Last week in California, a healthy 17-year-old died from COVID-19 after being turned away with respiratory issues at an urgent care centre. This may seem unimaginable, especially during a global pandemic, but this experience reflects a common reality for people who are medically uninsured in both Canada and the US.
Consider an equally probable hypothetical story of Mariana, an undocumented and uninsured woman from Colombia, who is forced to continue working as a cleaner without access to health care, like many others in low-income, precarious jobs in Canada. With protective supplies running low, she washes and reuses her gloves, hoping that she does not contract COVID-19. When she develops difficulty breathing, she delays seeking the healthcare she needs because of previous negative experiences in the hospital – like being told to pay cash upfront or cover a large bill. But COVID-19 does not discriminate based on health insurance and immigration status. Neither should we.
Although Canadians think of their healthcare system as universal, in reality, many are denied access to care on the basis of immigration status. In Ontario alone, there are an estimated 500,000 people who do not have access to healthcare: this includes newly-landed permanent residents, some temporary foreign workers (TFWs), and returning Canadians in the three-month waiting period. It also includes many international students, TFWs between contracts or working part-time, as well as undocumented people.
Knowing the dire situation for uninsured people, on March 16, over 1000 Ontario health providers, advocates, and organizations signed an open letter to Premier Doug Ford and Health Minister Christine Elliott calling for immediate healthcare access for everyone living in Ontario, regardless of immigration status. The government responded and announced their plan to remove the three-month waiting period for OHIP and provide healthcare services to all uninsured Ontarians during the COVID-19 pandemic.
This came on the heels of decades of public education and lobbying from Ontario’s migrant communities, grassroots organizations, and health and social service agencies. The Sanctuary City movement in Canada worked to ensure access to municipal services. A strong campaign in 2012 was responsible for reversing the federal refugee health cuts. Additional ongoing efforts have helped to end the three-month waiting period and ensure OHIP for all.
The recent policy changes represent a historic win, inviting us to imagine a future in which healthcare is truly universal in Ontario. But they also leave migrant communities, providers and advocates uncertain about the direct impacts on the ground.
Uninsured individuals have, for decades, avoided or delayed seeking care due to fear of debt, denial of care, or threat of deportation. This fear does not evaporate with a simple and temporary policy change. Historically, uninsured people in Ontario have been more likely to show up to hospitals with severe conditions, and more likely to die in the emergency room as a result of these delays – similar to the tragic case of the 17-year-old boy in California.
We must be thoughtful and thorough in putting this policy into practice – meaning no person can be turned away for not having an OHIP card, be asked for a fee upfront, or sent a bill after the fact. We also need a public communication strategy to ensure migrant communities are informed and know it is safe to seek care when they need it, rather than go without.
This issue must also be addressed nationally. Quebec has announced coverage for healthcare issues pertaining to COVID-19 alone, and BC has reversed the three-month waiting period for returning Canadians only. These piecemeal measures maintain the cracks in our system, leaving many vulnerable to the impacts of such a pandemic.
And what happens when COVID-19 settles? Beyond COVID-19, newly arrived pregnant immigrants will still need prenatal care, undocumented children and workers will still have injuries, and returning Canadians will still be at risk for delaying care for viral illnesses. It should not require a global pandemic to recognize the basic human right to healthcare.
The health of a community is determined by that of every person within it, whether we are facing a pandemic or not. We must uphold this human right and ensure health for all both during and after COVID-19.
All authors are writing on behalf of OHIP for All.