The Ford government is cutting healthcare for the uninsured, which threatens the lives of marginalized populations as well as funding for public healthcare. But government cuts have been reversed before, and the movement needs to do so again.
Healthcare for all
Canada is supposed to have a universal healthcare system, but an estimated 500,000 people across Ontario have no access to Ontario Health Insurance Plan (OHIP). This includes those with precarious immigration status, international students or those on temporary work permits, or new permanent residents in their first three months before OHIP access—as well as those facing barriers accessing an OHIP card because of homelessness or mental health issues. As a consequence, uninsured people are asked to pay for healthcare or turned away, which imposes a dilemma that nobody should ever have to face: avoid healthcare and suffer the medical consequences, or access healthcare and suffer the financial consequences.
In March 2020, in response to the pandemic and the demands from the Healthcare for All campaign, the Ontario government reimbursed hospitals for providing care for the uninsured. This funded 400,000 consultations, which improved healthcare for marginalized populations and funding for public healthcare. As Rose Celeste, an undocumented worker from the Philippines explained, “For migrant workers like me, this is very important and this is very crucial.”
According to a report by the Health Network for Uninsured Clients found, this new policy resulted in multiple positive impacts on health outcomes for uninsured people: reduced delays in accessing care, better access to emergency care, improved access to treatment for chronic conditions, improved access to mental healthcare, improved outcomes and experiences for prenatal/obstetrics/postnatal care, more accessible end of life care, and reduced financial and psychological stress. As a nurse from an uninsured clinic explained, “people are accessing care earlier, before disease, injuries or infections are chronic and severe. People are going to the ER when they need to, instead of waiting until things get worse. So I think it [the directive] is avoiding hospitalizations generally for people who are precariously insured.”
There were also other positive impacts for healthcare providers: less administrative and advocacy work, earlier and more cost-effective, and greater visibility of uninsured care which helped to educate healthcare providers about ongoing barriers.
In other words, providing healthcare for the uninsured was good for both patients and healthcare providers. The problem was not that too many uninsured people accessed healthcare as a result of this new policy, but that too many barriers still remained – including uneven implementation, where some uninsured people were inappropriately turned away despite the policy. As a result, the Health Network for Uninsured Clients made a number of recommendations to improve the policy: make it permanent, improve access to primary healthcare, educate healthcare professionals, OHIP for all, and at the federal level provide status for all.
Cruel and costly cuts, scapegoating the uninsured, and defunding healthcare
But instead of following evidence-based recommendations, the Ford government announced it will end healthcare funding for the uninsured on March 31. This is the same day the government is ending its temporary paid sick days program. According to the Ministry of Health, “With lower rates of COVID-19 and the ending of public health restrictions, the province is winding down its pandemic response measures to focus resources on delivering services Ontarians need the most.”
This is wrong for so many reasons. First, the pandemic is not over, 2022 was the deadliest year of the pandemic. This shows how declaring the pandemic over is a justification for cuts to healthcare.
Second, providing healthcare for the uninsured was never only about COVID-19, it was about closing a historical gap in healthcare coverage that preceded the pandemic and that resulted in multiple physical, mental and financial harms to the most marginalized communities. Ending this funding will reopen these gaps and result in human suffering.
Third, ending this funding will not facilitate more effective healthcare delivery, it will undermine it. The policy only cost $6.3 million last year, which is about 0.01 percent of the provincial healthcare budget. So funding for the uninsured is a tiny contribution to healthcare, but makes a massive impact on the lives of the uninsured. In other words, it’s a very cost-effective program and ending it will drive up costs as a result of untreated chronic conditions and delayed care for life-threatening emergencies requiring hospitalization.
Fourth, the focus on services for “Ontarians” betrays the real motivation for these cuts: scapegoating migrants for the healthcare crisis. Despite the fact that many health workers are themselves migrant workers—and have been on the frontlines of the pandemic, from long-term care to home care—the government is implying that providing them with healthcare is undermining healthcare for others. Like the fearmongering about migrants crossing the border at Roxham road, the cuts to healthcare for the uninsured is a form of scapegoating to distract from government cuts.
As the Ministry of Health stated, “As was the case prior to the pandemic, from April 1, those who are not eligible for the Ontario Health Insurance Plan (OHIP) and do not have any other form of health insurance coverage are encouraged to speak to the treating hospital and/or physician to develop plans for future care.” In other words, these cuts are about removing the government’s obligation to fund public healthcare, and pitting patients and providers against each other: either uninsured patients will get healthcare and hospitals will provide free labour, or hospitals will once again uphold their bills and deny care.
Defend and expand healthcare for all
Thanks to campaigns for Healthcare for All, and the migrant justice movement, there is broad support for healthcare for the uninsured—and there was immediate opposition to the government’s announcement. As the Ontario Medical Association stated, “this decision will be detrimental to the livelihood of marginalized Ontarians who often face the greatest barriers in our society.” As the Registered Nurses’ Association of Ontario explained further, “Denying necessary health-care srevices to those who are most in need is unconscionable. People who are homeless, migrant workers or others will see their health worsen. This decision has the potential to lead to devastating complications for those who are ill.”
This is also not the first time that a Conservative government has cut healthcare for marginalized communities, only to see a mass movement defend and reinstate the program: in 2012 the federal Conservatives cut refugee healthcare, but a broad and sustained campaign reversed the decision. Similarly, the current cut to uninsured healthcare can be confronted and defeated.
Healthcare funding for the uninsured was an important step towards healthcare for all, and needs to be defended and expanded. Challenging these cuts helps build solidarity with the uninsured, promotes migrant justice, and supports public healthcare.
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