Mathias Cormann (WA, Liberal Party, Shadow Parliamentary Secretary for Health Administration) Share this | Hansard source

I move:

That this bill be now read a second time.

The Health Insurance Amendment (Revival of Table Items) Bill 2009 amends the Health Insurance Act 1973 to provide for the revival of certain medical services items should later items be disallowed.

This bill is part of our efforts to stand up for patients across Australia in need of timely and affordable access to quality health care and is sponsored by the coalition together with Senators Fielding and Xenophon.

The aim of this bill is to address a serious shortcoming in the Health Insurance Act 1973, which has become apparent in the context of a majority of senators seeking to put a stop to ill-considered government moves to halve a series of Medicare rebates for cataract surgery.

On budget night in May this year the government announced that it would move to reduce Medicare rebates for cataract surgery by 50 per cent.

This meant in effect an immediate $313 increase in out-of-pocket expenses for the many thousands of mostly elderly patients accessing this surgery through the private health system.

The flow-on-implications for private health fund rebate arrangements meant further increases in out-of-pocket expenses as a direct result of the government’s actions.

The government owned Medibank Private for example announced that its rebates for cataract surgery would reduce by a further $290 as a direct result of the MBS rebate change, taking total additional out-of-pocket expenses to more than $600 per episode.

This would make this life-changing surgery unaffordable for many senior Australians.

There is no doubt that it would push many into an already overburdened public health system—a public health system in which the taxpayer would have to spend more than $3,500 for every cataract surgery procedure, providing those patients who are lucky enough to get in with free access to this procedure.

The government is in fact proposing to save $313 per procedure on one hand, and to force taxpayers to pay more than $3,500 for that same procedure in the public health system on the other.

It does not make sense.

Furthermore, cataract surgery is clearly a very cost-effective preventative health measure, helping to prevent falls, fractures and mental stress.

Affordable and timely access to this treatment can mean maintaining an independent life—continuing to live at home, continuing to drive a car, continuing to remain active. In short, this is indeed a life-changing treatment.

For these and many other reasons to be detailed during the debate on the disallowance motion immediately after this bill has been determined, the coalition together with Senators Fielding and Xenophon announced that we would move to stop the government from going ahead with this.

Given the budget cut was to be implemented by regulation the only procedural option available to us to achieve that objective was to move a disallowance motion in relation to the items the government was seeking to reduce in the Senate.

That is why the coalition, together with Senators Fielding and Xenophon, announced back on 8 September 2009 that we would seek to disallow the government’s 50 per cent reduction of cataract surgery related Medicare rebates.

True to form the Rudd government left things to the last minute, yet again only coming to the Senate at the last minute, on this occasion by tabling the regulations to give effect to the reduction of cataract surgery rebates two days ago—even though those reductions were announced as far back as May this year and even though those reductions are to take effect from 1 November this year. That is, those regulations were tabled in the Senate with only four days to go before they are to take effect.

The government has refused to take any responsible action despite the well-publicised intentions of a majority of senators.

Consistent with our previous announcements the coalition and Senators Fielding and Xenophon gave notice yesterday of the notice to disallow as well as circulating two amendments to the Health Insurance Act 1973.

Faced with a lack of support in the Senate for its budget cut, the government at first did nothing, then the minister went for the scare campaign, and then with only four days to go the government recklessly pressed ahead with its ill-considered budget cut regardless of the consequences for patients.

The Minister for Health and Ageing, instead of opting for the responsible course of action, seeking to respond constructively to the clearly expressed wishes of a majority of senators, decided to ignore the Senate, to scare patients, to scare doctors and to threaten the Senate.

Indeed, for a number of weeks now the minister has effectively threatened the Senate by stating that if the Senate were to disallow the various reductions in cataract surgery related MBS items then ‘There will be no payment, no scheduled fee for a cataract procedure.’

She indicated that those items would disappear altogether.

There is no proposal to ensure that does not happen, and no initiative from the minister to ensure patients do not get hurt because the government is not able to get the support of the Senate for its ill-considered budget cut.

The problem with the minister’s interpretation and with her legal advice is that, if it is correct and if it is allowed to stand, it would in effect mean that governments can make any cuts they like to the Medicare Benefits Schedule without the Senate ever being able to stop them.

So, however ill-considered the budget cut, however many senators are opposed to it, however sound and well considered the reasons for disallowance may be, the Senate would not be able to do a thing about it.

If this situation were allowed to stand, any disallowance motion in relation to cuts to the Medicare Benefits Schedule, now or at any time in the future, would be completely ineffective.

Clearly that cannot have been the intention of the parliament when delegating the power to make regulations to the government.

If the Health Insurance Act 1973 as it stands delegates power to the government to make regulations reducing any Medicare item rebate without the Senate being able to do anything about it, then clearly that legislation needs to be changed.

By supporting this bill the Senate would formalise its view that the current situation is unacceptable and that the Senate wants the relevant legislation changed with effect from 26 October 2009.

When asked by governments to give them power to make regulations under various acts of parliament, the parliament, and in particular the Senate, is invariably told reassuringly by government representatives, ‘Don’t worry; if you’re not happy with what we’re doing, you can always move a disallowance motion and stop it from going ahead.’

We have heard that recently in relation to the extended Medicare safety net bill. But, of course, the Senate very wisely introduced a different process, where both houses of parliament have to formally agree rather than go down the fraught path of disallowance motions.

The reality we are now faced with very clearly demonstrates that in relation to government initiated reductions in MBS rebates that appears not to be the case under the legislation as it currently stands.

Clearly this is a serious issue and one which the coalition and Senators Fielding and Xenophon have very seriously considered.

Our intention is to stop the government from reducing the cataract surgery related rebates.

Our intention is not to create a circumstance where there is no rebate at all—of course not.

Last Wednesday during Senate estimates we put the specific question to the senior official responsible for the MBS in the health department: ‘If the Senate were to disallow the reduction in cataract surgery related rebates, what would happen?’

The answer was, ‘The items would revert to the previous rebates,’ in clear conflict with the public assertions of the minister up to that time.

This clearly points to confusion and doubt on this issue, even at the most senior levels of the government.

By last night the minister had pulled her department back into line and back onto message—who would have expected otherwise?

However, by yesterday afternoon, the time of giving notice of the disallowance motion in relation to cataract surgery rebate reductions, nobody from government had made any moves to correct the record of evidence given to a committee of the Senate.

That is, the evidence from the senior official on this issue has been allowed to remain on the public record uncorrected for nearly a week.

The minister this morning circulated very recent advice which she obtained yesterday afternoon and the departmental official very clearly is trying to cover her bases. She is trying to say she was right then and she is trying to say that she is still right now. She is trying to say that she was right in saying that if we disallow these items they revert back to the previous items and she is also trying to say, ‘Actually, no, if you disallow those items, the items will be deleted altogether.’

It is done in a very clumsy way. It is clearly an attempt to walk both sides of the street and cover up something that was a mistake, that was wrong and that was false evidence to a Senate committee.

In any event, the coalition and Senators Fielding and Xenophon had long decided to take the necessary legislative steps to put the matter beyond doubt through an amendment to the Health Insurance Act 1973—an amendment to make sure that any disallowed item would revert to the previous MBS fee/rebate for those items that have been disallowed.

Indeed, it had long been the intention of the coalition and Senators Fielding and Xenophon to pursue this amendment to the Health Insurance Act 1973 through two simple amendments to the government’s Health Insurance Amendment (Compliance) Bill 2009.

That bill had been listed on the Senate Red on both Monday and Tuesday this week.

The government had given clear and repeated indications to the opposition that the Health Insurance Amendment (Compliance) Bill 2009 was an urgent bill to be passed as soon as possible early this week.

This would have been a very smooth and much less disruptive way to achieve the objectives of the Senate in relation to this issue.

Yesterday afternoon, a day after the government finally tabled the regulations in the Senate on Monday, in very good faith, we circulated our proposed amendments to the Health Insurance Amendment (Compliance) Bill 2009.

What happened next is breathtakingly reckless and irresponsible.

The bill had been fully considered by the House of Representatives and agreed to without amendments. It was about to be put to its third reading vote when, in an unprecedented move, the government decided to stop the process only seconds away from final passage of the bill by the House of Representatives. The government’s aim was clearly to ensure that the bill would not be passed and would not make its way to the Senate before the impending disallowance.

This whole process could have been much more straightforward. If the government had taken a more responsible and constructive approach the Senate would have lost much less time.

We have repeatedly confirmed that we did not support what we consider to be an ill-thought-out, short-sighted budget measure, which would end up hurting many thousands of patients across Australia.

By passing this bill before dealing with the disallowance of the government’s reduction in cataract surgery rebates, the Senate is giving the government a way out.

This is a well-considered and responsible course of action which will protect patients’ interests.

We urge the government to give this bill precedence in the House of Representatives and to support it.

If the government decided to vote this bill down in the House of Representatives or decided to delay its consideration and passage beyond 1 November 2009, the government would effectively be causing the deletion of the Medicare rebate for cataract surgery altogether, consistent with the advice that the minister has received from her department last night and consistent with advice that had previously been provided by the Clerk of the Senate.

We urge the government to very seriously consider its next steps.

If the Senate passes this bill as well as the disallowance motion on certain items of schedule 1 to the Health Insurance (General Medical Services Table) Regulations 2009 then the Senate is making its position very clear:

(1)

we do not support the government’s ill-considered and short-sighted 50 per cent cut in Medicare rebates for cataract surgery;

(2)

we want to stop the government from pressing ahead with that cut in rebates, which would hurt patients and put more pressure on our already overburdened public hospital system; and

(3)

we want the government to accept that, in the interests of the thousands and thousands of patients in need of timely and affordable access to quality cataract surgery in the private system, the rebates for cataract surgery should remain the same as they have been under the previous regulations.

We urge the Minister for Health and Ageing to come to her senses and listen to the Senate.

If she won’t, then we call on the Prime Minister to remember his solemn pledge to the Australian people that on health the buck stops with him.

I commend this bill to the Senate.