Refugee Health Cuts: The Context, The Current Coverage, and The Call to Action

Contents

I Introduction
II The context
III The current coverage
IV The call to action
V Resources

--Submitted by Ritika Goel

I Introduction

What happens when a government decides that instead of protecting and providing for the most marginalized people in the society, it will instead attack and deny services to them? The 2012 cuts to the refugee health program in Canada have been an exercise in determining exactly that.

By now, the Conservative government’s cuts to the Interim Federal Health (IFH) Program (http://laws-lois.justice.gc.ca/eng/regulations/SI-2012-26/FullText.html) are infamous. The program went from one which provided hospital and physician services, as well as important supplemental coverage for medications, and basic dental and vision care for refugees and refugee claimants, to one that forced healthcare providers to implement cruel immigration policies. The government’s cuts left a system that denied effectively all healthcare services to refugee claimants coming from any one of 37 countries, referred to as Designated Countries of Origin (http://www.cic.gc.ca/english/refugees/reform-safe.asp). It also cut funding for drugs, dental, and vision care for all refugee claimants and privately-sponsored refugees.

As a result, (http://www.wellesleyinstitute.com/wp-content/uploads/2013/10/Actual-Heal...) many pregnant women have been denied prenatal and obstetrical care, at least one refugee claimant was denied chemotherapy (http://www.cbc.ca/news/canada/saskatchewan/refugee-claimant-with-cancer-...) 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.

II The context

For many, the government’s cuts to the IFH program were unsurprising as they came in line with a long list of regressive immigration policy changes in the past several years, which follow several trends. The first trend has been to make it more difficult for certain vulnerable groups to come to Canada, namely refugees, parents and grandparents, and spouses.

Bill C-31, which completely overhauls the refugee claims system (http://ccrweb.ca/en/protect-refugees-c31-statement) drastically shortens processing timelines for all claimants. Refugee claimants are now expected to undergo a hearing within 30–60 days of arrival, significantly decreasing their chances of a claim being accepted. This does not provide adequate time for lawyers to gather evidence, or for traumatized individuals to fully reveal their experiences in order to obtain supporting documentation from healthcare providers. In 2012 Canada had the lowest rate of accepted refugee claims in 14 years (http://www.vancouversun.com/life/federal+rules+dramatically+number+refug...), with a slight improvement seen in 2013 in keeping with the increased difficulty in proving one’s claim. The government has also recently passed a law (http://www.thestar.com/news/canada/2014/10/24/refugee_access_to_social_a...) allowing provinces to deny social assistance to refugee claimants. Therefore, it is not surprising, that numbers of refugee claims made in Canada have dropped significantly (http://www.thestar.com/news/immigration/2015/03/26/global-asylum-claims-...) while they continue to grow around the world suggesting that persecuted individuals are increasingly choosing to go elsewhere.

As for parents and grandparents, the federal government had put in place a ban on sponsoring (http://www.thestar.com/news/canada/2012/11/05/canada_to_hold_parent_and_... these individuals to Canada, which was recently lifted only to be replaced by harsh provisions requiring sponsoring families to have much higher incomes than previously. As well, a recent law requires sponsored spouses (http://www.cic.gc.ca/English/resources/publications/family-sponsorship.asp) to stay in their marriages for two years after arrival upon threat of removal of their permanent residency status, putting women in situations of intimate partner violence at grave risk.

While we restrict entry to refugees, parents, grandparents and spouses, the government has also allowed historic increases in the number of temporary foreign workers brought into Canada. Unfortunately, these workers often are not subject to the same workplace rights (http://socialsciences.uottawa.ca/sites/default/files/public/research/eng...) as Canadian workers, and face the government’s ‘4 and 4’ policy (http://www.thestar.com/news/canada/2015/04/01/foreign-workers-warned-not...) which requires them to leave Canada for four years after working here for four years. Most such workers have no path to Canadian citizenship no matter how many years of work they put in, and serve largely to be a source of cheap labour that can also help drive down wages among Canadian workers.

The second trend is the increasing precariousness of existing immigration statuses and making it harder to move towards stable and permanent immigration status. For example, for those who do have a path to citizenship, as of June 2014 (http://www.thestar.com/news/immigration/2014/06/27/immigration_experts_s...) permanent residents must wait much longer before they are eligible to apply for citizenship, pay triple the cost of the old application fee, and no longer possess the right to appeal a negative decision. As well, for the first time, we have laws that are stripping people of their existing status. Permanent residents who have lived most of their lives in Canada can now be deported (http://www.cleo.on.ca/sites/default/files/book_pdfs/prcrime.pdf) to countries they have long forgotten, sometimes in cases of minor crimes.

The third trend is to actively detain and deport those who are non-status in an unprecedented manner. The negative mental and physical health consequences (http://www.thestar.com/news/canada/2014/09/25/red_cross_uncovers_problem...) of detention have been studied and cases have been documented of pregnant women being shackled during childbirth simply due to their immigration status. As well, immigration officials have been known to enter violence against women shelters, or show up in areas where undocumented workers are known to access jobs to carry out US-style immigration raids (http://www.thestar.com/news/immigration/2014/08/15/undocumented_migrants...)

Finally, while the refugee health cuts have caused outrage due to the denial of healthcare services to some of our most vulnerable members of society, such a practice has unfortunately been ongoing since Canada’s inception. There are an estimated 500,000 people in Canada (http://www.toronto.ca/legdocs/mmis/2013/hl/bgrd/backgroundfile-57588.pdf) who do not have access to health insurance due to their immigration status. This includes new immigrants and returning Canadians who have to undergo a three-month waiting period (http://www.health.gov.on.ca/en/public/publications/ohip/ohip_waiting_pd.... in Ontario, BC and Quebec. It includes spouses who are being sponsored and awaiting their approval. It includes people making a humanitarian and compassionate claim pending approval. It includes temporary foreign workers who are between contracts. It includes workers with a work permit who are working part time. It includes people who are undocumented for various reasons. All of these people continue to live and work among us and contribute to our economy and our society, and yet, when they get sick, we turn our backs on them. There have been countless stories of people being turned away from clinics and emergency rooms because they could not pay, others deciding to delay seeking care due to a fear of cost or being reported to authorities, and others who have left our healthcare services with unconscionably large bills.

III The current coverage

While many may have been unaware of the broader trend of immigration policy changes, the introduction of a new policy, institutionalizing refusal of healthcare to a vulnerable group certainly struck a chord. After significant public opposition and efforts from the health sector (http://www.pharmacists.ca/cpha-ca/assets/File/cpha-on-the-issues/SuppBen...), including a legal challenge (http://www.carl-acaadr.ca/articles/61), the federal government has been forced by a federal court to reverse many of their cuts to the refugee health program which were deemed ‘cruel and unusual’ (http://globalnews.ca/news/1433062/cruel-and-unusual-what-does-the-refuge...).  

This is strong language coming from the legal system but absolutely accurate. The federal government was given four months, until November 4th, 2014 to reinstate the original program as it existed before the 2012 cuts. Initially, no public statement was made, and at the last minute, the government asked for a delay in reinstating the program stating they did not have adequate time, which was also was denied (http://www.thestar.com/news/canada/2014/10/31/court_denies_federal_appea...). On November 4th, the government announced what it deemed “Temporary measures for the Interim Federal Health Program“ (http://www.cic.gc.ca/english/department/media/notices/2014-11-04.asp). 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 of the federal court’s decision.

Basic coverage for core medical services

The government has restored access to (http://www.cic.gc.ca/english/department/media/notices/2014-11-04.asp) physician, hospital and lab services for:

  • All active refugee claimants (regardless of country of origin)
  • Rejected refugee claimants from countries to which we cannot deport (Iraq, Afghanistan, DRC, Zimbabwe, Haiti, CAR, Gaza, Mali, Syria, South Sudan and Somalia)
  • All active and rejected refugee claimants who are children and pregnant women (regardless of country of origin).

However, the above is not a full reversal, as all rejected refugee claimants who are not children, pregnant women or from a country to which we do not deport still lose coverage as soon as their claim in rejected, while in the past they were covered until date of deportation. These groups continue to only have basic medical coverage for conditions considered a concern to public health or safety, which is a very limited list. Government-assisted refugees and privately-sponsored refugees continue to be covered as they were before and after the cuts.

Prescription drug coverage

The government has restored access to medications through IFH for:

  • Rejected refugee claimants from countries to which we cannot deport (Iraq, Afghanistan, DRC, Zimbabwe, Haiti, CAR, Gaza, Mali, Syria, South Sudan and Somalia)
  • All active and rejected refugee claimants and privately-sponsored refugees who are children and pregnant women (regardless of country of origin).

However, this too is not a complete reversal, as active and rejected refugee claimants and privately-sponsored refugees that are not children or pregnant women still do not have access to drugs as they did before 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, which is a very limited list. Government-assisted refugees continue to be covered as they were pre and post-cuts. It is worth noting that in Ontario, any of the groups not covered who are accessing provincial social assistance benefits can get access to drug coverage through the Ontario Drug Benefit program, but this is an effective downloading of costs from the federal to the provincial government. As well, privately-sponsored refugees are not eligible for social assistance.

Supplemental coverage

The government has restored access to  (http://www.cic.gc.ca/english/department/media/notices/2014-11-04.asp ) “supplementary benefits” (eg. dental benefits, vision benefits) for:

  • All children who are active or rejected refugee claimants and privately-sponsored.

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. As with prescription drugs, those claimants accessing social assistance may be able to access some benefits in this manner, but privately-sponsored refugees are not eligible for this. Government-assisted refugees continue to be covered as they were pre and post-cuts.

It is clear that what the federal government introduced is in no way a complete reversal of their 2012 cuts to the IFH program. Instead of returning to the original program which is what the government was instructed to do, the government has created a third version of the program with varying levels of coverage only further exacerbating confusion that has existed around the coverage since the 2012 cuts. As well, due to changes enshrined in Bill C-31 (http://ccrweb.ca/en/refugee-reform) refugee claimants making inland claims must wait for a meeting with an immigration officer for an eligibility interview before they get access to IFH. This can take up to six weeks and there have been several cases of pregnant women with due dates before this time, or others needing to seek healthcare, as such needs are, of course, unpredictable. In the interim, the Ontario Temporary Health Program is also available, which was created by the province to expressly fill the gap left behind by the federal health cuts, and can be billed for services IFH previously covered.  

IV The call to action

While the federal government still plans to pursue a formal appeal of the federal court’s decision calling on it to reverse the 2012 cuts to IFH, the partial reversal is still a victory that was obtained through a huge community mobilization. A combined effort including national health care associations, healthcare providers, community members and migrants themselves led us to this point. This is a great reminder of the importance of exercising our democratic rights and opposing policies where they stand against evidence and justice. However, the work is not yet done. The current coverage is purposefully referred to as ‘Temporary Measures’ and we must all work together to see a full restoration of the pre-2012 IFH program. We must also see this as but a first step in reversing regressive immigration policies and achieving a truly universal healthcare system where no one is denied healthcare on the basis of their immigration status. The opposition to the refugee health cuts has demonstrated our true concern for universality in our system, and if we all work together, we can not only restore healthcare for refugee claimants, we can have fair immigration policies, and finally achieve health for all.

Ritika Goel is a family physician in Toronto and an organizer with Health for All. She works with migrants with precarious status and is a volunteer and board member at the Scarborough Community Volunteer Clinic for the Uninsured. 

V Resources

Health for All – http://www.health4all.ca. An advocacy organization that works to obtain access to healthcare for all people in Canada regardless of immigration status. Check out the website for explanations of the immigration system, how one becomes uninsured in Canada, and other related information.

Canadian Council for Refugees – http://www.ccrweb.ca.  An advocacy organization that works on various immigration issues. Check out the website for excellent factsheets and position papers explaining various bills that have been passed and how they impact the rights of migrants in Canada.
 
Community Legal Education Ontario – http://www.refugee.cleo.on.ca. An excellent website designed for frontline workers to better understand the details of the refugee processing system, and other aspects of immigration to Canada.