Is Canadian Healthcare Truly Universal? Health Inequities Based on Immigration Status

Canadian communities are comprised of individuals with different immigration status, coexisting in the same spaces and sharing similar experiences and realities. For some, the attributes of “permanence,” that Citizens and Permanent Residents have, or “transience,” for those with expiry dates on their Canadian documents, bear little significance in the realms of community and daily living—we share meals and holidays, attend the same university classes, work together on professional projects, and even envision our futures in the same land.

Yet, the existing legal categories create tangible lines of separation that inhibit the progress and prosperity of Canadian residents living under a forced temporariness—one that welcomes their contributions without granting them the benefits of “permanence.” This is evident in the barriers that thousands of immigrants and refugees face in accessing public health insurance in Canada.

Universal access to healthcare is one of the most widely supported principles in Canadian public policy, with the approval of roughly nine in ten Canadians. Yet, it is estimated that around 500,000 residents in Canada live without health insurance (PDF), in most cases due to barriers related to immigration status.

Holding universal access to healthcare as a fundamental Canadian value, while simultaneously denying access to half a million people who live in Canada, is more than a simple omission—it delineates who belongs here and who does not.

These disparities stem from a conscious decision to strip away health benefits from individuals who, for all practical matters, reside in Canada and intend to do so for the long term. For example, landed immigrants (such as permanent residents, refugees, and some temporary workers) undergo a three-month waiting period before provincial health benefits come into effect in certain provinces, like Ontario, Quebec and British Columbia.

Others experience longer-term barriers. For instance, in Ontario, individuals within the following categories all lack access to healthcare: international students; temporary foreign workers who are unemployed, between contracts, or on remote work contracts with employers outside of the province; those with pending immigration applications; and undocumented migrants.

In the case of Seasonal Agricultural Workers, a category that is already subject to coercive employment practices with serious consequences for health and safety, their medical coverage needs to be coordinated by their employer, either through the provincial government or private insurance. In fact, a 2015 report by the Canadian Centre for Policy Alternatives found that 92% of migrant farm workers eligible for provincial health insurance were not signed up by their employer (PDF). Moreover, staff from provincial health agencies and health clinics are left to figure out the complex set of exceptions and conditions on their own, which can result in denial of care even to individuals who are eligible—as was reported in 2017 when refugees were barred from receiving healthcare by practitioners despite eligibility under the Interim Federal Health Program.

The solution is to provide all temporary residents full access to publicly funded healthcare—untied to their employer or employment status—for as long as their residence in Canada lasts, and to eliminate waiting periods for landed permanent residents. There is no justification to deny fundamental rights and social benefits to individuals based on their immigration status. Even from a purely financial standpoint (which should not supersede human rights obligations), these residents pay taxes and contribute abundantly to the growth of Canada’s economy, funding the same programs that exclude them.

The barriers to access publicly funded healthcare not only affect the individuals who are uninsured, but also put health professionals at odds with their duty to provide care. Amid a global pandemic, these restrictions create further vulnerability and may exacerbate medical problems, to the detriment of uninsured individuals and the healthcare system itself.

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