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Opinion A million people have no health cover as low-paid families are excluded from access to the medical card

Since 2012 there has been a 66% increase in the number of people with no private or public health cover, writes Feilim O’Rourke.

MORE THAN A million people in Ireland now have no health cover – that is they don’t qualify for the medical card but they don’t have private health insurance either.

And the number of households who are left out in the cold by our two-tier health system has shot up since 2012 when it was 640,000. That is a 66% increase in the number of people with no cover. 

While the population is growing, there also appears to be a deliberate policy of removing medical cards from low-paid households.

The methodology employed is pretty clever too, the government didn’t have to lower the income limit for the medical card at any stage – it just hasn’t raised it since 2006. Every year they fail to raise the limit, fewer workers qualify for the card. 

Back in 2006, the income limit for access to the medical card was set at 18% above social welfare rates, meaning that very low-paid families had access to free healthcare.

People who get all their income from social welfare have an automatic entitlement to a medical card, but for workers the income limit is now set below the level of the Job Seekers Allowance for all households, whether they are individuals or families.

For those people the impact of this can be devastating, if they experience illness and need hospital treatment they will have to pay, if they can’t afford to, they get into debt increasing the stress of having an illness. 

Just before Christmas, the Irish Cancer Society called on the HSE to stop using debt collection agencies to pursue cancer patients for monies owed.

Those who are dependent on social welfare get the medical card, the higher income group get tax rebates linked to their private health insurance but low-paid workers and their families are forgotten about.

The Minister for Health must be held responsible for the on-going erosion of Irish citizens access to healthcare. 


The Republic of Ireland has a population of approximately 4.8m. There are approximately 1.6m households with medical cards, 2.2m with private health cover and that leaves around 1 million people with no health cover.

Since health care is so essential, we have to assume that most of those people who don’t have any are low-paid and can’t afford private health insurance. 

During the period from 1998 to 2006, the Medical Card income limit was regularly adjusted and remained above the level of Job Seekers Allowance.

In 2006 the Medical Card income limit was set at 18% above Job Seekers Allowance rates but that income limit has not changed over the last 12 years, so now it has fallen below social welfare rates, which have increased by 35% in that time.

Any person whose entire income is from social welfare automatically gets the card.

Some low-paid workers have access to the card because certain forms of income such as Family Income Supplement aren’t counted as income for medical card assessment purposes. Also, some expenses, such as childcare and other costs of going to work are deducted to arrive at the net income for assessment. 

Because of these factors, it is hard to define precisely who does and doesn’t get the card but what is clear is that every year the government fails to increase in the income limit, more low-paid workers are being excluded. 

Safety net

Some low-paid workers, who don’t qualify for a medical card have been issued with GP cards but that is not the same thing at all. It only covers GP visits and doesn’t provide access to the range of health services people might need. 

The medical card provides for outpatient, inpatient and A&E services in public hospitals, some free dental work, vision and hearing treatment, reduced prescription charges and priority access to community care services.

It is also linked to other essential services which are exclusively offered to medical card holders, this system was developed when many low paid workers had the card. Those services include free school transport, free entry to state exams, cheaper childcare and a maternity grant.

Excluding low-income workers from access to the medical card is likely to be a significant disincentive for some people to return to work.

As such the system needs to be radically overhauled to bring low paid workers back under the safety net of free healthcare, to which they previously had access. 

When the Irish Cancer Society called on the HSE to stop using debt collection agencies to pursue cancer patients, the HSE responded by saying that they act “in a socially responsible, ethical, efficient and cost-effective way”.

But their actions are not ethical at all. They have silently removed access to the medical card from many of Ireland’s working poor.

It is time for the Minister of Health to intervene and increase the medical card income levels by 35% in order to restore public health care access to those who cannot afford to pay for it. 

Felim O’Rourke is an economist from Sligo with a particular interest in the impact of tax and welfare policy on ordinary workers.

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