THE CONTROVERSIAL legislation to remove universal entitlement to the medical card on reaching 70 years was introduced in the Dáil yesterday to repeated Opposition objections, and two votes, both of which the Government won comfortably.

Minister for Health Mary Harney said the Health Bill would "introduce new arrangements in order that the vast majority of people aged 70 years and over will continue to have medical cards under a new income threshold".

The Minister said in future people reaching 70 would have three "gateways" to a medical card. "First, under the new gross income limits, we expect 95 per cent will qualify because their income will be below the new limits of 700 a week for a single person or 1,400 for a couple. Second, people whose gross income is above the limits may still apply for a medical card using the standard net income means test which applies for people aged under 70 years. This takes account of personal circumstances, such as high outgoings on nursing home fees. Third, a person may still apply for and be granted a medical card if his or her health circumstances cause undue hardship, under the discretionary medical card arrangements." She also announced her intention to introduce an amendment to "ensure that a person aged 70 or over would not lose their medical card as an immediate consequence of the death of their spouse".

Criticising the legislation, Fine Gael health spokesman Dr James Reilly said "the fact is that the over-70s medical card cost 220 million last year, while 86 million of this was attributed to GPs' fees. Following all the brouhaha, the Minister has managed to save 16 million, which gives lie to the spin that this was all about GPs' fees."

He also had a "major issue" with "the line which states the Minister will review and may change the threshold, with the consent of the Minister for Finance".

Labour spokeswoman Jan O'Sullivan reiterated her party's "vigorous" opposition to the Bill and said that "the universal entitlement to a medical card, which gives free access to primary care, for all over-70s must not be taken away. I again urge the Minister to reconsider her decision." Much reduced income thresholds under the new system "only became more realistic in terms of including more people because of the outcry".

Sinn Féin health spokesman Caoimhghín Ó Caoláin vehemently opposed the legislation and pointed to acknowledgment by the Minister that the "number of people over the age of 70 who are in receipt of a medical card exceeds by 10,000 the number of people over the age of 70 in the State. She explained this anomaly by saying that it 'probably' resulted from "people who passed away" continuing to be "factored into the equation".

"It is a damning indictment of the Minister, her department and the HSE that for all their bureaucracy, they are unable to ensure that GPs are not paid medical card fees in respect of thousands of deceased patients."