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Medically Uninsured in Canada

An estimated 200-500,000 people in Canada do not have health insurance. For a country that prides itself on its universal healthcare system, this statistic comes as a shock to most people. In this country, we often say that we allocate healthcare on the basis on need and not ability to pay, BUT we also allocate healthcare on the basis of immigration status. Here are a few ways that being a migrant affects your access to healthcare in Canada. Slide4

New Immigrants and the 3- month waiting period
In Ontario, BC and Quebec, new immigrants (economic immigrants, family class, live-in caregivers) and returning Canadians have to undergo a 3-month waiting period before they get provincial health insurance. During this time, the assumption is that people either purchase private insurance (which many can’t afford, and often doesn’t cover the conditions they need anyway), or go without health care. This has led to many disastrous situations documented here, here and here. The Right to Healthcare Coalition has been working for years to get the 3-month waiting period removed with moral and economic arguments.

OHIP on arrival or acceptance
Those whose H&C claims are accepted, those who have refugee status on arrival (government-assisted refugees and privately-sponsored refugees), those in the Seasonal Agricultural Worker Program and those on a full time work permit have access to OHIP on arrival/acceptance without a waiting period.

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Refugees, Refugee Claimants and the Interim Federal Health Program
In 2012, new cuts were instated to the refugee health program (Interim Federal Health) which have since caused significant loss of access to healthcare and confusion within the refugee claimant and healthcare provider community. The drastic changes to the Interim Federal Health program cut off effectively all health coverage for refugee claimants from any one of 37 Designated Countries of Origin. It also denied access to drugs, dental and vision coverage for most refugees and refugee claimants. As a result, many pregnant women have been denied prenatal and obstetrical care, at least one refugee claimant was denied chemotherapy for his cancer treatment, and many have been wrongfully denied care due to the confusion created by a two-tier system based on country of origin.

A legal challenge launched on the basis of violation of the Charter of Rights and Freedoms was successful, and in July 2014, a federal court deemed the cuts to the refugee health program ‘cruel and unusual’ treatment. On November 4th, the government announced what it deems “Temporary measures for the Interim Federal Health Program“. This is not quite a full reversal of the cuts of 2012, but does restore some key provisions, while the government makes it clear they plan to pursue a formal appeal.

Here is a summary of the “Temporary measures for the Interim Federal Health Program” and how they compare to coverage before the 2012 cuts. For more detail, please see this flowchart.

1. Basic coverage for core medical services

The government has restored access to physician, hospital and lab services for:
– All active refugee claimants (regardless of country of origin)
– Rejected refugee claimants from countries to which we cannot deport (Iraq, Afghanistan, DRC, Zimbabwe, Haiti, CAR, Gaza, Mali, Syria, South Sudan and Somalia)
– All active and rejected refugee claimants who are children and pregnant women (regardless of country of origin)
– Government-assisted refugees and privately-sponsored refugees continue to be covered as they were pre and post-cuts
– BUT all other rejected refugee claimants still lose coverage as soon as their claim in rejected (in the past they were covered until date of deportation). These groups continue to only have coverage for conditions considered a concern to public health or safety (a very limited list).

2. Prescription drug coverage

The government has restored access to medications through IFH for:
– Rejected refugee claimants from countries to which we cannot deport (Iraq, Afghanistan, DRC, Zimbabwe, Haiti, CAR, Gaza, Mali, Syria, South Sudan and Somalia)
– All active and rejected refugee claimants who are children and pregnant women (regardless of country of origin)
– Government-assisted refugees continue to be covered as they were pre and post-cuts
– BUT active refugee claimants, privately-sponsored refugee claimants and rejected claimants until date of deportation still do not have access to drugs as they did before the cuts. These groups continue to only be covered for medications being used to prevent or treat a condition that is a concern to public health or safety (a very limited list).

3. Supplemental coverage

The government has only restored access to “supplementary benefits” (eg. dental benefits, vision benefits) for:
– All children who are active and rejected refugee claimants
– Government-assisted refugees continue to be covered as they were pre and post-cuts
Previously, these benefits were also available to all active refugee claimants, privately-sponsored refugees, as well as rejected claimants until the date of deportation. They were also provided on an ongoing basis for rejected claimants from a country with a moratorium on deportation.

4. Access to IFH coverage while awaiting eligibility interview

Due to Bill C-31, which overhauled the refugee determination process, refugee claimants making inland claims must wait for a meeting with an immigration officer for an eligibility interview, which can often take up to six weeks.

Temporary Foreign Workers – Access Issues
While both live-in caregivers (after the 3 month wait) and seasonal agricultural workers have access to health insurance, they both operate in extremely precarious work environments where access is limited by much more than insurance. Live-in caregivers live in their employers’ homes and employers may hold on to their health insurance cards. Seasonal agricultural workers have on many occasions been deported upon developing a health condition and live in rural areas where transportation to health clinics can be an issue as well as racism from local health care providers.

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Non-status or Undocumented
People who arrived in Canada without documents, or became nonstatus through various means have no health insurance at all. Even if they have lived in Canada for decades, even if they are undergoing a Humanitarian & Compassionate claim, even if they are pregnant, having a heart attack or are diagnosed with cancer, all of which have been documented, people in this situation have no health insurance at all. On top of the lack of health coverage, nonstatus folks also avoid seeking healthcare due to a fear of denial of service, debt or deportation.

 

*Designated Countries of Origin:
Australia, Austria, Belgium, Chile, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany. Greece, Hungary, Iceland, Ireland, Israel (excludes Gaza and the West Bank), Italy, Japan, Latvia, Lithuania, Luxembourg, Malta, Mexico, Netherlands, New Zealand, Norway, Poland, Portugal, Slovak Republic, Slovenia, South Korea, Spain, Sweden, Switzerland, United Kingdom, United States of America