Fine Gael and Labour squabble over victory in battle for medical card spending

Fine Gael and Labour sources were last night claiming victory in the internal battle within the Coalition over proposals to cut medical card spending by €113 million next year on foot of "probity measures".

The Government yesterday agreed to provide an additional €47 million in health spending next year, a move which facilitated a dramatic scaling back of the original target for cuts to the medical card expenditure.

Probity measures will now aim to generate savings of only about €23 million.

Fine Gael painted the result as a victory for Minister for Health James Reilly. Fine Gael sources said the level of savings on the probity tests imposed by Minister for Public Expenditure and Reform Brendan Howlin was shown to have been unattainable.

“This has to be seen as a victory for James,” said one Minister.

Strained relations
However, in a sign of remaining strained relations between the Coalition partners over health, one Labour source said Dr Reilly's contribution at Cabinet "was received with the usual rolled eyes".

Another source close to the Government said that the political system had decided that the Health Service Executive could not be trusted with the implementation of the original probity measures and pointed to the recent controversy surrounding the health authority asking terminally ill multiple sclerosis patient Marie Fleming for proof of her condition to qualify for a renewed medical card.

The source said there was fear among Ministers at the damage the health service could cause in pursuing the medical card probity plan.

One source maintained that the HSE had initially proposed an €80 million probity exercise that would have involved a means test being carried out on all medical card holders, including social welfare recipients.

However, in a confidential letter to Dr Reilly, issued as part of the service plan process, HSE chief Tony O’Brien said the €113 million savings target had been put in place “against the explicit advice of the HSE and the Department of Health”.

In the letter he said that even if 225,000 cards were withdrawn the maximum possible saving would be €44 million.

“Achievement of the full savings target is not in the [HSE] directorate’s view achievable without significant policy changes which would have the effect of rendering ineligible persons who currently are eligible, with the social and health consequences that would flow from that.”

Egging the pudding
Separately other sources in Government maintained that Dr Reilly was "egging the pudding" in relation to effect of the savings being sought.

The source maintained that a significant amount of the overall saving of €666 million would stem from payroll cuts already announced under the Haddington Road deal with about €100 million coming from the carry-over into next year of measures such as cuts in fees for GPs and pharmacists that were introduced in 2013.