Courting trouble: Why are we denying some refugees health coverage?

Cathy Gulli on the health care reality that exists for refugees in Canada
Health care providers and supporters hold a rally to protest federal cuts to refugee care on Parliament Hill in Ottawa, Monday, June 16, 2014. (Sean Kilpatrick/CP)
(Sean Kilpatrick/CP)
(Sean Kilpatrick/CP)

As pressure builds for Canada to accept more Syrian refugees, Canadian doctors and lawyers are defending the rights of asylum seekers, including pregnant women and children, to basic health care insurance once they have arrived here.

On Oct. 26 and 27, the federal court of appeal will hear the case between refugee advocacy groups and the Conservative government, which made drastic cuts to the Interim Federal Health (IFH) program in 2012.

The cuts stripped all refugees in Canada, except those resettled by the federal government, of health insurance for prescription medications, and “supplemental” coverage for services such as prosthetics, physiotherapy and counselling, as well as emergency dental and vision care—even for pregnant women and children.

At the time, the federal government said the cuts would save the country $100 million over five years, and deter “bogus claimants,” as Immigration Minister Chris Alexander has put it, from seeking asylum in Canada for medical reasons.

In July 2014, in response to a lawsuit against the Conservative government by parties including the Canadian Association of Refugee Lawyers and Canadian Doctors for Refugee Care, the federal court ruled that the cuts were “cruel and unusual,” and violated the Charter of Human Rights and Freedoms. Madam Justice Anne Mactavish determined that “the effect of the changes was to deny funding” for “life-saving medications such as insulin and cardiac drugs to impoverished refugee claimants” and “basic pre-natal, obstetrical and paediatric care to women and children.”

In her decision, Madam Justice Mactavish ordered the federal government to restore the same basic health insurance to all refugees within four months of the judgment. Last November, four months and one day after the federal court ruling, the government enacted “temporary measures” to appease the judge until the appeal is heard, which extended supplemental coverage to children, and prescription drug coverage to both children and pregnant women.
Minister Alexander muted any suggestion that the amendments were a sign the federal government had softened its position on refugee health insurance: “We are doing this because the court has ordered us to do it,” he said at the time. “We respect that decision while not agreeing with it.”

That reprieve, however, could soon expire. “If the appeal is allowed, the cuts will be reinstated,” says Lorne Waldman, a Toronto lawyer and former president of the Canadian Association of Refugee Lawyers—which would mean pregnant women and children would be denied prescription drugs and other medical care once again. Waldman, one of the counsels on the case, plans to “vigorously defend” the federal court’s ruling, which is unprecedented: “It’s an extremely important legal decision.”

The issue is particularly timely given the attention paid to the refugee crisis since the tragic drowning of two young Syrian boys and their mother while fleeing Turkey for Greece. The devastating image of three-year-old Alan Kurdi’s lifeless body washed ashore has become a global symbol of the humanitarian failure of many countries, including Canada.

In this way, the cuts made by the Conservatives to refugee health insurance in 2012—and the ensuing response by the opposition—serve as a window into each federal party’s approach toward the broader refugee crisis happening today. The recent criticism against the federal government —that is has been insensitive and exclusionary to refugees, and manipulative of the facts—mirror complaints it received after the IFH cuts. What should arguably be a non-partisan issue has become a full-blown controversy. “This government is converting a humanitarian issue into a political issue,” says Waldman. “So the Canadian public has to ask—is this the kind of government we want?”

Meb Rashid, a Toronto physician and co-founder of Canadian Doctors for Refugee Care (CDRC), emphasizes that it’s not just women and children who have been affected; more broadly, privately sponsored refugees and refugee claimants have also been denied supplemental and prescription drug coverage.
That means “someone in a refugee camp in Jordan would have access to medications like insulin if they’re diabetic or puffers if they have asthma, but as a privately sponsored refugee coming to Canada, they would no longer have that coverage,” says Hasan Sheikh, an Ottawa physician and member of CDRC. “So they would be getting, in some ways, better health care at a refugee camp in Jordan than they would in Canada.”

Before 2012, all refugees had received the same basic coverage since 1957, when the IFH program began, which included prescription medication and supplemental insurance. It is the same level of coverage that the lowest-income Canadians receive, says Rashid: “It’s identical to what you get on social assistance.”

This matter has become political fodder for some Conservative MPs who have, since 2012, reportedly mailed out flyers to various ridings that contained what some perceived to be loaded language about refugee health insurance. Over the Labour Day weekend, amid news of the worsening refugee crisis, Canadians tweeted photos of these supposed flyers: One flyer asked whether constituents believe refugees should receive “gold-plated” health insurance or not.

As a consequence of the IFH cuts, Rashid and Sheikh say many refugees delay seeing a doctor because they can’t afford it. “Almost all of our patients would not have $50 or $60 to go to a walk-in clinic,” says Rashid, whose clinic mostly treats refugees. Eventually, they wind up in the emergency room. “If they get so sick, they end up in the hospital,” he adds. “And that’s a very costly way to provide health care.”

Given the election campaign, the response of the federal parties to the plight of refugees—abroad and in Canada—is especially noteworthy. It is clear where the Conservatives stand on the issue of refugee health care. The position, however, is at odds with the views of most Canadians.

A survey commissioned by the federal government and conducted by Harris Decima last September, revealed that 62 per cent of Canadians agree that “refugee claimants in Canada should receive the same health care benefits as Canadian citizens.” The results were as high as 72 per cent among Canadians aged 25-34, and 81 per cent among those aged 18-24.

Since 2012 when IFH cuts were announced, individual MPs from the opposition parties have spoken out against them, and some have met with refugee advocacy groups. While refugee health insurance has not come up on the campaign trail, Maclean’s requested comments from each of the opposition parties. The Liberals had not responded as of press time. The Greens and NDP each told Maclean’s that they oppose the cuts to the IFH program, and would reverse them if elected.

“Providing health care to refugee claimants is our moral and legal obligation,” Green Leader Elizabeth May told Maclean’s. “To deny refugee claimants health insurance is nothing but cold cynicism.”

In her ruling last July, Madam Justice Mactavish said that by cutting refugee health insurance, the federal government had “intentionally set out to make the lives of these disadvantaged individuals even more difficult.”

One proof of this, according to Rashid, is the fact that since 2012, inland refugee claimants cannot receive health insurance until after an eligibility hearing. In Toronto, where many refugees land, that can take more than a month on average, he says.

It’s a startling realization in light of Alan Kurdi’s death. “If that little boy from Syria had made it on the boat, had arrived in Canada as a refugee claimant, [he and his family] would have had no health coverage for the first six weeks here,” says Rashid.

Depending on the outcome of the appeal hearing–and the federal election–that reality may persist for other refugees in Canada.

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