The Federal Court hearing in Toronto opens just the latest chapter in the ongoing legal debate over whether those awaiting a decision on their refugee claim ought to have all of their health care costs paid by the Canadian government.
The regime that's being challenged was put in place in November, after the court ruled that a massive overhaul of the program undertaken by the Conservatives in 2012 was unconstitutional and demanded a fix.
What was put in place as a result of that decision doesn't comply with the original ruling by Federal Court Justice Anne Mactavish, said Lorne Waldman, the lead lawyer for the refugee claimants and doctors behind the case.
"The minister reintroduced health care for some refugees but not for all," Waldman said.
"And we're saying that the changes didn't comply with Justice Mactavish's order because there are lots of people who aren't getting coverage."
The fight began in 2012 when the Conservatives suddenly repealed a decades-old program that covered all the health care costs of people waiting to find out if their refugee claim would be accepted.
In its place, the government began allocating coverage based on where a claimant was coming from, and further restricted that to cases only where there was a public health emergency.
All claimants lost access to coverage for drug costs and things like vision or dental care.
Refugee claimants and a group of doctors took the government to court. In July, Mactavish declared the system to be cruel and unusual, saying it placed people's lives at risk.
She gave the government four months to find a solution. The government sought a stay of that decision, but lost, leading to the changes they put in place in November.
The temporary plan expanded coverage for children and pregnant women, and removed the classifications based on where a refugee claim is coming from.
But the coverage is still tiered, depending on where a claim is in the process. Drug coverage also remains restricted.
The result of the program implemented in November has been confusion, not better health care, said Toronto family doctor Ritika Goel, who is also part of the Health For All advocacy group.
"I think many providers don't understand the details of what has happened and therefore are likely to continue to turn people away because they don't have the resources to determine who is covered and who is not for what," she said.
Meanwhile, the July ruling is still being appealed by the federal government. No court date has been set.
"Our government is defending the interests of Canadian taxpayers as well as the integrity of our refugee determination system," said a statement from Kevin Menard, a spokesman for Immigration Minister Chris Alexander.
Menard said the temporary program will cost an estimated $4 million.
The need to cut millions from the federal budget was cited as one of the reasons for the changes in the first place; the government argued it was unfair for those whose claims had yet to be founded to be receiving the same health care coverage as citizens or permanent residents.
In 2012-13, the government paid $49.1 million in costs to 102,354 beneficiaries, according to information provided by the immigration department. The following year, the program cost $29.3 million for 70,262 people.
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