Andrew Wallace (Fisher, Liberal National Party) | Hansard source

This bill, the Health Insurance Amendment (Incentive Payments and Other Measures) Bill 2026, has a simple purpose, but it has a deeply uncomfortable story. The simple purpose is to establish a clear legislative framework for Commonwealth health incentive payment programs. They're programs that have for many years been administered without adequate legislative cover for their administration, for their compliance and for their oversight—programs like the General Practice in Aged Care Incentive, the Bulk Billing Practice Incentive Program, the Practice Incentives Program and the Workforce Incentive Program. Putting these on a sound statutory footing is sensible, it's overdue, and the coalition will not oppose the bill in the House.

But the story of how we arrived here, of what this government has done to the health system it was entrusted to protect—it's that story that demands to be told. This bill was presented by a prime minister who made a promise not once, not twice—not in the fine print of a policy document, buried beneath the footnote—but 71 times. We all remember it. The Prime Minister told the Australian people 71 times that all they needed was their Medicare card, not a credit card. We all remember him holding up and waving around that green card. That promise is in tatters.

Let me first deal with what this legislation actually does and why the coalition supports its intent. For decades, Commonwealth governments, including coalition governments, have used health incentive payments to support quality care, to encourage digital health adoption, to sustain general practice in aged-care settings and to keep doctors working in rural and remote communities, where the economics of medicine are hard and the distances are great. The Bulk Billing Practice Incentive Program, the General Practice in Aged Care Incentive, the Workforce Incentive Program—these are not new inventions of this government. They are tools that my side of politics, that this side of the House, built, refined and expanded, because we understood—the coalition understood—that Medicare rebates alone are not enough. Every election, the Labor Party roll out these old tropes about the coalition not supporting Medicare. It's absolute rubbish. It's Mediscare. They do it every time. The coalition is committed to Medicare. I'm committed to Medicare.

The bill creates consistent processes for program approval and variation. It clarifies decision-making and review. It allows the Secretary of the Department of Health, Disability and Ageing and the Chief Executive Medicare to take compliance action with respect to providers. In principle, these are sensible housekeeping measures. Doctors and practices deserve a clear and stable legislative framework. The coalition won't oppose the bill, but we have referred it to the Senate Community Affairs Legislation Committee for proper scrutiny because you can never trust this government for what little pearls they might sneak into their legislation. We have moved a second reading amendment because this parliament must confront in plain language what this government has presided over.

Average out-of-pocket costs for GP non-referred attendances have hit a record high of $50.77 per service nationally, covering July to December 2025, up from $46.31 the previous year and up from $41.90 the year before—a 21 per cent increase in just two years. For a family with children, for an older Australian managing a chronic condition, for a worker who cannot ignore a symptom any longer—21 per cent more, simply to walk through the door of their family doctor. In the past financial year alone, Australian families paid over $2 billion—that's 'billion' with a 'b'—in combined GP out-of-pocket costs. Two billion dollars—that's money taken from grocery budgets, from mortgage repayments, from school fees, from power bills, redirected to pay the gap at the surgery, because the Prime Minister promised that a Medicare card would be enough though we all know it is not.

The variation across the country is stark, and it's damning. In my own electorate of Fisher, people struggle to find a bulk-billing GP, and money out of pocket means elevated stress for someone already unwell. Yes, we have just opened up an urgent care clinic in Little Mountain. That's great—one urgent care clinic for an electorate that has over 150,000 people! If you include the entire Sunshine Coast, it's 370-odd thousand people. And, when you're paying $60 to see your GP, you do not feel like the only thing you need is your Medicare card. In a growing area like mine, you're not going to get 370,000 people visiting one urgent care clinic. My people feel the calculation forming in the backs of their minds: 'Can I afford these out-of-pocket costs? Is it worth it? Can I wait another week? Can I wait another month?' And we all know what happens when people delay medical treatment.

At my mobile offices across Fisher, the conversations are consistent, and they are heartbreaking. Mothers with young kids are telling me that they've delayed taking a sick child to the doctor because they could not find a bulk-billing practice and could not cover the gap. Elderly constituents, many of them on fixed incomes, are rationing their visits, skipping follow-ups, managing worsening conditions at home, because $60 is $60 when you're on a pension. Some wait; some don't go at all.

Practice owners—people who built their clinics from nothing, who have served their communities for decades—are telling me they cannot hold the line any longer. Many GPs are getting older, like us all, but GPs in particular are. I know many GPs, and many of them are on the wrong side of 60. They've worked damn hard all their lives, and they're tired. They didn't go into medicine to turn patients away, but the economics that this government has created are making that choice for them. If clinics survive, what then? High volume, low continuity, fast throughput—it's a conveyor belt, where the patient is a number and the consultation is just a transaction and where the practice that managed your parents through their final years has been replaced by a corporate clinic that books six-minute slots and measures success in throughput, not outcomes.

That's the future that this prime minister is building, whether he admits it or not. When you drive out the independent family doctor through underfunding, through regulatory pressure, through threatening letters designed to coerce rather than support, you don't get a better system. You get a hollowed-out one. You get medicine that is cheaper to deliver and more expensive for the country to sustain. The continuity, the trust and the prevention that a good family GP, like my doctor in Maroochydore, provides cannot be replicated by a clipboard and a six-minute timer. That is where the human cost begins to accumulate.

Bulk-billing has collapsed under this government, no matter what those opposite say or how they try and spin it. Let's have a look at the facts. When the coalition left office in May 2022, the national bulk-billing rate stood at 88.5 per cent, an all-time record high. Under Labor, it has fallen to as low as 77.9 per cent, a drop of almost 11 percentage points. That is not a fluctuation at the margins or a temporary dip; that is a collapse. The Department of Health, Disability and Ageing has already conceded that this government will not meet its own bulk-billing targets until after the next election at the earliest. Australians are being asked to absorb years of record costs and declining access. It is simply not good enough.

The Medicare statistics make the human cost impossible to ignore. The number of GP consultations has fallen by more than 1.8 million, compared with the same period the previous year. That's 1.8 million missed opportunities for health care. That is older Australians deferring a check-up, parents putting off a visit for a sick child and workers dismissing chest pain or a mental health concern because they know there's a gap waiting for them and they are not sure if they can cover it. We all know what deferred care becomes. It becomes emergency department presentations. It becomes avoidable hospitalisation. It becomes preventable suffering. It is not good policy and it is certainly not good economics.

There was a time when the promise of Medicare was simple and it was kept. You felt unwell, you went to your doctor and you were seen. Prevention was possible because access was affordable. That chain—that simple chain of cause and care—is broken. It is not fair, and it sits in direct contradiction to a promise made 71 times to the people of this country.

But it is what came next that revealed the true character of this government. Confronted with the wreckage of its broken promise, the Albanese government did not acknowledge reality. It did not course-correct. It reached instead for intimidation. I understand that some Labor MPs have begun sending threatening letters to family-run GP practices. The letters are designed to pressure them, to lean on them, to bully them into bulk-billing so that the government could paper over the gap between its solemn promise and its catastrophic performance. This is a disgrace.

Let's be clear about who runs these practices. They are small businesses. I know this because I speak with them regularly in my own electorate of Fisher. They are bowing under the pressure. They are the backbone of local communities. They are owned and staffed by doctors who have spent a lifetime getting to know their patients, who track a child's development across years, who manage a pensioner's medication regime, who sit with someone while they receive a difficult diagnosis. These doctors, these practices, are already under significant strain from the rising cost of doing business under this government—wages, rent, insurance, equipment and a growing mountain of compliance demands. The last thing they need is political intimidation from their own government.

Instead of sending heavy-handed letters to local doctors, this government should focus on fixing the crisis it created, from record out-of-pocket costs to growing emergency department wait times and workforce shortages spreading through general practice. Those letters also reveal something more troubling about the direction this government intends to take. They are evidence of a plan to drive out independent family doctors and hand the system to corporate interests, running production line six-minute medicine—high volume, low continuity and fast throughput.

As I said earlier, there has been a 21 per cent increase in GP out-of-pocket costs in two years, a bulk-billing rate that's collapsed by almost 11 percentage points, 1.8 million fewer GP consultations and $2 billion paid by Australian families who were told they would only need a Medicare card. The Australian people deserve a health system that is sustainable, that's affordable and that keeps faith with the promises made to earn their trust. We will continue to support Medicare and the health of Australians.

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