Federal reversal of refugee health cuts still leaves many uncovered

What you need to know about the federal government’s reversal of the refugee health cuts

After significant public opposition and efforts from the health sector, the federal government has finally backtracked on many of their cuts to the refugee health program brought about in 2012. 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. The federal government was given four months, until November 4th, to reinstate the original program. At the last minute, the government asked for a delay in reinstating the program, which was also was denied. 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. This is a major change and means the country of origin no longer determines health coverage for an active claimant, including those going through an appeal. They have also restored this coverage for rejected refugee claimants from countries to which we cannot deport (Iraq, Afghanistan, DRC, Zimbabwe, Haiti, CAR, Gaza, Mali, Syria, South Sudan and Somalia), as well as for all children and pregnant women. In these cases, physicians, hospitals and laboratories should now once again be able to file IFH claims as before the cuts were implemented. However, other rejected refugee claimants still lose coverage immediately once their claim is rejected, while previously they were covered until the date of deportation. At this time, they receive what is called ‘public health and safety coverage’ which covers the provision of medical services only in the event of a public health or safety concern (a very limited list).

2. Prescription drug coverage

The government has restored access to medications through IFH for children, pregnant women and rejected refugee claimants from moratorium countries. While this is helpful in these populations, the government has not restored access to medications for all other active refugee claimants, privately-sponsored refugees or rejected claimants until the date of deportation, who were provided access to medications through the Interim Federal Health Program before the 2012 cuts. As after 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 children. 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. While some of the IFH cuts have been restored, this change means individuals making inland claims will still not be considered to have an active refugee claim until their interview, leaving them without access to health insurance or services such as social assistance for a significant portion of time.

Reversal still leaves too many without coverage

While the federal government has reversed many of the cuts to the refugee health program, the federal court had called for a full, not partial, reversal of the changes. This suggests that the government is still in violation of the court order. They have also, instead of returning to the original program, created a third program with varying levels of coverage that may only further exacerbate the confusion that has existed around the coverage since the 2012 cuts. Despite clear public and health sector opposition, the government plans to continue with a formal appeal. They also continue to put forward concerning policies denying services to this population, such as the current Budget Bill C-43, which opens the door for provinces to deny social assistance to refugee claimants.

At this time, however, it is also important to realize the victory that has been gained. The refugee health cuts have seen an unprecedented mobilization from the health sector including most of the country’s national health care associations, along with migrants and community members. This is a great reminder of the importance of exercising our democratic rights and opposing policies where they stand against evidence and human rights. The opposition to the refugee health cuts has demonstrated our concern as a nation around the denial of health care services to people in this country. As such, I hope this mobilization and the overturning of the refugee health cuts are a step towards truly universal health care. Currently 500,000 people in Canada do not have access to health insurance due to their immigration status, including those in the three-month waiting period and those who are undocumented. One day, I hope we have health for all, but for now, I will await the outcome of the formal appeal and hope that justice will finally prevail.

Ritika Goel is a family physician and public health professional working with marginalized populations in Toronto.  Follow Ritika on Twitter @RitikaGoelTO.

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