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 Header Item Funding of Disability Services: Motion [Private Members] (Continued)
 Header Item Health Insurance (Amendment) Bill 2012: Report and Final Stages

Tuesday, 4 December 2012

Dáil Éireann Debate
Vol. 785 No. 1

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  9 o’clock

(Speaker Continuing)

[Deputy Maureen O'Sullivan: Information on Maureen O'Sullivan Zoom on Maureen O'Sullivan] Cutting personal assistant and home help hours will be much more costly in the long run, in addition to the awful effect on the person with a disability whose quality of life is being affected.

  In terms of mental health, we are aware of the disproportionate relationship between the number of people with mental health issues and the financial allocation to services in this area.

Debate adjourned.

Health Insurance (Amendment) Bill 2012: Report and Final Stages

Deputy Billy Kelleher: Information on Billy Kelleher Zoom on Billy Kelleher I move amendment No. 1:

In page 4, between lines 6 and 7, to insert the following:
“(b) the necessity of ensuring, in the interests of societal and intergenerational solidarity, that the more healthy, including the young access health insurance cover so as to ensure that the health insurance market is made up of a sufficient mix of the more healthy, including the young and the less healthy, including the old,”.

This amendment is on foot of the discussion on Committee Stage about the difficulties the insurance market is facing and my concern that if we are to develop the notion of intergenerational solidarity, community rating and risk equalisation, the need to get young people into the health insurance market is of critical importance. That is the reason I put down this amendment. It is because of the necessity to ensure, in the interests of societal and intergenerational solidarity, that the more healthy, including the young, access health insurance cover and that the health insurance market is made up of a sufficient mix of the more healthy, including the young, and the less healthy, including the old.

  The purpose of this amendment is to ensure we have a sustainable health insurance market in the next number of years. The Minister has committed himself to bringing about universal health insurance. We can have a debate about that another day but in the meantime, even if we move towards universal health insurance, it is critically important that we have vibrancy and sustainability in the health insurance market. That means we must have an approach whereby young people see it as beneficial and there is merit in taking out private health insurance with a health insurer. Otherwise, we will have a situation, as is currently the case, in which people are reducing their cover and even reducing the number of people insured in their families. We now have cases in which the father in a family has given up health insurance because he cannot afford it.

  I do not expect the Minister to resolve the difficulties families are under in terms of funding private health insurance but, at the same time, it is within his remit at least to try to curtail rising health inflation and to ensure also that we have an attractive health insurance market that gives people some reward for taking out private health insurance. If we do not do that we will not have a sustainable intergenerational support base for young people to assist in community rating and cross-subsidisation in terms of those who are older and drawing on health insurance. That is the reason behind this amendment. I tabled it knowing the Minister would reject it, but I wanted to stimulate some debate between now and the time when universal health insurance is established, so that in the meantime we can have a sustainable, vibrant insurance market in which there is cross-subsidisation, risk equalisation, community rating and intergenerational solidarity.

Deputy Denis Naughten: Information on Denis Naughten Zoom on Denis Naughten I support Deputy Kelleher's amendment. He has made a valid argument, which we raised with the Minister on Committee Stage, regarding the challenges we face. The reality is that unless we can encourage young people to go into the health insurance market we will continue to see the haemorrhaging of individuals and families out of the system. It is estimated that by the end of this year approximately 200,000 people will have left the health insurance system since 2008. Something must be done to incentivise people to take up health insurance and encourage others to join up for the first time.

The difficulty is that the Health Insurance Authority has said that is a pointless exercise at this stage in that universal health insurance will be introduced in four years' time and therefore it will not make a huge difference. The reality is that it will take a period of time to implement universal health insurance in its totality. It will not happen in four years' time. Hopefully, it will commence at that stage, but it will take a period of time to roll out. There was a contribution by the health insurers at the Oireachtas committee recently and, according to their evidence, it will take ten years to implement universal health insurance. If we are talking about up to 14 years for the full implementation of universal health insurance, many people will have leaked out of the system in the intervening period. Some type of incentive must be built in.

The argument is being made by the Health Insurance Authority that once universal health insurance comes in everyone will be legally obliged to sign up to health insurance and therefore we will not have to try to incentivise it. The difficulty is that we must try to get new people into the system now if we are to make the health insurance system sustainable in the short term. The argument I made to the Minister on Committee Stage was that some sort of incentive must be put in place, and not just for young people coming into the health insurance market. Why should someone who has continuously paid his or her VHI subscription year in, year out for the past 40 or 50 years have to pay the same amount for the same benefits as someone of the same age who is signing up for the first time?

In the past, when the Minister articulated the view on universal health insurance, he said there would be an incentive for insurers to improve the quality of health of the cohort of people they have insured. They would encourage people to give up smoking, lose weight and so forth, but how do we encourage that? Some incentive must be given to the individual for them to lose weight or give up the cigarettes and if that is not built into the price of the policy some other added bonus must be offered. I have suggested to the Minister that whatever carrot, so to speak, is looked at under universal health insurance, it should also be offered to people currently in the health insurance system in advance of the introduction of universal health insurance here. It is a fair proposal that is being put forward because incentives will be built into the universal health insurance system. Regardless of what they are, they will be decided by the insurers in many cases. Surely we can make some provision, as part of the roll-out of universal health insurance, that people already in the system get some additional benefit on foot of others coming into the new system in the future.

Deputy Timmy Dooley: Information on Timmy Dooley Zoom on Timmy Dooley I support my colleague's amendment to this legislation. It is difficult not to be repetitive considering that the two previous speakers valiantly pleaded for this amendment to be accepted. It is clear that health insurers are having difficulties not just in trying to get the intergenerational mix about which my colleague, Deputy Kelleher, has spoken but also to retain the existing participants in the scheme. I see that as a major challenge, knowing many people who have had no choice, because of the decisions taken by this Government, but to cease payment in the private health insurance market. Some of those are more likely to be young, healthy individuals who by their nature are taking a gamble now in the hope that they will not need insurance in the future.

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