Trudeau offers premiers $46.2B in new funding for health-care

OTTAWA –

The federal government is pledging to increase health funding to Canada’s provinces and territories by $196.1 billion over the next 10 years, in a long-awaited deal aimed at addressing Canada’s crumbling health-care systems with $46.2 billion in new funding.

This new cross-Canada offer includes both increases to the Canada Health Transfer (CHT) as well as federal plans to sign bilateral deals with each province and territory that are mindful of each system’s unique circumstances.

This funding influx is coming with an expectation that in order to access new federal dollars, provincial and territorial governments have to commit to new transparency and accountability requirements around how health information is collected, shared, used, and reported to Canadians.

Here’s what the federal government has put on the table:

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  An immediate national and “unconditional” $2-billion top-up to the Canada Health Transfer (CHT) to address urgent pressures being experienced at pediatric hospitals, emergency rooms and surgical centres;
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  A five-per-cent increase to the CHT over the next five years provided through the annual top-up, to be rolled into the CHT base after five years to ensure a permanent increase that would provide an estimated $17.3 billion over 10 years;
• 
  $25 billion over 10 years for decade-long bilateral deals with each province and territory tailored to their health-care needs, but connected to shared priorities such as family health access, investing in mental health and substance abuse services; and modernizing the health information system;
• 
  $1.7 billion over five years to support hourly wage increases for personal support workers and related professions as levels of government work together on retaining, recruiting, and recognizing the credentials of health-care workers;
• 
  $150 million over five years for the Territorial Health Investment Fund to help cover medical travel and the cost of health care delivery in the North; and
• 
  $2 billion over 10 years aimed at addressing the access challenges uniquely faced by Indigenous people.

“These additional federal investments will be contingent on continued health care investments by provinces and territories,” said Prime Minister Justin Trudeau’s office in a statement unveiling the details. 

Trudeau— accompanied by a handful of ministers—has spent the last two hours presenting this proposal to his provincial and territorial counterparts at the first in-person meeting of all First Ministers since the COVID-19 pandemic.

While the prime minister met the premiers behind closed doors, federal officials provided reporters a technical briefing on the plan.

Ahead of the meeting, Trudeau said that while Canadians are proud of the universal public health-care system, it hasn’t been delivering up to the level expected.

From staffing shortages and a cold-weather surge of illnesses compounding extended wait times in emergency rooms, to hundreds of thousands of surgeries and medical procedures backlogged due in part to COVID-19 cancellations, there have been steady calls from those in the sector for urgent action as Canada’s population continues to grow and age.

“Obviously it’s been a tough few years, but there’s a need for support now, and better results for Canadians now, but also into the coming years,” Trudeau said, briefly stopping to speak with reporters as he arrived for the meeting.

NO DEALS TODAY, NEXT STEP? ‘ACTION PLANS’

Neither Trudeau nor the premiers plan to walk out of today’s “working meeting” with deals in hand. Rather, now that this offer is on the table, premiers will have to work out how the plan will work in their jurisdiction.

The next step for provincial and territorial governments will be to develop “action plans” describing how they plan to use the funding and measure improvements to their systems.

Among the metrics the federal government says it will be looking at to assess whether tangible progress comes from these funding arrangements:

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  The net new family physicians, nurses, and nurse practitioners in each province and territory;
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  The percentage of Canadians who have access to a family health team or family doctor;
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  The size of the COVID-19 surgery backlog;
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  The median wait times for community mental health and substance abuse services; and
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  The percentage of Canadians who can access their health records electronically.

The federal government made a point on Tuesday of stating that the bilateral agreements have to respect each government’s jurisdiction and uphold the Canada Health Act to protect Canadians’ “access to health care that is based on need and not ability to pay.”

Recently, in an effort to address their over-capacity operating rooms and winding wait lists, some provinces have announced plans to allow more private clinics to offer certain procedures. This has revitalized a debate over privatization and whether what some provinces are doing goes against the longstanding requirement to provide reasonable access to publicly-funded health services.

In order to maintain eligibility for their full Canada Health Transfer, provinces are required to uphold the Act’s criteria and ensure there is no extra billing and user chargers for insured health services.

Ahead of Tuesday’s meeting, calls were made on Parliament Hill by front-line health-care worker unions, advocates, and NDP Leader Jagmeet Singh to insist not a single new federal dollar flows to a for-profit provider.

With both federal and provincial governments working on drafting their 2023 budgets, the expectation is the bilateral details will need to be worked out in time for the funding to be accounted for in the upcoming fiscal plans.

Despite concerns raised by some premiers that the federal government’s negotiations were being conducted through the media, Trudeau already has plans to hold a press conference at 5:30 p.m. ET to discuss what came out of the meeting.

OFFER LESS THAN PREMIERS CALLED FOR

Prior to the details being revealed, there were indications that some provinces such as Ontario were ready to sign on the dotted line in short order, while other provinces such Quebec may want more time before agreeing to any new accord, depending on how they feel about federal conditions being imposed on how the new money will be spent.

Overall there was a sense of optimism coming from the premiers—who put their heads together ahead of their meeting with Trudeau—that the two sides finally were able to meet to discuss how to address Canada’s strained health-care systems.

“I think this is a great first step. We’ve been asking the prime minister to come to the table, he’s at the table,” Ford said on his way into Tuesday’s meeting. “This is about certainty and sustainability. It’s about building a health-care system across this country, not for five years, not for 10 years, but for decades to come.”

The premiers’ longstanding ask has been for the federal government to increase the share of Canada’s health-care costs that they cover, from the current 22 per cent to 35 per cent. This deal does not satisfy this demand.

While it remains to be seen how premiers will take this—not receiving an annual $28 billion funding increase— there had been strong signals in the weeks leading up to today that this would be the case and it hadn’t sparked much consternation.

Chair of the Council of the Federation and Manitoba Premier Heather Stefanson told reporters on Tuesday morning that, while this has been their years-long request, the premiers’ goal is “to ensure that we have predictable and stable long-term funding put into the baseline of the Canada Health Transfer to ensure… that predictable, stable long-term funding for Canadians.”

Premiers are poised to react to the federal offer in the next hour, ahead of Trudeau’s planned presser with a backdrop of the cabinet ministers who accompanied him in the meeting.