Some 220,000 adults at risk of poverty in Ireland do not have medical cards, the Combat Poverty Agency has said.
At a seminar on the Analysis of the Poverty Impact of Budget 2009, agency policy and research analyst Jim Walsh also said the Budget was a "backward step in terms of child poverty".
The agency found that over 30 per cent of households at risk of poverty do not qualify for a medical card, including 220,000 adults and 45,000 children.
And 35 per cent of those under 70 earning less than €174 a week do not have a medical card.
This contrasts with an over 70s threshold of €700 a week, which offers almost universal coverage for all income groups.
The agency said the findings did not suggest that people over 70 should not have medical cards, but raised the question of why those under 70 years old should be assessed in such a different manner.
There was a high rate of non-coverage for a medical card among low income families, the report found, while at the same time "and rather surprisingly for a means-tested benefit medical card, coverage extends well up the income range".
This may be related to the discretionary clause in the medical card system, the report said. However, it said, it is hard to explain the "significant level" of medical card coverage, of 20 per cent, for people on middle incomes.
The report recommended that income thresholds be reviewed to protect those on low incomes and at risk of poverty, who are more prone to health problems.
The agency also said targeted improvements in child income support will not compensate for the cuts in universal schemes and the changes will have the greatest impact on families on the lowest incomes.
Mr Walsh said the Budget was a backward step in terms of child poverty.
He said the reduction and eventual removal of child benefit for 18 year olds and cuts in the early childhood supplement would save €51 million by 2011.
These cuts would have the greatest impact on people on the lowest incomes, he said, because the supplements made up a greater proportion of their income. Recipients could lose up to €38 a week by 2011.
