Though limits and fees for access to health care, education and other social services by the province’s 279,500 non-permanent residents narrowly won support in Alberta’s recent referendum, the provincial government is widely expected to enact the changes – mostly because it tried to do something similar last winter.
That’s when it removed eligibility for publicly funded health care for a subset of non-permanent residents, including individuals under the International Experience Canada permit and Co-Op Work Permit holders, with no public notice.
“(Initially, it was a) shock to us because we weren’t informed and nor were the patients,” said Sarah Roberts, Office Manager at the Canmore Medical Associate Clinic.
Natasha Lay, Executive Director of the Bow Valley Immigration Partnership, said the organization first became aware of the change when one resident ran into complications while attempting to renew their provincial health coverage. She fears for what’s to come.
“Everyone who works in Alberta makes income tax contributions toward health care and other public services, regardless of their immigration status. Any uncertainty about what residents can access can lead to practical (and) financial impacts,” says Lay.
While the government reversed the changes last winter following public outcry, the impacts of limiting access to health care for individuals with precarious immigration status, many of whom lack access to a primary care physician, arrived quickly, said Roberts. Visits dropped sharply, even though the clinic reduced its fee for non-insured patents from $300 to $100.
“Like our neighbours, we don’t know each other’s (immigration) status,” says Dr. Annalee Coakley, co-director of the Migration and Humanitarian Health Collective at the University of Calgary. “The person working at the meatpacking plant supporting the second largest industry in Alberta (…) the person caring for your elderly mother in long-term care (…) they are temporary residents who are working here, paying taxes and providing a valuable service. To deprive your neighbours of access to health care or basic social services, or to deprive their children of access to education doesn’t make sense for society. It doesn’t make sense for our economy,”
She said her heart sank when Premier Danielle Smith proclaimed that the narrow margin of victory for resolutions supporting waiting periods for non-permanent residents to be eligible for health care (53.1 per cent) along with annual fees for health care and public school tuition (51.9 per cent) would be enacted.
“If you’re looking at health equity, which is usually my sphere, health equity is cost effective. Plus, it’s the right thing to do,” said Coakley.
Specific details on the proposed premiums for health care are scarce, though Smith suggested charging $1,400 to $1,900 per person annually for health care, similar to the Immigration Health Surcharge (IHS) in the United Kingdom.
“We recognize that prolonged uncertainty (for Bow Valley community members) can be difficult and can impact people’s wellbeing and sense of belonging,” said Lay via e-mail correspondence. “By strengthening local systems, we can build regional resilience for the future.”
The Alberta government has cited population growth for the need to impose greater control over health care, education and other social services to “put Albertans first.” As of July, Alberta was home to just over 5 million people, with 279, 500 non-permanent residents.
The government suggests that the provision of social services to non-permanent residents costs Albertans nearly $1 billion annually though critics have disputed that argument. In 2024-2025, Alberta received more than $8 billion in federal support through the Canada Health Transfer and Canada Social Transfer to support the provision of health care and other social services. Yet, non-permanent residents with work or study permits remain ineligible for the majority of publicly funded social services.
“The problem is that all levels of government have not planned for population growth (and) have not invested in the infrastructure the way they needed to starting decades ago. Instead of taking accountability for that, (the government is) trying to scapegoat migrants,” said Coakley.
“My worry is now what happens? Are we going to go down this path of excluding a significant number of our neighbours from basic rights? (…) It’s going to create another layer of administrative burden on health-care staff (and) we’re going to have the haves and have nots. That’s not my definition of a good society.”
