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Column: Medical cards are a hot issue – but the Government shouldn’t shy away

Means-testing medical cards for the elderly got a previous government in trouble – but that doesn’t mean it’s a bad idea, writes Eoin Lynch.

Eoin Lynch

MINISTER FOR FINANCE Michael Noonan has stated that people will have to “wait and see” what Budget 2013 brings. However, Government kite-flying has indicated that it is likely Minister Noonan will toe the line in accordance with an IMF report published in July of this year and review child benefits, social welfare payments and means testing criteria for the medical card.

Means testing for the medical card is a volatile area for any government, as was proven by the public’s reaction to the decision in Budget 2009 that over 70s would not automatically be entitled to the card.

In a recent statement Brian Hayes said: “It seems to me that the Irish political system will never countenance cutbacks on the elderly. My view is that all this needs to be on the table.” Reacting to these comments Mairead Hayes of the Irish Senior Citizens Parliament stated that “this matter is so serious that both the Tánaiste and Taoiseach should state publicly if the remarks by the junior minister are representative of the views and depth of knowledge of the cabinet as a whole with regard to older people”.

As anyone who has recently visited an A&E department can attest, the health system is still in dire straits. The HSE is currently running at a deficit of €400 million, the Fovernment are looking to close essential facilities in regional hospitals and an apparent €1 billion is due to come off health spending in 2013. So is it now time to appraise the medical card scheme and be more specific about those who are entitled to it?

In Budget 2000, Charlie McCreevy announced that people over 70 would automatically be entitled to the medical card. The allowance was a last minute addition to the budget and was seen by many as an irresponsible move by the government to win over the grey vote for the following year’s election. The repercussion of McCreevy’s generous gesture is that the medical card scheme is based on a person’s age, and not, as it should be, on their income.


In 2008 Brian Lenihan made an attempt to address this problem created by his predecessor. That year saw the budget brought forward to mid-October as opposed to the usual December date. The reason given at the time was “the global economic crisis”. This was Lenihan’s first Budget and the implication of bringing the date forward meant that there was little indication, or kite flying, as to what to expect.

It was a budget that saw HPV testing for 12-year-olds shelved, widespread cuts to education spending and a levy on all income. However, the issue that garnered most media attention was a move to means test the medical card for over 70s. The announcement was mishandled by the Government – Lenihan read this section of his budget quickly and even though he clearly stated the criteria of the means testing, it could be argued that he should have driven home the point that this would only affect the wealthiest five per cent of the over-70 population.

It was proposed that individuals over 70 who had a weekly income of €650 plus, or couples with an income of €1300 plus, would not automatically be entitled to the medical card. It would have meant a saving of around €16.5 million per annum. But the grey army mobilised itself very quickly and did something that no other sector of society, bar students, had done to an Irish government in quite a while – they collectively stood up and said “NO”.

Due to a day of protests outside Leinster House – and the fact that the Government was all too aware that the elderly of Ireland will get themselves to a polling station by hook or by crook on election day – the criteria changed so that those with a weekly income of €700 plus or a couple with €1400 plus would not automatically qualify for the medical card scheme, a change in conditions that would affect just 20,000 people.


The government’s turnaround was seen as a victory for the senior citizens of Ireland but it proved less clear cut than initially thought. This was a battle won on behalf of a relatively well-off section of the over 70s, many of whom would never use the card.

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Later in 2009, Mary Harney introduced a 50 cent charge on every prescription to medical card holders, a move that affected all card holders regardless of their income. The Fianna Fáil/Green coalition was a government that showed such a lack of foresight that it would be laughable were the consequences not so dire, but ministers should have had the gumption to articulate that any concessions given on the medical card means testing would be recouped, as they were, at a later date.

The danger of grouping people based primarily on their age means that the economic diversity within that group is not taken into account. If the government goes after ‘the elderly’ in the forthcoming budget it is likely to go after them as a collective group. Fine Gael, as the dominant party of the coalition, are likely to push their right-of-centre ideology and apply general taxes and cuts onto the elderly as opposed to aiming at the wealthier proportion of the over 70s.

With the growing rate of unemployment the number of people entitled to the medical card has increased. At the moment there are 1.76 million people in the State who hold a medical card. Means testing for over-70s will have to take place, because if it does not a time will come when the scheme will be stretched to a breaking point and those who are most in need of the services provided through the scheme will suffer.

Approximately 9.6 per cent of the Irish population over 70 years of age are living below the poverty line. If general cuts are applied, these are the people who will be worst affected by reductions in heating and electricity allowances, home help and possibly the medical card. These are the people most at risk: a small proportion of our society, who must be looked after.

Eoin Lynch tweets at @Eoinlyncho

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