Mark Butler (Hindmarsh, Australian Labor Party, Deputy Manager of Opposition Business in the House of Representatives) Share this | Hansard source

I rise to speak on behalf of the opposition in relation to the Private Health Insurance Amendment (Income Thresholds) Bill 2021. I indicate that the opposition will be supporting the passage of this bill, although I also foreshadow that, at the end of my remarks, I'll be moving a second reading amendment.

The bill is relatively modest in its terms but substantial in its impact. It essentially extends the freezing of income thresholds for the different rates of private health insurance rebate and also the incomes at which different Medicare levy surcharge rates cut in. This was a decision in the first Abbott and Hockey budget in 2014 which has operated since that time. At the time that government decided to freeze the Medicare rebates, the MBS rebates, a decision that they maintained until we pressured them to lift those in 2019.

I think it's important that middle-income Australians, particularly, remember this when they listen to the government's rhetoric about them standing up for the financial position of middle-income households in Australia because the freezing since 2014 of these thresholds does have a substantial financial impact on middle-income households. If your income creeps over particular thresholds through the very modest wage rises that people are able to obtain under this government's wage settings then there is a substantial impact on your household budget, irrespective of whether you have chosen to take out private health insurance or not. For example, if the wage of a single person, not a couple-household but a single person, creeps over $90,000, one of the relevant thresholds in this legislation, to, say, $90,100 and they do not have a qualifying private health insurance policy then they will move from not being liable for the Medicare levy surcharge to being liable for a one per cent Medicare levy surcharge—that is, one per cent of taxable income. It not only takes account of their wage or salary but also takes account of reportable fringe benefits. For example, someone with no reportable fringe benefits who has a salary of $90,100, because these income thresholds are being frozen by the Morrison government and not rising as wages are rising, that person will move from having no Medicare levy surcharge liability to having a one per cent liability, which for that person would be as much as $884 per year, or $17 per week. If that person does have a qualifying private health insurance policy then moving their wage or salary to $90,100 will also cause their private health insurance rebate to drop by as much as 8.2 per cent. For a single person on a $2,000 a year private health insurance policy, their rebate, because their wage has moved up, would drop by 8.2 per cent, or about $164 per year.

This position that the government initiated in 2014 and, through this legislation, is proposing to extend for the next couple of years would have a substantial impact on middle-income households. Granted the budget papers indicate that not many people are going to get a wage rise over the coming four years under this government's wage settings, but for those people who, through increments in their agreement or whatever, are able to see their wage or salary rise above that threshold of $90,000, or the other thresholds contained in this legislation, there is a hit to their household budget yet again, as there has been every year since this government came to power, irrespective of whether you do or do not have a qualifying private health insurance policy. This is the same group of middle-income households, in addition to low-income households, who will be hit with a tax hike next year. For someone on $90,100, their tax hike next year will be $1,080—that is, $1,080 in addition to the impact on the household budget through the operation of this legislation. We're not going to get in the way of this government doing this, as we haven't since 2014. This is a substantial fiscal saving for the government, although it's not set out in the explanatory memorandum. If you go to the budget papers, this does return to the budget about $300 million over the course of two years because of an extension for two years. This saving to the budget is essentially money taken off those middle-income households by this government and returned to the budget. As I said, these same households are facing the prospect at the moment of a tax hike from next year of about $1,080 per year.

As I've said in relation to the other very narrow, and in some case modest, pieces of legislation the government has brought forward over the last couple of weeks since the budget was announced, this federal budget had next to nothing. It was incredibly hollow in the general health space. There was essentially nothing there. There were substantial announcements in mental health that people are still going through, particularly in light of more substantial announcements again from the Victorian government following the Victorian royal commission into mental health. There was a substantial amount of money allocated to aged care; although we would say that it misses some of the very important central recommendations of the Royal Commission into Aged Care Quality and Safety, particularly around workforce, around clearing home-care waiting lists and also around transparency and accountability by providers for the money they receive either from taxpayers or from user contributions. But in the area of general health, there was next to nothing in this budget.

There are a couple of issues, though, that were raised from the budget that I do want to address. The first is telehealth. This was one of the very few announcements in the budget that goes to the general health of the population. The member for McMahon, when he was the shadow health minister last year, time and time again urged the government, as Australia locked down in the beginning of the pandemic, to put in place broad telehealth measures to allow patients to consult with their doctors and other treating health practitioners under the MBS scheme, to do so remotely, to do so over the phone where appropriate or over video consultations where appropriate as well. We on this side were glad that the Minister for Health finally agreed to that urging by the member for McMahon and also by health groups, health practitioners and patient groups as well.

The minister, to his credit, said in November that it was his intention to make telehealth broadly a more permanent feature of the Medicare system. Again, that is something we welcomed and hope it is something that unites both sides of the House but, since that announcement six months ago, all we have seen is a six-month by six-month extension of the telehealth measures. They good as far as they go but not a very firm foundation for certainty and for planning either on the part of health practitioners or patients.

Telehealth measures were due to expire in June, so when the minister over the last few weeks—I cannot remember the date exactly—announced another six-month extension to the end of calendar 2021, that was broadly welcomed. It wasn't a permanent extension, which was what the minister foreshadowed in November, which is what people would like, but it was at least an extension that gives us some certainty over the course of this calendar year. But frankly, there was a fly in the ointment. Health practitioners, health groups and patients who welcomed the minister's announcement initially, once they went to finer detail, were quite shocked, because this was detail about which, as I am advised at least, there was no consultation. There was no consultation with doctors' groups, patients groups or other health groups about the decision that the minister made to extend telehealth measures but to discontinue, really, all but two MBS items for phone consultations.

These items have been a very significant part of the telehealth system through the pandemic. For example, there were 2.8 million items for level C phone consults, as I am advised, through this period since the beginning of the telehealth measures in the first half of last year, and 200,000 items for level D consults over the phone since the measures were introduced. The AMA president, Dr Omar Khorshid, said the profession had been blindsided by the decision the minister made to discontinue these phone consultations with no consultation and no notice, pretty much immediately. The AMA president said: 'The permanent future of telehealth must include access for people who are disadvantaged, and that means, at this stage, telephone consults. The beneficiaries of telehealth are patients, not doctors.' He further went on to say, 'We believe that the quality of care provided over telephone consultation is excellent, so long as it's being done appropriately, and is no different to what is provided over video.'

There are obviously circumstances in which a remote or virtual consultation between doctor and patient needs to be by video because there needs to be a level of visual contact and communication between them—to inspect something visually, for example, or a range of other circumstances that are too manifold for me to outline. That ultimately, though, has to be a matter of clinical judgement. We had heard talk in this city that the department or the minister or both were concerned that these phone consult items were being overused or were being misused. We hadn't heard any particular examples of the way in which that was alleged to have happened, but we'd heard that there was concern about the use of these phone consult items. But I've not seen anything specific. If there is misuse of anything in the MBS system, there are strong avenues for the government to take action. But I've heard no specific allegations.

Then we heard that there is a view that phone consult items are generally just not appropriate, that there should always be a visual element to the virtual communication between doctor and patient. That just ignores the fact that there are vast swathes of the population still who are uncomfortable with that type of communication, particularly older Australians. Many older Australians are comfortable with it, but, disproportionately, older Australians—GPs tell me, and I'm sure they tell other members of this House—are not at the moment comfortable with that level of technology. And there are different levels of access to that technology through the country.

Ultimately we should trust the clinical judgement of our medical workforce in this respect. Doctors will take the view that in certain circumstances they need a video consult, but in other circumstances it might be quite sufficient for them to have a conversation over the phone with their patient, particularly where that patient is more comfortable with the telephone or is restricted to the use of telephone rather than video communication. I still do not understand—and the GPs I talk to as I travel around the country do not understand—why the government, with no specific allegations of broad, systemic misuse, with no consultation with representative groups like the AMA, the college and others, have made this decision. It looks brash. It looks knee-jerk. I think it needs to be reconsidered by the government.

The second thing that I think was notable in a very modest offering from the government around broad health policy in the budget was a decision to increase bulk-billing incentives in rural, regional and remote Australia—something we would all support. Labor has always supported the judicious use of incentives through the system to lift bulk-billing rates. We understand, through long experience, that having access to bulk-billing rates and medical workforce is more challenging in rural and regional Australia than in our big cities. We're not pretending things are all hunky-dory in our big cities—there are very significant access issues and bulk-billing issues in our big cities as well, particularly bulk-billing issues as a result of the government's long-term freeze of Medicare rebates over many years. But we know that it's more problematic in rural and regional Australia.

The issue this raises, though, is this ongoing anomaly in the system that flows from the introduction of the Modified Monash Model. As we understand it, these increased bulk-billing incentives apply to Modified Monash Model areas 3 to 7 and not to 1 and 2. On this side of politics, on this side of the House, we have been raising time and time again the issues that some outer suburban areas continue to have with workforce shortage—what we used to call the old districts of workforce shortage, now called DPA. We've been raising that time and time again. Particularly we've also been raising the challenges in access to medical services in some of the regional areas that were reclassified through the introduction of the Modified Monash Model.

I was in the Hunter Valley and on the Central Coast in the past couple of weeks. I spent time with Labor members in those areas, talking to general practitioners at roundtables and one on one about the trouble they are having in filling their practice with GPs. I talked to patients about the trouble they're having getting appointments and, when they do get appointments, getting bulk-billing appointments. We know that the change in status of those areas has been an ongoing problem since that time for the Hunter Valley and for the Central Coast.

Last week I had the absolute pleasure of spending time with my friend and colleague the member for Richmond, who's got a great background in health, as a former aged-care minister, and understands these issues very, very well and deeply understands the circumstances in her electorate. Again, in that beautiful part of northern New South Wales—one of the most beautiful parts of our country—there are exactly the same issues that I encountered in the Central Coast and the Hunter Valley with the application of this modified Monash model. They get no relief from this budget, either.

This was a very modest budget. We've wracked up $1 trillion in debt and the Treasurer spent $100 billion in one night, but for general health there was pretty much nothing—the cupboard was pretty much bare. There's a $300 million saving measure through the health budget contained in this bill. We won't oppose that measure but, in terms of additional services, at a time when demand is skyrocketing, we have an ageing population, an increasing incidence of chronic disease and a more complex level of demand placed on our health system, this government had nothing for the general health system. With those remarks, I move:

That all words after "That" be omitted with a view to substituting the following words:

"whilst not declining to give the bill a second reading, the House urges the Government to better protect Australians’ health during the pandemic and deliver a more sustainable, equitable, and effective health care system."

See this speech in context