Health Insurance Amendment (Incentive Payments and Other Measures) Bill 2026

Senator RUSTON (South Australia—Deputy Leader of the Opposition in the Senate) (19:18): I too rise to speak on the Health Insurance Amendment (Incentive Payments and Other Measures) Bill 2026. Let me say at the outset that the coalition will not be opposing this bill. We support Commonwealth health incentive payments.

In fact, we established several of them when we were in government. We support proper administration, we support transparency, and we support real accountability for the use of public money. Australians have every right to expect that health programs are well managed, that payments are made under clear rules and that taxpayers' money is protected from waste.

We'll not stand in the way of this bill, but we do need to be honest about what it is and what it is not. At its heart, this bill is about the machinery of Medicare. It sets up a legislative framework for programs that already exist—the Bulk Billing Practice Incentive Program, the Practice Incentives Program, the Workforce Incentive Program—and the general practice in aged care incentive.

It is about how those programs are approved, administered, checked and enforced. These things matter, because good administration matters. And these are important programs.

They back the doctors, the nurses and the practices that hold our health system together. But let's be clear about what this bill does not do. The member for Mallee, Anne Webster, my colleague in the other place, put it best.

She called this 'process reform, not patient-care reform'—and she's right, because tidier paperwork does not get one extra doctor into a country town, it does not open or re-open a maternity ward, and it does not make a GP appointment affordable for a pensioner who is choosing between the groceries, the power bill and their medicine. Behind every one of these programs is a simple test: can an Australian actually see a GP, and, when they get in, is it at a price they can afford?

On that test, this government gets a big fail. The Prime Minister promised Australians, by one count 71 times, that all they would need to see a doctor would be their Medicare card, not their credit card. Today that promise is in tatters.

Average out-of-pocket costs for a standard GP visit have hit a record high of more than $50 a visit, up from $46.31 the year before and up from $41.90 two years ago—a 21 per cent rise in just two years. All told, Australian families paid more than $2 billion in GP out-of-pocket costs last financial year alone. In some communities it is far worse.

Patients in parts of the country are now paying more than $60 just to walk through their GP's door. These are not abstract numbers. They are families deciding whether they can afford to take a sick child to a doctor.

The government will point to bulk-billing rates ticking back up in the most recent figures, and I absolutely acknowledge that. Any improvement is welcome. But let's keep it in perspective.

Even now, the bulk-billing rate sits well below the 88 per cent that the coalition delivered in government. It took billions of dollars and a great deal of noise just to call part of that back, and it has done nothing to bring out-of-pocket costs down from their record highs. The real question is not whether the number moved for a single quarter; it is whether it lasts and whether an older Australian in the regions feels any of it at all.

The human cost is already here. In the past year the number of GP visits fell by 1.8 million. That's 1.8 million appointments that did not happen because people said they simply couldn't afford to go.

When people put off seeing a doctor, small problems become serious ones. People end up sicker, and too often in an already overcrowded emergency department. Even the government's own department concedes a strain on general practice.

Its own modelling shows that nearly one in three GPS would be worse off if they moved to bulk-billing every patient. So this is a government asking GPs to do the very thing its own figures say would hurt them and then wondering why the system is under pressure. Rather than fix the problem it created, this government has gone after the very doctors who are holding the system together.

Rather than fix the problem it created, Labor members have been sending letters to family-run GP clinics, leaning on them to fully bulk-bill. These are small businesses, the backbone of their communities, not political pawns. They're already carrying rising rents, rising wages, rising insurance costs and compliance costs.

The last thing they need is to be pressured by the very government that made their job harder. Nowhere is the gap between the rhetoric and the reality wider than in the bush. As Dr Webster reminded the parliament, you cannot run rural health care on a city business model.

In too many country towns there are not enough doctors, not enough patients and not enough of a workforce to make a simple market model work. And when a practice closes or a maternity unit shuts down, people cannot walk around the corner to the next one. A Medicare card does not help if there's no doctor to see in the first place.

A rebate doesn't help if the gap fee is too high. And a new name on an act does not help if the local practice cannot keep its doors open. What regional Australia needs is structural reform: funding built around access, not just volume; funding that recognises the real cost of keeping care available in our smaller communities; and workforce pathways that help doctors and nurses build a life in the bush, not just fly in and fly out.

It needs maternity care closer to home so a mother is not forced to leave her community weeks before her baby is due. Regional Australians already travel further, wait longer and pay more. Their postcode should never decide whether the care they receive is actually going to be delivered.

This bill does not change any of that. It tidies the administration of a system that is still leaving them all behind. As I said, the coalition will not oppose this bill, but the coalition will be moving a series of amendments to strengthen the bill, and they are as follows.

The first is the establishment of an expert advisory group. Far too often, we have seen this government make decisions without proper consultation with key stakeholders, who ultimately bear the consequences of rushed decisions and botched rollouts. This amendment sets out in primary legislation a requirement for the government to establish an expert advisory group with relevant stakeholders to oversee the implementation of incentive programs.

We think that is a sensible idea that will help identify problems before they become major issues. The second is further clarification on the discretionary powers of the secretary of the department and the chief executive of Medicare. The bill enables the secretary or the chief executive of Medicare to approve, vary or reject practice incentive payments on their own initiative.

This amendment that we put forward would require that the secretary and the chief executive develop a clear policy framework outlining how and when these discretionary powers would be applied. This would provide greater confidence to stakeholders in terms of when and how these discretionary powers could be applied. The third is safeguards on autonomous decision-making.

This bill enables certain decisions in relation to incentives to be made autonomously. While this might be suitable in some circumstances, we have already seen in other policy areas, such as aged care, how autonomous decision-making without human oversight has resulted in disastrous consequences. This amendment imposes additional requirements on what decisions and actions can be made autonomously, in addition to the requirements already contained in the legislation.

I move: At the end of the motion, add ", but the Senate: (a) notes that: (i) during the 2025 election, the Prime Minister promised, again and again, that all Australians would need to see their GP was their Medicare card, not their credit card, (ii) the latest bulk billing rate still sits well below the 88 per cent reached under the Coalition, (iii) the latest Medicare data shows average out-of-pocket costs have risen to a record $50.77 per visit, up more than 20 per cent in two years, (iv) the total number of GP attendances fell by 1.8 million visits in the past year, (v) these delayed and deferred visits leave Australians sicker, and add to the pressure on our emergency departments, and (vi) the Government is pushing GPs towards bulk billing despite its own modelling showing nearly one in three would be worse off; and (b) condemns the Government for misleading the public and breaking its promises on primary care".

The coalition supports well-run programs, we support accountability, and we will not stand in the way of this bill, but we will not let better paperwork be mistaken for better health care. The coalition wants a strong Medicare, working alongside strong general practice, where seeing a doctor is affordable and where the place you live does not decide the care you get.

Australians were promised they would only ever need their Medicare card. Today, too many of them need their credit card as well. They deserve a government that closes that gap, not one that simply files it away more neatly.

Debate interrupted.