The federal government has finally backtracked on some of their cuts to the refugee health program brought about in 2012. The drastic changes to the Interim Federal Health program restricted access to drugs, dental and vision coverage for most refugees and refugee claimants, but most seriously, cut off effectively all health coverage for refugee claimants from 37 so-called "safe countries".
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 with a two-tier system based on country of origin.
After significant public opposition and a legal challenge on the basis of violation of the Charter of Rights and Freedoms, in July 2014, a federal court deemed the cuts to the refugee health program 'cruel and unusual' treatment. The federal government was given four months, until November 4, to reinstate the original policy, and at the last minute, asked for a delay to reinstate the program. That delay too was denied by the Federal Court on October 31, so the government announced what it deems "Temporary measures for the Interim Federal Health Program," not quite a full reversal, while they plan to pursue a formal appeal.
Here is what the temporary measures provide and still don't provide:
1. Core medical services
The government has restored access to physician, hospital and lab services for all refugee claimants. This is a major change, as after the 2012 cuts, refugee claimants from one of the 37 Designated Countries of Origin got effectively no health coverage. They have also restored this coverage for rejected refugee claimants from countries on which there is a moratorium on deportation (Iraq, Afghanistan, Haiti, DRC, Zimbabwe). All other rejected refugee claimants still do not have access to these services, except for children and pregnant women.
2. Access to medications
The government has restored access to medications for children, pregnant women and rejected refugee claimants from moratorium countries. While this is helpful in these populations, before the 2012 cuts all refugees and refugee claimants on the Interim Federal Health Program had access to medications, which are a crucial part of healthcare today.
3. Supplementary benefits
The government has restored access to "supplementary benefits" eg. dental benefits, vision benefits and some others for children only. This is a big problematic as such benefits are crucial for all refugees and refugee claimants. In Ontario, while many refugee claimants can access emergency dental benefits through social assistance, they cannot access vision benefits at all.
As you can tell, this is not a complete reversal of the refugee health cuts. While for healthcare providers the details of the program are crucial, even more important is for us to note what this entire process has taught us on a grander scale and what it suggests for the future.
1. A pattern of cruel and unusual policies
It is clear that the federal government wants to deny health and social services to vulnerable people. Despite the significant public opposition, despite the court ruling, despite being denied a stay, the government still chose not to full restore the original refugee health program, and still plans to pursue a formal appeal. Without a full reversal to the original program, the government can be found in contempt of court and also will further confuse healthcare providers as to what is and is not covered.
In keeping with this pattern of cruel and unusual policies, the current Budget Bill going through parliament includes a measure to deny refugee claimants access to social assistance even though most cannot access a work permit for months. The government has also overhauled the refugee determination system so there are much higher rates of denial of claims heard, making the legitimacy of denying healthcare on the basis of accepted vs. rejected claims even more problematic. They have put bans of sponsorship of parents and grandparents, made it increasingly more difficult to obtain citizenship and made it easier to lose both citizenship and permanent residency.
2. A victory for grassroots mobilization
While the government has not restored the refugee health program to its original form, restoring core medical benefits for all refugee claimants is a huge victory, as is winning a charter challenge that deems the cuts in violation of the Charter. The refugee health cuts have seen an unprecedented mobilization from the health sector including most of the country's national healthcare agencies, along with migrants and community members. While we know the government is submitting a formal appeal, there is no doubt here that justice will prevail, and in the end, the government's cruel and unusual policy change will in fact be reversed. This is a great reminder of the importance of exercising our right to be critical and oppose policies where they stand against evidence and human rights.
3. A step towards universal health care
In Canada, we pride ourselves on having a universal health care system, yet half a million people in Canada live without health insurance due to their immigration status. As you read this, a family newly arrived to Canada is running a crowdfunding campaign to pay for the healthcare bills they endured in the three month waiting period for OHIP when their three-year-old child sustained severe burns. Similarly, countless cases are known of undocumented patients being denied access to care, in some cases resulting in death from terminal illness. The federal government's policy to cut refugee health care simply added people to the ranks of the uninsured. The large public opposition to this policy shows that people in Canada do not want anyone enduring sickness to be denied access to health care.
While the federal government's decision to not fully comply with the court's ruling means there will be increased confusion among health providers, and yet further money wasted on an appeal of a policy that has already been deemed cruel and unusual, the temporary measures are a significant victory and we are well on our way to overturning the refugee health cuts completely. This process has shown us both the capacity of the federal government for enacting cruel policies and fighting tooth and nail to keep them, as well as the power of grassroots mobilizations. It gives me hope that we will in fact reach a day when we overturn the refugee health cuts completely, and eventually move to a system where healthcare is provided regardless of immigration status.