If we are going to cut the NDIS for wealthy disabled people, isn't it time to do the unthinkable to Medicare? PETER VAN ONSELEN

By PETER VAN ONSELEN, POLITICAL EDITOR, AUSTRALIA Published: 04:39, 13 April 2026 | Updated: 04:39, 13 April 2026 There is a familiar pattern in Australian politics that tends to repeat itself regardless of which party is in office.  What gets condemned in opposition becomes quietly adopted in government. Few issues illustrate that dynamic more clearly right now than Labor’s evolving position on the National Disability Insurance Scheme. Before the last election, Labor didn’t just disagree with the Coalition’s concerns about the trajectory of the NDIS, it sought to delegitimise them.  When Peter Dutton raised the need to rein in costs and flagged making potential savings if elected, Labor framed the Coalition’s position as reckless and dangerous.  The language was deliberately alarmist: cuts would amount to a ‘sledgehammer’ taken to a scheme that underpinned the dignity and independence of Australians with disabilities. In fact, Labor has been scaremongering over the NDIS for years now. In Labor’s 2021 women’s budget statement, it attacked Coalition changes on the basis that they would be used to ‘pave the way for cuts’ and ‘make it harder…to access NDIS support.’ That was Albo as opposition leader attacking the Morrison government’s plans. It was effective politics to be sure, yet here we are, with Labor finally admitting that it needs to do what it’s previously condemned time and time again. The NDIS enjoys broad public support, and any suggestion of reducing its scope is easily weaponised. By casting even modest restraint as ideological extremism, Labor boxed itself into a corner, because the hit to the budget is becoming more and more fiscally concerning, even for Labor. The idea of means testing the NDIS raises an obvious follow on question: if targeting is appropriate here, why not also look at means testing Medicare?  The NDIS is now one of the fastest growing components of Commonwealth expenditure. When it was first designed, the scheme was expected to stabilise at around 1 per cent of GDP. It’s now projected to exceed that and comfortably, with annual costs heading towards $50 billion, and forecast to shoot well beyond that across the forward estimates. Its growth rate has, at times, been more than double that of the overall budget. Treasury, Finance, and independent analysts have all pointed to the same issue: without serious intervention, the scheme’s trajectory is fiscally unsustainable. Alongside these macro pressures are more granular concerns that have been well documented: over-servicing, price inflation among providers, inconsistent eligibility decisions, and outright fraud.  Even advocates for the scheme accept that its design has created incentives that are being exploited. The PM recently admitted that there is a yawning gap between what the community expected the NDIS to do and who might be eligible, with the length and breadth of the scheme now. None of this is new. These issues were being raised well before the last election, including by the Coalition. The difference is that they were politically inconvenient for Labor to acknowledge at the time, and so they were attacked as heartless observations. Now, safely re-elected off the back of a scare campaign that included protecting the NDIS, Albo’s government has responded in the only way it realistically can, by announcing NDIS cuts to come. It has committed to capping the scheme’s growth rate, tightening access criteria, and reviewing the types of supports that are funded. More significantly, it has opened the door (carefully, but unmistakably) to the idea of means testing elements of the scheme. In policy terms, this is perfectly defensible. Mean testing exists right across the policy spectrum in Australia, and a program of the NDIS’ scale, growing at its pace, needs to be open to all manner of ways of reducing its costs in the coming decades. The question of whether individuals with significant personal wealth should receive the same level of taxpayer funded support as those with less financial capacity isn’t unreasonable. Especially in a constrained fiscal environment. Means testing the NDIS raises an obvious follow on question: if targeting is appropriate here, why not also look at means testing Medicare?  Apparently it’s OK to limit the help wealthy disabled people get - but not the free healthcare able-bodied wealthy Australians have access to, writes Peter van Onselen Like the NDIS, Medicare is a large, taxpayer-funded social program with escalating costs driven by demographic pressures, technological change, and rising demand.  The fiscal case for reforming Medicare is at least as strong as the case for reforming the NDIS, and arguably stronger given its size and scale. Yet the idea of explicitly means testing Medicare, limiting access or benefits based on income or wealth, remains politically radioactive. Apparently it’s OK to limit the help wealthy disabled people get - but not the free healthcare able-bodied wealthy Australians have access to. The distinction isn’t grounded in a clear policy principle so far as I can tell. If anything, the ethical case for universality is stronger in the context of disabilities, where need is often more acute, lifelong, and less subject to individual control.  Health, by contrast, encompasses a broader spectrum of services, many of which already involve co-payments and private provisions anyway. What explains the difference is pure politics. Medicare occupies a unique place in the Australian political imagination, especially for the Labor Party. It has been the subject of decades of partisan conflict, and Labor in particular has built a significant part of its political identity around its defence.  To propose explicit means testing now would be to invite a level of electoral backlash that few Labor governments would willingly risk. When the Coalition has proposed even minor chipping away at the universality of Medicare, Labor has always swooped on the suggestion. The NDIS is seen as a more viable target for reform, even if the underlying policy logic for doing so is not fundamentally different to Medicare The NDIS, by comparison, is newer, less deeply embedded in the political culture, and more obviously under fiscal pressure, even if the fiscal costs of Medicare are much greater. The NDIS is seen as a more viable target for reform, even if the underlying policy logic for doing so is not fundamentally different. Labor is (according to growing pre-budget speculation) prepared to abandon the principle of universality in one domain while defending it in another, not because of a coherent philosophical framework but because of differing political constraints. None of this is to argue against reform. The NDIS does need to be brought under control.  Its costs are too high, its growth too rapid, and its administration too inconsistent to be left as it is. The presence of rorting and inefficiency only strengthens the case for change. But we’ve known all of this for quite a while now, including when Labor used to make political mileage out of any attempt by the Coalition to make the NDIS more sustainable and narrow access to it in a bid to help achieve that. Let’s hope the Coalition doesn't seek to attack looming Labor cuts, in a desperate bid to get its polling off the ground.  That’s precisely what Albo did in opposition and even in his first term in government as the 2025 election loomed large.  He’s finally been mugged by the fiscal reality that something has to change. No comments have so far been submitted. Why not be the first to send us your thoughts, or debate this issue live on our message boards. By posting your comment you agree to our house rules. Do you want to automatically post your MailOnline comments to your Facebook Timeline? Your comment will be posted to MailOnline as usual. Do you want to automatically post your MailOnline comments to your Facebook Timeline? 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