Some shape is emerging on the timetable for implementing the universal health insurance (UHI) policy championed by Minister for Health Dr James Reilly.

After dire warnings in recent weeks from the Department of Public Expenditure that UHI could cost up to €1,600 a year per person, the Cabinet will not get an exact estimate of the costs until the first three months of next year.

Government sources said this time frame was always envisaged, but the lengthy consultation period, which includes a constitutional convention-style assembly, means there will be no detailed costings this side of the local and European elections.

Politically, it means any mention by the Opposition in the coming months of the €1,600 can be somewhat neutralised. Expect Government politicians to say no costs have been finalised, and the process is ongoing. It may not hold much water, but at least it is an excuse.

Some in political circles are raising the prospect of Reilly not being in the Department of Health following a Cabinet reshuffle, expected later this year, and question what effect this will have on UHI, his signature policy. However, one senior figure said "Government is continuous" and UHI will be pursued over two terms.

White

Paper

The health cover is expected to be discussed by the Cabinet today, a little sooner than expected, and publication of the White Paper will follow soon after.

The memo circulated by the Department of Health yesterday is “another step along the road”, according to one source, and it provides some more detail.

Under Reilly’s proposed timetable, publication of the White Paper would be followed by an immediate consultation process to be completed by mid-July.

A proposed citizens’ health assembly to be established as part of the broader consultation process would be put in place by the end of May and a final set of costed recommendations would be sent to Reilly by the end of next January.

The proposals to be considered by the Cabinet confirm that people who refuse to take out cover for a standard package of universal health insurance face having the cost deducted at source from “earnings or benefits”.

However, the proposals also say uninsured people may on occasion require emergency healthcare and that a special fund should be established by the State to pay their treatment costs.

Drug costs
The draft proposals say the inclusion of drug costs – subject to a co-payment – either as part of the standard UHI package or through a separate eligibility scheme replacing the GMS and drug payment scheme will have to be considered.

“In particular the Government will wish to cover the drug costs of the lowest income groups, as currently applies to those with medical cards,” the document says.

It also says that, in drawing up its proposed standard basket of services to be covered, the Government will have to examine the status of groups who have been given access to free medical services in the past such as hepatitis C patients, people affected by thalidomide and women who underwent symphysiotomy.

Under the proposals, the first stage of UHI to be rolled out will be free GP care, beginning with children aged under six this year, with the rest of the population covered by free GP services by early 2016.

The proposals say it is the intention of Dr Reilly that all legislation to support the phased introduction of UHI will be put in place during the lifetime of the Government, including a comprehensive Universal Health Insurance Act.