THE HSE has missed another big target by issuing 40,000 more medical cards than planned this year.
Health budgets are under additional pressure as a result of the unexpected spike.
The number of people covered by either a medical card or a GP-visit card is now edging towards 2 million, latest figures show.
However, Stephen McMahon, the head of the Irish Patients' Association (IPA), has warned in advance of the Budget that there should be "level heads" in response to the recession.
He said "fiscal surgery" should not be performed without taking into account the long-term effect on patients.
"It's absolutely critical that citizens who can no longer afford to pay for their primary care are provided with medical cards to gain access to medical care," he said.
"If they can't visit a family doctor and they have a serious condition, they will end up in a far more serious position."
This will then place more pressure on an overstretched hospital system.
Mr McMahon said many working people are struggling to afford GP care, and there are huge challenges ahead in the provision of services.
The HSE said that there had been an increase of 144,540 people eligible for a medical card by the beginning of October.
The number of people covered now stands at over 1.8 million, while the numbers covered by a GP-visit card is 131,191.
A recent HSE performance report said that the growth beyond service plan levels is "putting upward pressure" on general medical costs.
The number of items reimbursed on the medical card scheme has grown by 3.1 million items when compared to the same period last year.
Meanwhile, HSE figures show that more than 95pc of properly completed medical card applications were processed within the target time frame of 15 days.
A report from the HSE said that the remaining cards are a "work in progress and the majority of these relate to the assessment of discretionary medical cards".
Last week, Health Minister James Reilly promised to introduce free GP care for everyone from 2015 -- but could not say what it would cost. The minister made the pledge of free doctor visits for all as he outlined a timeline for major health measures, including the introduction of universal healthcare insurance from 2016.