Asylum seekers and Medicare access
In the midst of the Covid-19 pandemic, thousands of asylum seekers living in the community who were eligible for Medicare went without government health support, due to a bureaucratic quagmire that remains unresolved.
The Saturday Paper has established that these people, most of whom arrived by boat, were entitled to Medicare but have had their access repeatedly revoked because of processing delays, visa “issues” and conditions that have been incorrectly applied to them.
For many asylum seekers, the consequences have been diabolical. Last year, a woman living in Victoria with stage 4 breast cancer lost access to Medicare in the middle of treatment and was told by her oncologist that they could no longer provide her with care.
The Asylum Seeker Resource Centre’s health program manager, Sheenagh McShane, says the woman was “absolutely beside herself”.
“She was lucky though … compared to others in a similar situation, in that she is a really good self-advocate and knew that she could come and speak with us,” McShane says.
The ASRC stepped in on the woman’s behalf, and eventually Victoria’s health department intervened and her treatment resumed. She is currently still receiving treatment.
“There are plenty of examples like this and it shouldn’t be happening,” McShane says. “People are being kept in poverty and powerlessness.”
Beyond the human rights implications – these Medicare rights are written into law for certain visa holders – experts warn there are also broader public health risks to excluding asylum seekers from healthcare access.
During the pandemic, for example, testing for Covid-19 was meant to be available to everyone, regardless of their visa status. But Carolyn Graydon, the ASRC’s Human Rights Law Program principal solicitor, tells The Saturday Paper people on bridging visas were frequently turned away, or told they had to pay $500 for the tests.
“We know that in at least one of those cases the person actually had Covid-19,” she says. “It wasn’t detected for some further days because of that.”
In theory, asylum seekers are also eligible for Australia’s free Covid-19 vaccination program. But Graydon says confusion on the ground poses a serious risk.
Complexity and disorientation, Graydon says, is a design feature of Australia’s immigration system, most keenly felt by people seeking asylum.
“We have people on the so-called “Rolls-Royce” bridging visa who have work rights and Medicare, others who have no work rights, and some people don’t even have a valid bridging visa, which is a misnomer anyway because it is a bridge to nowhere,” Graydon says.
There are about 2200 people living in the community who have no valid bridging visa, which means no work rights, no study rights for adults and their children are unable to go to school.
While there are many government policies explicitly designed to punish asylum seekers who arrived in Australia by boat, it is less clear that the Medicare exclusion is deliberate.
In most cases, asylum seekers who are eligible for Medicare have a Bridging Visa E, which gives them “work rights”. When these rights are granted, a meagre support payment from the federal government, worth about 60 per cent of the relevant Centrelink payment, is ceased. In return, the government has publicly stated they receive Medicare.
“Our service exists to help people who are ineligible for Medicare,” the ASRC’s Sheenagh McShane says. “But what we are finding is we are having to support those who are eligible but still cannot access it.
“Over the past two or three weeks, we had 22 referrals. Of those, 15 were people waiting for Medicare who should have had it.”
It’s a troubling trend, but McShane is also worried about the asylum seekers the organisation isn’t seeing. “Not everybody gets referred to our program,” she says.
Last year, the ASRC saw hundreds of such cases.
Sources in asylum seeker and refugee support networks estimate that 20 to 30 per cent of all asylum seekers and refugees on bridging visas have lost Medicare rights, or will again.
Medicare access is tied to visa status, which means whenever someone has to renew their bridging visa – for some, this is every three months – the process to receive healthcare support via the safety net is reset. Medicare access is voided and people must start again, including enduring the months-long delays that plague the application process for bridging visa recipients.
“It is taking up to four months for people to actually receive their Medicare cards,” McShane says. “When you or I go into Centrelink, they can do it in a day.”
It is during this waiting period when most asylum seekers have lost Medicare access.
By all accounts, the delay is not an issue for Services Australia but instead with the Department of Home Affairs.
“There is a breakdown in the system,” says one senior refugee sector source. “Apparently the system is so convoluted and complex that Services Australia officers can’t make what should be simple decisions because it has to go through Home Affairs.”
The refugee sector source says “there are numerous ways that people seeking asylum are unable to access Medicare”.
“Some of which are intentional policy – with the Department of Home Affairs explicitly revoking Medicare or revoking work rights, which are generally linked to Medicare – as well as a series of unintentional ways from delays in cards being issued to a lack of clear bureaucratic procedure.
“Regardless of the means, the results are the same, the most vulnerable people in our community are not receiving basic healthcare services, even during a pandemic.”
Caught up in this are thousands of people who have already suffered years of abuse within Australia’s immigration system.
In October last year, The Saturday Paper revealed the Coalition government had started sending letters to hundreds of people living in the community telling them they were cutting their income support. The letters were written in English, with no translation offered.
Previously, this cohort had been exempted from a 2017 government program to turn off asylum-seeker welfare support because of their complex vulnerabilities such as trauma, serious medical conditions, having very young children or being elderly and frail people who cannot work.
But last year this cohort was moved on to a new visa – a Final Departure Bridging Visa – which advocates say was a scare tactic employed by the government to persuade asylum seekers that they would not be receiving another bridging visa in Australia and would have to leave the country.
“The Australian government has made the decision that you are no longer entitled to government welfare support including accommodation and income support,” the letter sent by the Department of Home Affairs reads.
Hundreds of people who had never previously had the right to work, and had spent years in offshore detention, were shunted on to these final departure visas. In theory, they had access to Medicare, but they have also been caught up in this administrative nightmare.
The system is so maddening, Carolyn Graydon says, that it isn’t even possible to say precisely who has Medicare eligibility and who doesn’t. The department can attach conditions seemingly at random and these conditions are not subject to any kind of review. They cannot be appealed, even judicially.
In at least one case, an entire family has been denied eligibility for Medicare because one of their children listed on the application does not have work rights.
“It is a cruel lotto. We cannot even predict which people are going to get the bridging visa and which ones aren’t,” Graydon says.
These asylum-seeker bridging visas must be approved or rejected each time by the minister for Immigration, a portfolio now held by Alex Hawke.
“We’ve got these heartbreaking situations, like this family we have – they’re from Myanmar, and Rohingya – and they’ve got three school-aged children and their case is now before the Federal Circuit Court,” Graydon says. “Dad had a bridging visa with work rights and Medicare. Kids were at school, receiving Medicare. He has had a regular job for three or four years and when he applies for judicial review no bridging visa is granted to this family.
“So, then he has to resign his job, he cannot support his family, the children can no longer remain in primary school. And it all comes down to the minister … We’ve been arguing for that family to be granted a bridging visa for more than a year now without getting any response at all. No response.”
In another case, a man on a bridging visa with severe trauma has been turned away from further psychological support because his Medicare has been stopped.
A spokesperson for the Department of Home Affairs said anyone “can access Medicare services as soon as they are enrolled in Medicare” but did not define what enrolled means in this context.
“A Medicare number is allocated to them once they are enrolled,” the spokesperson said. “People do not need to show their Medicare card when they visit a doctor, they only need to provide their Medicare number.
“As the purpose of a final departure Bridging E visa is to give a person a lawful stay period while they, or the department, organise their departure, the visa period will align to the relevant departure milestone.”
Carolyn Graydon has seen Australia’s broader asylum system operate for years now. Medicare, she says, is one part of a much bigger picture.
“When you add all these bits up there is no doubt that the whole system is designed to be as difficult for people as possible. To motivate them to desist, to give up, to go home, to stop persisting and pressing their claims,” Graydon says.
“It’s the removal of access to any forms of support, no income support, no housing. Medicare is on-again off-again, even the legality of your status may or may not exist. You’re living under constant threat of detention and the processes drag on for years and even decades due to government maladministration.
“The picture doesn’t add up to being one that is accidental. It adds up to be one which is intentional, malevolent and designed to deter people.”
This article was first published in the print edition of The Saturday Paper on Mar 27, 2021 as "Medical disorder".
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