepped up. And discretionary medical cards, Taoiseach, is a whole area that needs to be examined and improved. And as a start, we need to ensure that cancer patients have full medical card cover. Now, on the 6th of March, 2025, the Minister for Health, who is sitting beside you, told me the following reply. She said that, I can assure the deputy in my department keeps medical card issues under review. Over the course of 2025, we will review the existing eligibility framework to clearly assess what is working well. This is an important step towards delivering full universal health care. And I agree with her on that. But we're 105 years since the independence of this state. So Budget 2027 is coming. And I know everything can't be done at once. I accept that. But it's coming in 12 weeks' time. And will the government ensure, as the next step towards implementing Sláinte Care, that you will increase the income thresholds to give medical card cover to these workers and families who don't have any at present? Will you ensure, very importantly, that cancer patients have full medical card cover? And will you expand further? I know you have expanded the number of training places for GPs. And I welcome that. But will you expand that further and directly employ HSE-employed GPs to fill the gaps in rural and urban areas for recent access at present? Thank you, Deputy, for raising this issue. And you mentioned we're well over 100 years now in existence as a country, as a state, an independent state. And actually, there's a great book by Mark Henry, Ireland at 100, Facts. There's a great chapter on health. And I'd invite you to read it. And if you look at what people were dying of in 2022, 2023, and the lifespan at that time, and compare it to today, there is no comparison. What it represents is an incredible benefit or improvement in terms of lifespan, which ultimately has to be the measurement of any health service and a broader societal approach to health and well-being. So with a life expectancy now of 83 years in 2024, Ireland ranks sixth highest among EU member states. And I was Minister of Health from 2000 to 2004. We were nowhere near that statistic. And the reason was we didn't have any national strategies in terms of the key killer diseases, cancer and cardiovascular. We developed national strategies late 90s onwards in terms of cancer and in terms of cardiovascular with very dramatic beneficial impacts. Those strategies were followed by very substantial investments as well. So our mortality rate fell by 16.1% or even over the decade 2015 to 2024. Mortality rate for all circulatory system diseases fell by 28%, with heart disease and stroke falling by 34% and 42% respectively. Mortality rate for all cancers dropped by 13.7%, with cancer of the trachea, bronchus and lung and breast cancer dropping by 19.3% and 11.7% respectively. And respiratory diseases, mortality rate down by 23%. So I just need to make those general points. We are making progress. The investment has been huge. We've invested exponentially now in our health services. And in respect of GP and primary care, we now have had the biggest expansion of access to free GP care in the history of the state. So if you take medical cards and GP visit cards, about 2.3 million people are eligible for free GP care. So I repeat that, 2.3 million are eligible for free GP care, including medical cards and the GP visit cards. We've reduced the drug payment scheme threshold to 80 euros a month. We did that progressively over the last number of years. We funded diagnostic scans now for patients. We've introduced free contraception to women up to the age of 35. We're publicly funding assisted human reproduction, including IVF, free HRT. We also have developed a much-needed revolution in women's health care in terms of C&T, gynae, fertility hubs, specialist menopause. All that helps to gain greater access for patients. All fair and good. And I acknowledge that there is progress. Of course there's progress in 105 years. And I mean, there's progress in my lifetime, which is a bit less than 105 years. But what I would say to you is this, is that the fundamental question, and I'm hoping to get a bit longer than 83 of it, but the fundamental question here is that the people who do not have health cover, there is progress being made towards launching care. And I acknowledge particularly the stand taken by the Ministry in relation to the contracts for consultants. If you're a pet to work the full week by the state, you can't do private work during that. If it's a plumber working for the OPW, they can't be off doing extras during the day for somebody else. And we support her in that. But universal health care is where we have to get to. And we are now at a step ahead of our states. And the thresholds you have to admit, and you haven't addressed this since your time as Minister for Health. And I acknowledge all the progress that's been made. But we have a distance to go yet. Those thresholds haven't increased. €184 for a single person, €266.50 for a couple, a family of four, €345.50 per week. Thank you. Taoiseach to respond now, please. Thank you, Deputy, again for raising that issue. The biggest movement in the last number of years has been the GP access card, the visitor's card. More than the medical card, I acknowledge that point. But then we've reduced the drug threshold payment as well. And also we're building up the public health system as per scientific care and as per government decisions. Which is extremely, I think, in many respects, very important in terms of the diagnostic hubs, the community-based model that has been evolved over the last number of years, which actually gives people very ready access to diagnostics and to treatments in terms of not just having to access the acute hospital system all of the time. On growing college and training places, which you referenced earlier, we are creating, as you know, it was a big investment in 2026, enabling higher education institutes to deliver over 1,100 new health care course places each year over the next three years. And we've had a particular significant investment in more GP places in our colleges and clinical placements thereafter.