COVID-19 exposing cracks in our universal healthcare
The COVID-19 crisis has exposed the myth of universal healthcare in Canada.
To be truly universal, healthcare must be provided on the basis of need rather than the ability to pay. But hundreds of thousands of migrants are excluded from the healthcare system.
In 2018, the United Nations Human Rights Committee admonished Canada for denying migrants health coverage for life-threatening illnesses. This ruling is germane to Canada’s response to COVID-19. Our economic privilege, built on the labour of migrants, makes the provision of truly universal healthcare an attainable goal and a moral responsibility.
Health, immigration status and COVID-19
Access to healthcare is conditional on immigration status. Excluded from publicly funded healthcare are non-status persons, including those who have overstayed visas and those whose refugee claims have been rejected. Also excluded are precarious status migrants, like most temporary foreign workers and others with authorization to live (and work) in the country but with no realistic prospect of securing citizenship. Although refugee claimants and immigrant detainees may be eligible for the Interim Federal Health Program, this is a poorly implemented program with inadequate coverage.
To live with precarious or no status at all is to live in perpetual fear of deportation. It is to be separated from family and forced to work in unsafe, underpaid and exploitative conditions. It is to do so without healthcare, where preventable and treatable illnesses are left to worsen and may require emergency care with increased downstream individual and system-level expenses and poorer health outcomes.
Government and corporate neglect have exposed migrants to the brunt of COVID-19. Migrant Workers Alliance for Change, Justice for Migrant Workers and others have reported systemic violations of health and labour laws in Ontario’s agricultural sector. Thousands of seasonal agricultural workers have tested positive for COVID-19. Three people have died (Bonifacio Eugenio-Romero, Rogelio Muñoz Santos and Juan López Chaparro), several others have required ICU-level care and more than 40 per cent of cases in some regions are migrant workers in the agri-farm sector.
The situation is similar in cities. Confirmed COVID-19 cases in Toronto and Montreal are concentrated in low-income neighbourhoods with relatively high proportions of racialized and immigrant residents. Restrictions on international travel have left international students and visitors stranded; temporary workers have lost jobs, which can result in loss of status and thus healthcare; non-status persons and many precarious status migrants are ineligible to receive federal or provincial social assistance, including CERB, EI and CRB.
Improving access to healthcare
The pandemic has highlighted the need for more comprehensive healthcare coverage. Each province sets its own health laws and policies but there is a need for convergence and consistency.
Ontario moved in the right direction in March when it began: 1) covering the costs of “all medically necessary” hospital services for uninsured clients, not limited to COVID-19 treatment; 2) compensating physicians in the community to provide assessments for uninsured patients; and 3) waiving the three-month wait for returning Canadians and new immigrants so they could access provincial healthcare immediately.
However, some hospitals have continued charging patients or demanding unnecessary documentation. This invokes fear in patients of healthcare denial or deportation, thereby dissuading them to seek out care. Substantial work has been done by the Health Network for Uninsured Clients, Healthcare Access Ontario and OHIP for All, to address misinformation, support uninsured clients and ensure hospitals implement policy.
The situation is similar in Québec, where COVID-19 related testing and care is formally covered through the provincial health plan. But where policy changes have been made, these have failed to reach the level of frontline healthcare providers and institutions and yield any real outcome. Cost is another issue. Covering costs only for COVID-19 related care has dissuaded people from seeking healthcare, fearing they will be billed. Médecins du Monde and other organizations are advocating for better policies and implementation.
A call to action
Driven by a lack of action in some provinces and poor implementation in others, the Healthcare for All National Coalition sent an open letter signed by more than 200 organizations to the federal government and all provincial governments on May 21. The letter demanded that all people living in Canada be able to access healthcare regardless of immigration status and advocated for comprehensive coverage for all medically necessary services, not limited to COVID-19 treatment alone. It also pushed for clear and consistent implementation, including communication and collaboration with hospitals, walk-in clinics and migrant rights organizations. Finally, the letter called for sustainable solutions to fill long-standing cracks in the healthcare system and that recent policies be made permanent.
A critical issue is the spectre of deportation. While health providers should be focused on providing dignified and confidential care to all patients, there is a sordid history of health authorities calling the CBSA to check the status of clients. According to an Access to Information and Privacy release in our possession, the Fraser Health and Coastal Health authorities in British Columbia contacted the CBSA 719 times between 2013 and 2018. Under its COVID-19 emergency laws, Ontario gave police access to “critical information” about persons who have tested positive for COVID-19, including names, addresses and date of birth; this access was revoked in August following a legal challenge from human rights groups. Healthcare for All has called on the CBSA to pledge it will not detain or deport persons for accessing healthcare and for hospitals and clinics to abide by patient privacy and confidentiality laws.
Although incomplete in their implementations, Ontario and Quebec have shown more comprehensive healthcare for migrants is possible. Measures need to be refined, socio-economic barriers removed and more inclusive and sustainable policies extended beyond COVID-19 and across Canada. Ensuring the well-being of each person is not just a matter of public health measures to reduce the spread of COVID-19, it is a matter of human rights and defines the kind of society we want to live in.