Did the federal government have a last-minute change of heart on cutbacks to refugee health care?
Not according to Immigration Minister Jason Kenney, who’s been under unusual pressure from protests by the country’s most prestigious medical orgs.
In April, Kenney announced reforms to the Interim Federal Health Program that would have stripped refugees of coverage for all but essential medical treatment, a measure that he argued would prevent bogus claimants from abusing Canada’s health system and save the government $100 million over five years.
The proposed cuts set off waves of protest and provoked a rare push-back from respected medical associations like the Royal College of Physicians and Surgeons and the Canadian Dental Association. Then, on June 29, two days before the changes were to come into effect, information on the Citizenship and Immigration Canada website was quietly altered to indicate that the cuts were less sweeping.
Government-assisted refugees (GARs), those pre-identified as legitimate claimants, would lose no coverage, the website stated.
Despite the protests, a spokesperson for the minister denies that he bowed to public pressure, and says Kenney had always been clear that GARs wouldn’t lose coverage.
No matter how the policy shift came about, some are warning that it doesn’t go nearly far enough. Canada accepts only 7,000 GARs a year, a fraction of the 100,000 people who were on the IFHP rolls before July 1.
Refugees whose claims are pending or being appealed, as well as most claimants being sponsored privately or by church groups, no longer receive coverage for supplementary medical care as of July 1. This means they will be denied access to post-arrival health assessments, dental and vision care and potentially life-saving prescription medicines like insulin and heart medication.
Critics say depriving vulnerable newcomers of such treatment is not only unethical but will also overburden provincial health systems by eliminating preventative care for most refugees and forcing emergency rooms to deal with the consequences. While the new policy still covers “urgent or essential” care, it’s unclear to which conditions this applies.
“It’s going to drive up the cost of the provincial health care system, because more people will be showing up for emergency care when a situation has gone way beyond the point of ignoring it,” says Andrew Cash, NDP MP for Davenport. “What they’re really doing here is a backdoor downloading of costs onto the provinces.”
Ontario Minister of Health Deb Matthews has identical concerns. In a letter to Kenney and federal Health Minister Leona Aglukkaq, she writes, “By abdicating your responsibility towards some of the most vulnerable in our society, you have effectively downloaded federal costs onto the provincial health care system.”
Quebec went a step further and vowed to temporarily cover the medical bills of those affected.
Politicians aren’t the only ones who don’t see the logic in denying refugees health coverage.
Danielle Frechette is executive director of policy for the Royal College. She applauds Kenney’s decision to preserve coverage for GARs, but describes the original policy as merely “shifting the burden of care” rather than reducing costs.
She argues that it makes little economic sense to put up barriers to preventative medicine, particularly for newcomers who are already less likely to seek treatment.
“Patients left untreated really do present with a lot more acuity, and they just cost more,” she says. “If you don’t take care of them early, it doesn’t serve anyone well.”
Meanwhile, front-line health workers are already feeling the strain of the policy change. At Unison Health & Community Services in North York, employees were trying to find ways to keep serving refugees in the run-up to the July 1 drop date.
Andrea Cohen, who was Unison’s CEO until last week, when she left for another facility, says the centre’s social workers were trying to connect clients with pharmaceutical companies that would fill their prescriptions on compassionate grounds.
“It does put stress on our providers, who are taking time away from patient care to find alternate solutions,” Cohen says.
No matter how creative employees get, she admits they will inevitably be forced to turn some people away.
“It’s rough,” she says. “There’s no question that there are going to be negative outcomes for some individuals.”
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