I am pleased today to speak to the Health Insurance Amendment (Incentive Payments and Other Measures Bill) 2026. The Australian Greens support primary care incentive programs and recognise their role in ensuring people have access to safe, affordable and effective primary health care. The Bulk Billing Practice Incentive Program has contributed to much-needed rises in the rates of bulk-billing, which the Australian Greens welcome. The Workforce Incentive Program stream allows a general practice to hire nurses, midwives and allied health professionals, as well as Aboriginal and Torres Strait Islander health workers. This enables practices to utilise multidisciplinary teams. It allows general practices to do this in a way that enables interprofessional working. The Greens are supportive of this because we know that these allied health professionals are the best placed to work together in support of better outcomes for those that they work with, because they see a person as more than simply a set of symptoms; they see the whole of the person before them. Another stream of the Workforce Incentive Program is the Rural Advanced Skills Stream, which provides payments to doctors working in rural and remote communities who have advanced skills or training in emergency care.

These programs are just a few of the incentive payments that are within the scope of this bill, and the Greens believe that these should be protected. The purpose of this bill is to ensure that there is a clear legislative mandate for these programs and to ensure their continued operation. As stated, we absolutely support the objective of these programs. We understand they are central to ensuring that our Medicare system is able to provide funding to primary health care. However, we do question why these programs have been operating for years without a clear legislative mandate. The practice incentives program has been running in various forms since 1998, and it is only now, in 2026, that the government has realised that these programs need a clear legislative basis. It's not really good enough. The government should do better when it comes to these vital programs. People expect better from the politicians they elect and the governments that they fund with their taxes.

This bill also changes the name of the Health Insurance Act to the Medicare Act. In the minister's words, 'This change better reflects the scope and purpose of the legislation and improves public recognition and understanding of the act.' It is important that the legislation stays up to date with what people need. This is why it is so important that the telehealth rules within Medicare are updated to better reflect the needs and circumstances of the people who rely on telehealth medicine. Access to telehealth appointments isn't just a matter of convenience; for many Australians it is a vital lifeline. Yet Medicare rules typically require people to have attended an in-person GP appointment within the last 12 months before they can book a telehealth appointment. For disabled and chronically ill people, that requirement can place care out of reach, especially for people with conditions like ME/CFS, where travelling and securing support can place an unnecessary stress on a body that is already struggling to cope. For those in rural and regional communities, it can mean hours on the road, added expense, and time away from work, family, daily life and daily responsibilities, simply to preserve access to a service that could be safely accessed remotely. This just does not make sense.

The government needs to fix these dated rules so that people who cannot reasonably attend appointments in person can have access to affordable, appropriate GP care through telehealth. I foreshadow that I will be moving a second reading amendment to this bill which calls on the government to update these telehealth rules so that they are not preventing access to health care for disabled people, for people with chronic illnesses and for others who struggle to attend in-person appointments.

I would also like to take this opportunity to highlight some of the suggestions that came through to us throughout the period of inquiry into this bill. The committee heard that the bill should use the opportunity to further strengthen the role of nurses, midwives, allied health professionals and other non-medical healthcare professionals in primary care. The Australian Nursing & Midwifery Federation explained in their submission:

Allowing health services to access practice incentive programs will support their sustainability and … provide high-quality consumer care and create opportunities for consumers to obtain accessible, equitable—

health—

care, particularly in rural and remote communities where access to general practices can be challenging or even impossible.

Nurses and other non-medical professionals play an important role in primary care. But, for too long, their skills and contributions have been overlooked in government policy. This is the reality. This is an opportunity to incentivise and encourage better utilisation of the expertise of nurses, midwives, allied health professionals and Aboriginal and Torres Strait Islander Health workers.

We know that interdisciplinary care, supported by a culture that enables interprofessional working, can be transformative for patient health and wellbeing. It is so important that this legislation is sufficiently flexible to allow a broad range of models of care to be included in future programs. This flexibility is particularly important in rural and regional communities, where alternative models of care play a critical and often unique role in improving access to high-quality, equitable health outcomes.

Another concern that was raised through the inquiry was around the bill's use of automated decision-making powers. The Royal Australian College of General Practitioners highlighted that these concerns are serious and are genuinely held. In their submission to the inquiry, they said:

Decisions relating to eligibility, compliance and participation often involve complex clinical and operational circumstances that require professional judgement and cannot be adequately reduced to a set of automated rules. Eligibility determinations may involve nuanced clinical and practice-level considerations that automated processes are unlikely to fully capture, increasing the risk of inaccurate or unfair outcomes.

Here we see, again, government pushing for automated process, thinking that an algorithm or a computer can do better than an expert, a clinician or a trained professional. Senator Allman-Payne would know a bit about this in the aged-care space. I certainly know a lot about it in the disability space. How many times do we have to learn the lesson? Automated decision-making processes that remove human beings from the loop or constrain their ability to intervene and utilise their expertise do not work. They place people at risk of harm. The private sector tech whiz-kids selling this crap to government have figured out just how to pitch it. They say that it is quicker and cheaper, that it will prevent people from challenging outcomes, improve government efficiency and deliver an improved bottom line. It's nonsense; you're falling for the con.

The people who will pay the price are the people who will be subjected to faulty decision-making about their aged care, their health care and the disability supports that they need. There is a reason why administrative systems in the social care spaces were built originally with the idea that human beings would get to know human beings and their unique and individual circumstances before making decisions that would affect their lives. It was recognised that, without that, there was a huge danger to health, safety and wellbeing. We must turn back. We are going the wrong way, and people will be harmed. The Greens will continue to fight automation and to fight these programs that will remove your ability to appeal, request review and articulate your expertise everywhere that the government attempts to insert them.

These concerns, as I say, are genuinely held. They reflect this broader pattern of government decision-making, this preference for automation. Once again, they appear to be accompanied by inadequate safeguards, human rights oversight or adequate pathways to appeal. When the analysis of these programs is ultimately written, I fear we will see yet another report identifying yet another systemic and cultural failure that put people at risk, that caused harm, injury and potentially even loss of life. We cannot just sit by and let that happen. Both sides of politics cannot say they are not now being warned. Act, for goodness's sake. Think of your loved ones subjected to these systems, and act. Use the power given to you to push back. The Greens are supportive of calls to ensure that automated decision-making in healthcare incentive payment programs is subjected to meaningful human oversight, transparent decision-making criteria and appropriate review mechanisms.

This bill protects, as I said, important programs that help Australians access affordable primary health care. But we must go further by making telehealth fairer, supporting nurses and allied health professionals and ensuring rural and regional communities can access the care that they need. When important decisions are being made about people's health care, there must always be human oversight, transparency and a right to review. The Greens support this bill and will continue to push for primary care systems that work for everyone.

I thank members for their contribution to the debate on the Health Insurance Amendment (Incentive Payments and Other Measures) Bill 2026. Medicare represents the very best of Australia. It is a system that is literally the envy of the world, allowing Australians to receive high-quality health care regardless of their bank balance. Our government is deeply committed to Medicare, deeply committed. We are strengthening Medicare because it is at the heart of universal health care. We are making it easier for Australians to see a GP for free. This bill establishes for the first time a clear and enduring legislative framework for Commonwealth primary care incentive payment programs. These programs are a central part of how the government supports access, affordability and quality in Australia's primary healthcare system, including in rural and regional communities.

Primary care incentive programs represent more than $1.4 billion of annual government investment. Yet a number of quite significant programs operate without a dedicated legislative scheme that is tailored to establishment, administration, compliance and review. And so, the bill before the Senate at the moment addresses that gap. It inserts a new part into the Health Insurance Act 1973, creating a consistent statutory basis for incentive payment programs while allowing detailed program settings to be dealt with in rules. That approach will give providers and government greater certainty, but it also preserves the flexibility that is necessary to keep program settings up to date as health system needs evolve. The bill establishes clear processes for participation, administration and decision-making, and that includes approval pathways, notification requirements, reconsideration rights and access to independent merits review through the Administrative Review Tribunal. It strengthens the integrity of public expenditure by applying appropriate compliance, recordkeeping, information use, civil penalty and debt recovery arrangements to these programs. Importantly, the bill does not change the underlying policy settings of existing programs. It does not alter substantive eligibility criteria or payment amounts, and existing participants are intended to transition into the new framework without any requirement to reapply.

The bill also supports efficient high-volume administration by enabling specified administrative action to be undertaken with the assistance of computer programs. This is subject to oversight, transparency, substituted decision safeguards and review rights. And I do want to take some time to address the remarks made by my colleague Senator Steele-John, because we should approach this discussion carefully, and a blanket assertion that the use of computers in the administration of government is dangerous is an unhelpful way to approach this debate. The government does now use and has for many years used computers to make high-volume decisions. These processes are already in place. These are essential tools of public administration, and they allow many thousands of transactions to be completed every day.

Raising fear about that process in the community and necessarily causing alarm about the use of computers in government is a foolish way to approach this debate. But of course we should be thoughtful about the safeguards that are necessary with any use of computers. Of course we should be careful. And this bill establishes a regime of transparency around the use of computers. I want to talk a little bit about that. The bill's automated decision framework is strictly limited to the administration of incentive payment programs. For example, it does not authorise and it cannot be used for any form of clinical decision making—any form whatsoever. So it can't be used in relation to a patient's diagnosis, their treatment or their health care. And so to come into the chamber and to imply that perhaps it can be used for these purposes is not helpful to an informed debate. I think if we could agree on anything in this place it might be that, in 2026, what would be useful would be a debate based around fact rather than fear. And I think every senator in this place has an obligation to pursue debate on those terms.

The approach that we propose is intended to support efficient, timely and consistent administration of high-volume programs, and it is expected to be used for objective administrative functions. This might be assessing objective eligibility requirements and some payment calculations where the relevant criteria can be reliably applied by a computer program. For example, verifying GP practice accreditation or whether Medicare billing information indicates that a required service threshold has been met might be a way that you can reliably, predictably and safely use a computer to make a decision. Importantly, any decision that is proposed for automation must be capable of being reduced to sufficiently objective criteria. Where a matter requires individual judgement, discretion or consideration of a person's particular circumstances, like a serious compliance action, like a banning order, it will remain subject to human decision-making. This is a sensible and proportionate application of a technology that is available to us, and I think it's incumbent on people in this chamber—we owe it to the Australian community—to have a sensible conversation about how we use these technologies in the public interest. The bill includes strong safeguards to ensure that automation is used safely and appropriately. Only actions that are specified in rules may be automated. Importantly, automation does not displace review and reconsideration rights for providers.

I make these points because I do think that we are at risk of allowing this debate to descend into one based on fear and unfounded assertions rather than one based on facts. Today, I seek to put these facts on the public record in the hope that the debate may proceed in a slightly different direction from here on. I note that the bill also strengthens information sharing arrangements to support administration of program integrity while ensuring that those arrangements remain targeted, rules based and subject to appropriate protections for personal information. Importantly, this bill provides stability. Patients can continue to benefit from the outcomes of these programs and from the strengthened access to primary care that they provide.

A further important feature of the bill is the amendment to the short title of the Health Insurance Act 1973 to the 'Medicare Act'. This includes a transition period to support the consequential amendments and systems changes required across Commonwealth, state and territory frameworks. This is a foundational reform that will strengthen the administration, integrity and sustainability of Medicare incentive programs and help ensure that the government investment in primary care is delivered effectively.

I note that a number of senators have circulated and moved second reading amendments, and I thought I might use the time remaining to address the substance of those amendments. I'll turn first to the second reading amendment circulated by Senator Steele-John. The government won't be supporting this amendment. We do recognise the important role that telehealth plays, and that is especially true for vulnerable groups and for people in regional and remote Australia. There are currently more than 200 MBS items for telehealth services that are available nationally for eligible patients. They are available for consultation with a general practitioner, of course, but also with a nurse practitioner, a non-GP specialist, a consultant, a physician, an allied health provider and other providers. In the last financial year, 2025-26, more than 11 million patients received more than 35 million MBS telehealth services from more than 92,000 providers. The total benefits that were paid out for these services were $1.88 billion.

Current telehealth eligibility requirements reflect contemporary evidence and expert advice. They balance this with the role that telehealth plays in supporting patient access to health care. Patients are eligible for telehealth from a GP or a nurse practitioner if they have had at least one face-to-face service, either with that provider or another provider at the same practice, in the last 12 months. This reflects the evidence that telehealth is best integrated with continuous care and a relationship with the provider that is established face to face. Patients are also eligible if they are registered in MyMedicare at the practice they are receiving the service from or if they meet one of the exemptions for these requirements. The government acknowledges the very significant role that telehealth plays, but we do not support the approach suggested by Senator Steele-John in the second reading amendment that he has circulated.

I want to turn to the amendment circulated by Senator Ruston. The government is very proud of the record investments that we are making in Medicare and bulk-billing, and we note that, since commencing that investment and since commencing the payment incentives that we have put in place to encourage GPs to bulk-bill, we have seen very significant increases in bulk-billing across the country. This is of course immensely important because bulk-billing and the ability to see a GP for free lies at the heart of the Medicare promise. It's why we did go to the Australian people promising to invest in Medicare and promising to deal with the collapse in bulk-billing that occurred because of the previous government's negligent approach to Medicare and their hostility to Medicare. We're unapologetic about our continuing investments to drive bulk-billing so that you can see a doctor for free. We continue to invest in urgent care clinics for the same reasons.

Pleasingly, we are seeing more and more Australians avail themselves of the services either of a bulk-billing GP or of an urgent care clinic. We do see more and more Australians who are seeing a doctor for free. This matters. It matters because Australians should be able to access health care when they need it. They shouldn't have to worry about the cost of health care, and it's why we continue to prioritise these investments in Australia's public healthcare system.

We don't agree with the assertions in Senator Ruston's second reading amendment, and the government will not be supporting them. What we will do is we will continue to make investments in strengthening the Medicare system, including, as this bill does, strengthening the legislative framework that enables it. I also table an addendum to the explanatory memorandum relating to the Health Insurance Amendment (Incentive Payments and Other Measures) Bill 2026. The addendum responds to matters raised by the Standing Committee for the Scrutiny of Bills.

The question is that the second reading amendment moved by Senator Ruston be agreed to.

Senator Steele-John foreshadowed a second reading amendment. Senator Steele-John, would you like to move that now?

Yes, I would. I move:

At the end of the motion, add ", but the Senate:

(a) notes that:

(i) telehealth is an increasingly important part of Australia's health care system, and many people rely on telehealth to access healthcare when they are unable to attend appointments in person,

(ii) to access a Medicare benefit for a telehealth consultation with a GP, a person needs to have had an in-person consultation with that practitioner within the previous 12 months, subject to very limited exceptions,

(iii) for many disabled and chronically ill people, this in-person attendance requirement is prohibitive and can be a significant barrier to accessing affordable and ongoing healthcare, and

(iv) for people living in rural and remote areas, the requirement can mean hours of travel, substantial costs and significant time away from work, family and other responsibilities to attend an in-person appointment; and

(b) calls on the Government to update the telehealth rules for accessing Medicare benefits for GP appointments with a view to ensuring that disabled people, chronically ill people, and other people who cannot attend in-person appointments can access affordable and appropriate care".

The question is that the second reading amendment moved by Senator Steele-John be agreed to.