Three case studies
• Paula Dorrington (41) from Drimnagh, Dublin is blind. She also suffers from a range of other health problems including epilepsy, diabetes and high blood pressure.
While it would seem that Paula's lot is difficult enough, last January she learned that she was no longer entitled to a medical card. She and her husband, Gus (who is partially sighted) were earning too much.
Paula now has to pay to see her doctor every week as well paying for medication and visits to specialists. On an average week she says she spends around €80 on medical expenses.
The cost of the care she needs sometimes proves prohibitive.
"I have to be careful now. For example if my doctor says I need to see a specialist for my diabetes, sometimes I have to delay the visit because I can't afford it," says Paula.
"I feel my health is suffering as a result of not having a medical card.
"Now I wake up every day hoping nothing will go wrong. When I had the medical card I felt there was something to lean on. Now I've nothing."
• Siobhan Devine (33) from Fairhill in Cork city is a single mother with a 12-year-old son, Aaron who has muscular dystrophy
While she has a six-month discretionary medical card for her son at the moment, since she went back into full time employment last January, Siobhan does not know whether Aaron will keep his medical card from one six month period to the next.
"In March I'll spend another six weeks trying to get it back. I'll have to go to my doctor to get another letter to explain Aaron's case, then go to the social welfare and supply them with the medical information I have before, and wait."
With an income of less than €300 a week, Siobhan says there is no way she could ever afford Aaron's medical bills.
"Every year Aaron goes to Crumlin where he sees a neurologist and has MRI scans and other treatment. He is also partially deaf and has to visit the National Rehabilitation Board to have general check-ups and have hearing-aids replaced," says Siobhan.
"It stressful and I'm angry, to be honest, that people can choose whether you get one or not, when Aaron has such medical problems. It makes me totally fed up," she says.
• Pat McKenna, (not his real name) a truck driver, from Ballinasloe, Co Galway is separated but his wife and two sons are financially dependant on him.
He was diagnosed with an inflammatory bowel condition called Crohn's disease in May and was admitted to hospital, but once discharged he found paying for the drugs a financial strain.
"I was on tablets and they were expensive, about €40 a week. I found it pretty tight to afford them so I stopped taking them for a fortnight."
As a result Pat had a severe relapse and had to attend hospital as an outpatient.
"If he had a medical card, he would not have gone off his medication and would not have relapsed," says Dr Martin Daly, Pat's GP.
Pat is not entitled to a medical card despite his considerable medical costs which include having to attend the doctor every month and paying for medication. His income is over the threshold.
Dr Daly is worried he does not see Pat as often as he should and has just written his second letter to the Western Health Board, outlining Pat's need for a card.
"The State is forcing people to become ill first and then they apply for the medical card. This is not getting a card because you're on a low income; this is getting a card because you're begging for it. It's humiliating for people," he says.