Shayne Neumann MP
Federal Member for Blair

Australian Labor
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Health Insurance Amendment (Safety Net) Bill 2015


I think Australians are rightly proud of our health system. Labor's reforms in government saw 11,000 more doctors, 26,000 more nurses, and more doctors in the bush. It was Labor that built Medicare, it was the Hawke and Keating governments which sustained it and supported it, and we had to rescue it when we came to power in November 2007. Under the stewardship of the member for Warringah as the then health minister, bulk-billing rates were as low as 67 per cent. We attained record GP bulk-billing rates of over 82 per cent by the time of the fall of the last Labor government in September 2013. We invested more money. We invested $20 billion extra in our hospitals and that funding would have continued up until 2020 but for the election of the coalition government.

I do recall seeing that blue book with the smiling visages of the member for Warringah, the member for Wide Bay, and the now Prime Minister, the member for Wentworth. They were smiling sweetly about their plan, the dog-eared plan—the blue book. It looked a bit crusty by the end of the campaign. It was going to set out what they were going to do. When I had a look at this particular legislation, I thought: 'What were they actually going to do on health?' So I pulled out and dusted off the Fiscal Budget Impact of Federal Coalition Policies, which was released a couple of days before the election. I went to section 5.0, Coalition's Health Policies. They were going to strengthen GP practice—well, that has really gone down very well with the GP co-payment proposals in various iterations and the 'GP co-payment by stealth' as the President of the AMA, Brian Owler, talks of. They were going to double practice incentives and invest in regional and rural teaching infrastructure, and a whole range of things such as investing in medical internships and boosting front-line health care and research.

I wonder how that front-line health services boosting is going on with the $60 billion in cuts to health and hospital services. There were a whole range of things. I went down from 5.1 through to 5.17 and the Net Budget Impact—Health Policies as $344 million out to 2016-17. I went through it again to see if I could find a GP co-payment in there anywhere, or a change to the safety net in terms of Medicare, and I could not find it anywhere. In fact, it is not to be found anywhere because the coalition, before the 2013 election, said absolutely nothing whatsoever about this. In fact, the member for Warringah, the then opposition leader, was very quick to say there were going to be no cuts to health, no cuts to education, no cuts to pensions. So the people trusted the coalition when they came to power that they would support Medicare, that they would not make front-line health services harmful and that they would not undertake cuts in relation to hospitals and the kind of care that Australians expect. Why? Because under the previous Labor government we had invested in medical workforce training, shorter times had been achieved in terms of waiting times for emergency and we brought in a Growing Up Smiling package, a kids dental package which was a revolution in terms of what it was going to do. But this government coming to power seemed to break all of that. We had the disastrous budget in May 2014, where they said that Medicare was lacking in sustainability in the health service. They then undertook cut after cut after cut but they did not direct it towards the system, or the sector whatsoever; they directed it towards a future fund.

Research is good. Who could seriously argue that putting money into a medical research fund is a bad thing? Of course we think it is a good thing. We ultimately supported it. But this government undertook cuts everywhere and, in the end, did not put any money back. We saw more than $60 billion cut from Australia's public hospitals. There was an attempt to increase the cost of medicine for every Australian, including through the unfair changes to the Pharmaceutical Benefits Scheme.

Labor are very proud of the Pharmaceutical Benefits Scheme, because we built it; we founded it. The Pharmaceutical Benefits Scheme has been helping millions of Australians each year with the cost of essential medicines. We are very proud of it and we support it. We championed bulk-billing rates. We got them to record highs. We were helping to keep the health costs of Australians lower and helping working families nationwide. But the coalition came into power not saying anything about what they were going to do in terms of the changes they made in the May 2014 budget. They have made it much harder for families to get the kind of health care they need. Families are forced to use their credit card rather than their Medicare card.

What are the government doing here? What are they arguing? They are arguing that the Medicare safety net is primarily utilised not by low-income earners but by middle- and high-income earners. Through this legislation, although the government is introducing a new Medicare safety net with a lower threshold for patients, there are restrictions on some out-of-pocket costs that accumulate towards that threshold, and the benefits payable once patients reached the safety net are also restricted. Why are they doing that and on what basis are they doing it? Is there any empirical evidence whatsoever to support this? How will this enhance the health of the country and the health of families? Will it help in terms of their health costs?

We know that if you take $270 million out of the government contribution towards the health system someone will have to pay. It will be families who will pay. They will pay more. Legislation for family tax benefit cuts came before the chamber yesterday and will be looked at I think today or tomorrow. The impacts on the family tax benefit part A supplement leave 14,715 families in Blair hundreds of dollars a year worse off and the cuts to the family tax benefit part B supplement hit 13,041 families in Blair.

When we made changes to the Medicare safety net in 2009, we did so based on empirical evidence, based on reports done by the Centre for Health Economics Research and Evaluation. We released those reports and, on the basis of empirical data, we looked at what would best make the system sustainable and what would best help families. So we are not opposed to better targeting and making changes; we are opposed to making it harder in the name of simplification. The government is proposing to simplify Medicare safety net arrangements, and that was indeed the theme of their 2014 budget.

You have to look behind the rhetoric to see the impact. This simplification results in an adverse impact on thousands and thousands of patients. It does the three things I mentioned before. It lowers the safety net threshold for all patients, which in and of itself sounds good, but it restricts the out-of-pocket costs which contribute to the patient reaching the safety net and it reduces the amount the patient receives back once they reach the safety net. So on the surface it looks fine, but there is a sting in the tail.

Speaker after speaker on this side of the chamber have talked about the impact on radiation oncology patients—those suffering from cancer, whether malignant melanomas, prostate cancer or breast cancer. The government is simply not listening to the sector. It is certainly not listening to the AMA. My colleagues on this side of the chamber have quoted Brian Owler, President of the AMA, on numerous occasions. As he has said, the new Medicare safety net arrangements, together with the ongoing freeze of Medicare patient rebates, mean that growing out-of-pocket expenses will become a reality for all Australian families, including the most vulnerable patients in our community. The AMA is not an affiliated union to the Australian Labor Party. The AMA is an organisation that is very independent and that is quite prepared to give both sides of the chamber a hit up the chin if it wants to. It is quite prepared to tell both sides they have got it wrong. This is not, as the government suggests, about taking away from wealthy families. In fact this is going to have an impact, as the AMA said, on the most vulnerable patients in our community. It does not have the support of the Royal Australia College of General Practitioners either.

This will have a big impact on my electorate, where bulk-billing rates have hovered between 88 per cent and 92 per cent in the last year or two. So will the GP co-payment by stealth that has been inflicted by this government. That will rip $1.3 billion out of Medicare over the next four years. The amount that we are talking about today is a small amount but it will have an adverse impact on families. If there is a rebate freeze, it will have an impact on the profitability of GPs. A study done by the AMA and the Medical Journal of Australia has found that by 2017-18 the shortfall will leave GPs $8.43 worse off, forcing many doctors to charge patients who are currently being bulk-billed, and resulting in increased gap payments for other patients. On top of the freeze the government is imposing there is another whammy on vulnerable families. In relation to the GP co-payment, which they were talking about before, they could not work out whether it was going to be $7 or $5—there were various iterations. According to the data, it would have had an impact of about $4.7 million on families in the Blair electorate.

The legislation before the chamber is not good legislation. It will have an adverse impact. Let us look at the current arrangements. Under existing arrangements, all out-of-pocket costs for out-of-hospital Medicare services count towards the threshold. Once a patient reaches the extended Medicare safety net, 80 per cent of their out-of-pocket costs are covered for out-of-hospital Medicare services.

This is not good legislation. The government should have a look at itself and withdraw the legislation. That is why Labor is opposing it.