Welcome to Australian Health Daily’s federal Budget Special.
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A hopeful Frydenberg charts 'recovery plan'
By Marion Rae and Melinda Rollinson
Treasurer Josh Frydenberg is betting on a Covid-19 vaccine, a surge in economic activity from subsidised workers, new tax breaks, and wallet-opening income tax cuts to return Australia to a growth path by late next year.
Heavy on hope and heroic economic assumptions, the policy blueprint nevertheless delivers a record-breaking deficit of A$213.7 billion in 2020-21 — equivalent to 11% of GDP — for a deficit of A$480.5 billion over four years to 2023-24.
"There remains a monumental task ahead. But there is hope," Frydenberg said.
Details of the few 'new' decisions
Actual policy decisions since the last economic update in July largely reflected the government's response to the pandemic and quest for economic recovery.
Funding for aged care gains A$2.2 billion, which includes A$1.6 billion for 23,000 additional home care packages.
"Continuing to improve transparency and regulatory standards" will cost A$705.0 million in 2020-21, and A$2.0 billion over the four years to 2023-24, signalling the scale of a future response to final aged care royal commission's recommendations.
Additional funding provided in the budget also includes A$245 million to extend the Covid-19 Supporting Resident Care Supplement to support aged care providers to meet additional costs associated with Covid-19, including infection control training.
There's A$205.1 million for a Workforce Retention Bonus Payments for aged care workers, in recognition of the challenges they face delivering frontline aged care services .
Some A$103.4 million will extend the Aged Care Covid-19 preparedness measure which supports aged care providers experiencing a Covid-19 outbreak, including funding extra surge staff for emergency deployment.
The measures fall short of the approach in last week’s special report from Aged Care Royal Commissioners Tony Pagone QC and Lynelle Briggs, which demanded a cracking pace from the Morrison government to clean up its "insufficient" Covid-19 response in aged care.
Frydenberg also announced the release "in coming weeks" of the Productivity Commission's Mental Health final report and the interim report into suicide prevention.
"These reports will guide our future actions, working together with states and territories to save lives," he said.
Ongoing big spend for health response
Assuming a vaccine is available, A$1.7 billion over two years from 2020-21 has been set aside to secure access to more than 84.8 million doses of potential vaccine candidates developed by the University of Oxford and the University of Queensland.
Some A$24.7 million will purchase vaccine needles, syringes and sharps disposal containers as well as ensuring the supply and storage logistics within the National Medical Stockpile.
The mental health impact of Covid-19 gets a A$100.8 million acknowledgement over two years from 2020-21 to pay for a doubling of current sessions for people with a mental health care plan — accessing up to 10 additional Medicare-subsidised individual psychological therapy sessions.
Ongoing access "through to March 2021 for telehealth and the home medicines service" is also covered, including key elements of the Covid-19 suppression strategy through funding testing and respiratory clinics and securing access to vaccines and treatments when they are available.
Health Minister Greg Hunt said ongoing reforms to private health insurance would "widen patient choice, support access to essential care, and improve its affordability, value, attractiveness and sustainability".
"Our first wave of reforms reduced costs for insurers and consumers, increased access to mental health services, and improved transparency and affordability for policy holders. This budget begins a second wave of reform," he said.
Insurers will be able to increase the age of dependants — from 24 to 31 — to encourage continuity of cover and will also allow people with a disability to remain on their family policy.
"The government will also make home and community-based care when clinically appropriate, more accessible through PHI for mental health and general rehabilitation services, with an initial focus on mental health and orthopaedics, with the goal of commencing on 1 April 2021," Hunt said.
Falling short of last week's recommendations from the aged care royal commissioners, "continuation of temporary MBS telehealth services for GP consultations, mental health, allied health and specialist services" gets A$111.6 million to support the elderly or those with chronic conditions, or for people experiencing lockdowns.
"This additional support builds on the government’s increased investment in mental health and suicide prevention, and brings the investment for 2020-21 to $5.7 billion," according to budget documents.
Not just a Covid-19 budget, Hunt said the blueprint strengthened the "four pillars" of the long-term national health plan.
"It guarantees Medicare, delivers a Pharmaceutical Benefits Scheme New Medicines Funding Guarantee, invests in mental health and backs medical research."
The government will also spend A$256 million in the expansion of its Digital Identity system over the next two years.
Arguably the most important budget in a generation or two, the full gamut of lobbyists had their say in a blizzard of pre-budget submissions, and some had a second go after the budget was deferred from May.
Most were barred from parliament's COVIDSafe corridors in recent months, and this year's budget lockup, prompting a drawn-out period of scrutiny in coming days.
Australian Medical Association president Dr Omar Khorshid tonight said the health and economic impacts of Covid-19 warranted the A$16 billion Covid-19 health response but said a "safe, effective and widely available vaccine" was not guaranteed for next year.
"The government needs to be willing to rethink scaling back JobSeeker and JobKeeper if a vaccine-led economic recovery is delayed or doesn't eventuate," Khorshid said.
"Governments cannot drop the ball and must continue a broad range of strong policies to keep Covid-19 out of the community in order to ensure a sustained health and economic recovery."
Khorshid commended the federal government for a number of the specific health portfolio measures and said sound decisions had been made tonight.
"The government has retained its commitment to enrolling patients in General Practice by preserving A$448 million for the deferred patient enrolment program.
"It's also taken a modest step to continue health insurance for younger people by adjusting ages of children able to use private health services through their parent’s health cover."
Khorshid said Health Minister Greg Hunt had also committed to an actuarial review of the private health reform proposals outlined in the AMA’s Prescription for Private Health report.
However, beyond those "modest measures", Khorshid said the budget had left most healthcare challenges "for another day".
"More is needed on preventive health. More is needed on long term public hospital funding. Private health is facing viability issues, and General Practice in particular needs help now."
Shadow treasurer Jim Chalmers said the budget failed to build for the future and left too many Australians behind while racking up a trillion dollars of debt.
"There is no plan to lift the permanent rate of JobSeeker from A$40 per day, tackle insecure work, create opportunities for women or to improve access to child care," Chalmers said.
"No plan for social housing, cheaper and cleaner energy, or to address the crisis in aged care."
National Seniors Australia chief advocate Ian Henschke said the extra 23,000 home care packages in aged care weren't enough.
"This will only do a little bit to help what is a massive problem," Henschke said.
"We'll be holding Scott Morrison to his promise to fix the aged care system. This particular budget does not appear to have done this."
Australian Council of Social Service CEO Cassandra Goldie said:
"The extra funding for aged care is welcome, including 23,000 aged care packages, but this falls far short of what is required to meet demand.
"There is some extra funding for community services, including mental health services, but again, it is insufficient to meet what is required."
Goldie said the budget missed key opportunities for job creation initiatives that would have delivered public good, particularly in female-dominated sectors.
Australian Small Business and Family Enterprise Ombudsman Kate Carnell welcomed the A$4.26 million budget commitment for a new mental health program targeting small business owners.
Carnell said there had never been a tougher time to be in business and small business loans were often secured against family homes.
"It means the stakes are incredibly high and that is understandably taking a huge toll on small business owners’ mental health," Carnell said.
The service which is expected to kick off next year will provide small business participants with six one-on-one sessions with their designated coach.
"Importantly, the program is designed to appeal to people who might not otherwise seek support for their mental health, which we know applies to members of the small business community."
Misha Schubert, CEO of Science & Technology Australia, welcomed the additional A$459 million announced for the CSIRO over the next four years.
"Keeping that asset safe through a crisis like Covid is really important," Schubert said.
"A significant part of CSIRO's budget relies on commercialisation.
"In light of Covid-19 that's going to be much more challenging. So, we welcome the Government's decision to provide this additional funding to ensure they can come through that and maintain capability through this critical time for science and research."
Tasmanian independent MP Andrew Wilkie said the government had forgotten that we live in a society and environment, "not just in an economy".
"It simply beggars belief that it's spending hundreds of billions of dollars in additional budget measures and still there is no financial certainty for the unemployed, no lift in the paltry disability and carers payments, no resolution of the housing crisis, and no big boost for health and education.
"Older Australians in particular have been abandoned, with no solutions for older unemployed nor improvement in the age pension."
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