It is the mess that refuses to go away. For over a year, issues surrounding the withdrawal of discretionary medical cards nibbled away at the Government, before taking a big bite out of its credibility during last month’s elections.
But even yesterday, confusion remained the order of the day, with Ministers promising that some of those who had their discretionary cards removed following a review would have them returned.
At the same time, the HSE issued a statement restating the formal position, which is that there is currently no legal basis for reinstating eligibility.
While Department of Health officials were sent off to consult with the Attorney General on the legal options available, the practice on the ground was causing even more confusion.
Warning letters threatening the withdrawal of cards are still arriving in people’s houses, and cardholders who should be safely able to hold on to their card following last week’s suspension of reviews are still being told to file medical reports and tax papers.
Adding further to the confusion is the fact that thousands of over-70s are set to lose their medical cards around now due to the change in income thresholds for eligibility in last year’s budget.
This has nothing to do with the row over discretionary cards but the loss of their entitlement is clearly causing anguish among this age cohort. Those who lose their cards in this way will still be entitled to a GP visit card.
Legal challenge
The decision by Ministers to order officials to find a fix that will lead to the reinstatement of cards poses a significant legal challenge. Two years ago, the Government backed off extending free GP care to people with long-term illnesses because of the legal issues that arose. Now it’s effectively heading down the same road again, and predicting a different result.
Conditions
Government sources say there is a difference. In 2012, the proposal was to extend entitlement through the long-term illness scheme, which includes a haphazard and outdated list of conditions.
Now, what is being suggested is a complete redrafting of the basis on which medical cards are awarded, with the qualifying conditions being determined by an expert panel of doctors.
That should be a more secure approach legally, but it won’t happen fast. In fact, it sounds like a complex task, both clinically and legally, and the outcome is likely to be challenged by disappointed applicants. The likelihood is that more medical cards will be issued, on top of the 1.9 million already in existence. Who is going to pay for that? The Minister for Health is unlikely to be around for much longer, while his Minister of State, with responsibility for medical cards, is likely to be focusing all his energy on getting elected as Labour leader.
With the European Commission saying we are already spending too much on health, the extra money spent on medical cards will almost certainly be recouped from some other part of the health service, to the detriment of some other group of patients.